President Donald Trump is scheduled to have lunch Tuesday with 13 senators to discuss the Senate’s progress, and holdups, in repealing and replacing Obamacare.
The Senate has worked for nearly a month now on its Obamacare replacement bill, which is expected to include some features of the House’s American Health Care Act but differs in other aspects, like Medicaid expansion funding and Obamacare taxes.
The consensus-driven body is expected to send its bill to the Congressional Budget Office for scoring in the coming days, but will reportedly not release the scoring to the public before they vote on the measure. A vote is expected before Congress leaves for the July 4 recess.
The members in attendance at Tuesday’s lunch with the president will include: Republican Sens. Rob Portman of Ohio, Pat Toomey of Pennsylvania, Lisa Murkowski of Alaska and Susan Collins of Maine, Politico Playbook reports. These senators attendance is particularly important, as they have either voiced concerns over key provisions of the House bill or are looking to be important votes for Republicans who can only afford to lose no more than 2 to pass their version of health care reform.
The House bill includes an aggressive roll back of federal funds granted to Obamacare’s Medicaid expansion program and would allow for some insurance companies to charge higher premiums to consumers with drug addictions. Sixteen out of the 20 Republican House members that voted against the AHCA are in states that saw drastic increases in the number of opioid-related deaths over the past decade. (RELATED: Divide Among GOP In Congress Isn’t Going Anywhere)
The same situation could present itself in the Senate. Some 20 Republican senators are in states that chose to expand Medicaid under Obamacare, and many are concerned about the number of Medicaid recipients who would lose coverage under the House bill.
Portman is leading the charge for Republican senators, expressing concern that rolling back Obamacare’s Medicaid expansion program without offering consumers another affordable option would place an undue burden on those seeking substance-abuse treatments.
Ohio has become the poster child for the opioid epidemic, with double-digit increases in opioid-related overdoses in 2014 and 2015. Deaths from opioid use in the U.S. have skyrocketed from around 8,000 in 1999 to over 30,000 in 2015, the Center for Disease Control reports. The state also has 700,000 individuals who receive health coverage under Obamacare’s Medicaid expansion program.
“So many people on Medicaid and expanded Medicaid rely on that funding for their treatment for substance abuse,” Portman told reporters. “This is clearly an issue where you don’t want to make matters worse by reducing access to treatment.”
Senate Majority Leader Mitch McConnell is pushing for a 3-year roll back of Medicaid expansion funding to give consumers more wiggle room to adjust. Moderate senators want something closer to a 7-year timeframe for rolling back funds. Senate conservatives, like House conservatives, want a quicker, 2-year roll back of the Medicaid expansion program.
Toomey, a conservative fiscal policy hawk, wants an aggressive, immediate cut to Medicaid funding.
“Medicaid is growing at an unsustainable pace,” Toomey told reporters. “If we’re going to overhaul this program, which we need to by virtue of Obamacare, we can at least put it on a sustainable path.”
As the July 4 recess approaches, the Senate bill appears to be leaning more towards moderate members, who want to keep some of Obamacare’s taxes and include a more gradual wind-down of the Medicaid expansion program. A moderate bill is likely to push some senators, like Rand Pual of Kentucky and Mike Lee of Utah, who want a full repeal of Obamacare, to vote no.
If that happens, McConnell can not afford to lose a single Republican vote, as the Senate has a slim 52 Republican majority. That would make two key conservatives–Collins and Murkowski–the swing votes for Senate Republicans.
The senate majority leader has expressed that he isn’t quite sure how to get to 50 votes, but has pledged to put the bill up for a vote in July. If the bill does not pass, McConnell has expressed his intention to move forward with tax and regulatory reform.
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