As senators started to leave Washington for the Fourth of July recess, a compromise over their beleaguered healthcare bill that would attract enough votes to pass seemed distant.
Days after the Senate Republican leadership faced a revolt from both wings of their caucus over a draft bill to repeal and replace Barack Obama’s Affordable Care Act (ACA), lawmakers were considering whether to reach out to moderates by keeping the former president’s tax increase on wealthier people’s investments and retreating on cuts for subsidies to the poor and elderly.
Senate majority leader Mitch McConnell’s decision to postpone the healthcare vote he hoped would occur before the Independence Day holiday was a stunning twist in Republicans’ seven-year effort to repeal Obamacare, raising the spectre that the demands from conservatives and moderates may be irreconcilable.
The legislation introduced last week, crafted in secret and pushed toward a vote without a public hearing, would repeal major pieces of the ACA and carve deep cuts into Medicaid, a public health insurance program for low-income Americans. The independent Congressional Budget Office has estimated that the bill would increase the number of people without health insurance by 22 million over the next decade.
Over the past few days, Republican senators have paraded before McConnell’s office with requests and proposed amendments that would earn their support.
Some Republicans are concerned about the steep cuts to Medicaid, which would hurt elderly Americans, while others are seeking more funding to combat the nation’s opioid epidemic or stabilize health insurance markets.
On Thursday, Bob Corker of Tennessee, an establishment Republican, said he expected the GOP leadership to scratch a provision in their legislation that would have eliminated an ACA tax on high earners.
Democrats and opponents of the GOP repeal effort had attacked their plan as a “massive transfer of wealth”, referring to it as “wealthcare”.
Corker said it was “not an acceptable proposition” for Republicans to put forward a bill that “increases the burden on lower-income citizens and lessens the burden on wealthy citizens”. His remarks echoed the sentiment of several senators who on Wednesday started to question whether the plan should eliminate taxes on wealthier Americans while dramatically reducing the benefits available to low-income, disabled and elderly Americans.
Mike Rounds of South Dakota, another establishment Republican, noted of Obamacare’s 3.8% investment tax, which had been a subject of debate among Senate Republicans: “I am open, like most of the members of our conference, to discussion on all of those items.”
Rounds added: “We’re still repealing 80% of all the Obamacare taxes.”
The tax, which applies to dividends and capital gains earned by individuals with incomes over $200,000, has not only become a target of Democratic critics but has been seen by Republicans as a way to pay for subsidies that moderates feel are essential in any replacement of the Affordable Care Act.
But some conservatives pushed back.
“We pledged that we would repeal Obamacare,” said Pat Toomey of Pennsylvania, who supports the legislation’s rollback of Medicaid as drafted. “I don’t remember anybody going around saying ‘except for these job-killing tax increases’, so I expect that we will repeal all of the taxes.”
Ted Cruz of Texas, who opposed the draft bill because it did not go far enough in repealing the ACA, said he did not agree with push toward fewer tax credits to the wealthy.
“I think one of the central issues in this election was a support for tax cuts and tax reform,” Cruz said. “I recognize that the Obama administration believed massive taxes and massive regulation were a good idea and we’ve seen as a result millions of people losing their job, losing their healthcare, seeing their premiums skyrocket, and that approach doesn’t work.”
Cruz has suggested an amendment that some of his colleagues are open to which would allow insurers to sell plans that do not comply with the ACA’s regulations as long as they offered at least one plan that did.
House speaker Paul Ryan told reporters on Thursday that he thought his chamber could “move fairly quickly” on any legislation passed by the Senate.
The Wisconsin Republican said he viewed the legislative morass in the upper chamber as a hiccup and compared it to his struggles to pass Obamacare repeal legislation in the House.
“This is exactly what we did in the House,” said Ryan. “We brought it to the floor and then we pulled it back and then we brought [and] passed it. It’s basically the process Senate is going through.”
Ryan added that he was feeling “a sense of déjà vu” and that he had told McConnell: “I know exactly how he feels.”
The House managed to assemble legislation that appealed to just enough conservatives and moderates in May, and Republicans narrowly approved the bill without help from Democrats.
On Thursday, North Carolina congressman Mark Meadows, the chairman of the House Freedom Caucus, told reporters that the House would move directly to a vote on the Senate’s healthcare plan once it had passed. Traditionally, the plan would be sent to a conference committee to iron out the differences between the House and Senate version.
After the vote was delayed, Donald Trump stepped in to play a mediating role. The president, who has mostly been on the sidelines of the healthcare debate, invited Republican senators to the White House for a discussion and sat between two moderate skeptics of the bill, senators Lisa Murkowski of Alaska and Susan Collins of Maine.
The following day, Trump promised “a great, great surprise” on healthcare that has yet to be revealed.
But on Thursday, Trump interrupted the ongoing negotiations on healthcare with vulgar attack on Morning Joe host Mika Brzezinski, who he said had been “bleeding badly from a face-lift” during a meeting at Mar-a-lago, his Florida estate, this past New Year’s holiday. The assault drew swift and bipartisan condemnation – as well as now familiar hand-wringing about how the president’s commentary distracts from the Republican agenda.
“The American people need us to be focused on health care and tax reform, not Twitter fights and cable news,” South Carolina senator Tim Scott, a Republican, wrote on Twitter.
Republican senator Lindsey Graham, also from South Carolina, said Trump’s outburst was “inappropriate” – but did not believe it would alter the dynamics of a healthcare vote.
“I don’t think anybody is going to vote based on his tweet,” Graham told reporters. “This is not about policy – it’s about the person. It’s about President Trump as an individual. I want to help him, I want him to be a successful president. Tweets like this are inconsistent with the greatness of the country and the office.”
Vice-president Mike Pence was on Capitol Hill on Thursday for one-on-one meetings on healthcare, White House deputy press secretary Sarah Huckabee Sanders told reporters. She expressed hope that Senate Republicans would “fulfill their promise to the American people and come together around a consensus plan to fix this broken system”.
She suggested that Trump would be “supportive” of a deal that allocated extra resources to fighting the opioid crisis but that working with Democrats was highly unlikely. “I can tell you that Obamacare is failing and new policy is around the corner. From our ongoing negotiations, we’re confident that any amendments the Senate agrees to will make the bill stronger.”
She claimed: “The other bill out there that’s gained the support of a majority of House Democrats is the Bernie Sanders single-payer plan that would cost the government $32tn over the next decades … The president believes that it’s completely unaffordable and creates a one size fits all government approach to healthcare. That bill and others like it on the other side that have been proposed are clearly deal breakers.”