Back to the negotiating table: Four Republicans ready to block Senate health care bill

This FILE photo shows Sen. Rand Paul (R-Ky.) explaining to reporters why he is opposing the Senate healthcare bill. The bill was released on Thurs. June 22, 2017 (Sinclair Broadcast Group)

Four Republican senators announced on Thursday that they will not be supporting the draft health care legislation at this time, creating a potentially serious problem for the GOP leadership which can only afford to lose two votes for the bill to pass.

Senators Rand Paul of Kentucky, Mike Lee of Utah, Ron Johnson of Wisconsin and Ted Cruz of Texas issued a joint statement saying they are "not ready to vote" for the Better Care Reconciliation Act without further negotiations.

The group acknowledged that the draft bill makes some improvements to the current health care system, but does not "accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs."

Sen. Rand Paul has consistently been a vocal critic of both the Senate and House plan. He told reporters on Thursday that for him to get to yes, "the bill needs to look more like repeal of Obamacare and less like we're keeping Obamacare."

The four senators issued the statement to send a message to the leadership that they need to come back to the negotiating table, Paul explained.

"Now that it is known that there are not 50 votes for this, I hope that those who are writing the bill – who have written the bill will negotiate with us."

Some members of the Republican leadership are less than impressed with the negotiating tactic. Sen. John Thune (S.D.) chair of the Republican Conference, commented that he's not sure Rand Paul will "ever" get to yes on the bill.

"I think that the four members who are expressing that view at the moment, the need to let us know what it is they need changed or fixed," Thune said. Asked if he is concerned that the GOP is at least two votes short to pass the bill, he shot back, "We're not voting yet."

One of Paul's biggest problems with the legislation is the creation of a stabilization fund, which will help subsidize health plans for low-income Americans and individuals with high health care costs.

"This is one of the real sticking points," he said of the $112 billion fund. With the stabilization fund plus new tax credits based on income, Paul believes the cost to the federal government "may exceed" the costs of Obamacare in the next two years.

"This bill doesn't fix the death spiral of Obamacare, it simply subsidizes it," Paul charged.

Read the full text of the draft bill.

As noted in their joint statement, each senator's reason for rejecting the initial draft is different.

Sen. Ron Johnson expressed frustration that the deadline Majority Leader Mitch McConnell set for a vote is too soon. Earlier this week McConnell outlined the timeline for passage of the health care bill, saying the goal is to bring it to the floor for a vote before the July 4 recess. That gives senators slightly more than one week.

"I don't see how I can get the information I would need to get to yes within a week," Johnson said. He explained that one week is not enough time to get input from his constituents, from the governor and state legislators, as well as the major health care stakeholders.

"We actually have to get the information, which we don't have yet," he stated.

One of the architects of the legislation, Sen. Orrin Hatch of Utah, suggested that members have "a lot of time" to review the health care plan. "They've got tomorrow, the next day, the next day after that and even the next day after that." He added somewhat sarcastically, "It doesn't get any better than that."

Hatch acknowledged that there are elements of the bill he would like to change, but he will vote for it.

The main objection from Sen. Ted Cruz is that the draft bill fails to fulfill the Republican pledge to lower Obamacare premiums. In the last election Republicans often pointed to the spiraling costs of plans in the Obamacare exchange, where the average increase in premiums was 22 percent in 2016.

"That should be the central issue for Republicans – repealing Obamacare and making health care more affordable," Cruz said in a Facebook post. "Because of this, I cannot support it as currently drafted, and I do not believe it has the votes to pass the Senate."

For the past seven years Republicans have been campaigning and getting elected on the promise that they would repeal Obamacare. After taking control of the House in 2010, Republicans unsuccessfully voted to repeal the Affordable Care Act more than 50 times.

Barack Obama responded to the release of the Senate bill on Facebook, repeating a statement he regularly made to Republicans when he was president. "[I]f Republicans could put together a plan that is demonstrably better than the improvements we made to our health care system, that covers as many people at less cost, I would gladly and publicly support it."

But the former president said he could not support the bill which he described as a "massive transfer of wealth from middle-class and poor families to the richest people in America ... paid for by cutting health care for everybody else."

He warned that even if the Republican bill were amended, it "cannot change the fundamental meanness at the core of this legislation."

Moderate Republicans, like Susan Collins of Maine, have also raised concerns about how the bill may impact the poorest and most vulnerable.

Maine is among the states that was eligible for Medicaid expansion under the Affordable Care Act. It did not accept the additional federal funds to pay for the state-run health plan, though more than a quarter million people in the state rely on the program. Under the Senate plan, Medicaid expansion would be phased out beginning in 2021 and ending in 2024.

Supporters of the provision argue that after 2024, expansions in Medicaid will match the rate of inflation in health care costs. Collins is skeptical.

"I'm concerned ... it would translate into literally billions of dollars in cuts," she said. Those cuts would leave states with "very unpalatable" choices, she continued, including restricting eligibility or allowing rural hospitals to out of business.

In the coming days, Collins said she will discuss the draft bill with major stakeholders. "This is extremely complex," Collins stated. "The details really matter."

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