Senate lawmakers return to Washington Monday after a weeklong recess with the goal of coming to some consensus on how to repeal Obamacare, but the time at home appears to have made the path forward anything but easier on Republicans.
Instead of returning to their Washington offices with a clearer sense of how to move forward, lawmakers find themselves dealing with at least one more Republican defection and a reignited, fierce debate between moderates and conservatives.
Senate Majority Leader Mitch McConnell delayed the vote on the Senate health care bill Tuesday, announcing he would push it back until after the July 4 recess. After dealing with outside pressure from the health care industry’s lobbying arm, disagreements between moderate and conservative Republicans, and unanimous opposition from Senate Democrats, McConnell said Tuesday that he did not see a path to passing the bill before lawmakers returned home.
“We will not be on the bill this week, but we’re still working toward getting at least 50 people in a comfortable place,” McConnell said. Senate leadership is trying to pass their legislation through the Senate’s budget reconciliation process, which only requires 50 votes instead of the usual 60 votes necessary to pass a bill.
Lawmakers were not met with support from their constituents, but rather with vitriol in town hall meetings and protests. Obamacare supporters and health care activists mobilized against Republican senators over the recess in states that either chose to participate in Obamacare’s Medicaid expansion program or are particularly vulnerable in the 2018 election cycle. (RELATED: Republican Sens. Face Blowback For Trying To Repeal Obamacare)
Only three Republican senators were brave enough to hold public town halls in their districts: Sens. Bill Cassidy of Louisiana, Ted Cruz of Texas and Jerry Moran of Kansas. Senators who chose not to hold a public forum for constituents to voice their concerns were met with protests outside their offices and a slew of targeted advertisements on social media and television.
Sen. John Hoeven of North Dakota told a local news outlet that he was unwilling to throw his support behind the legislation as it currently stands. Hoeven joined nine other Republicans who have already come out against the legislation, including Sens. Rob Portman of Ohio and Dean Heller of Nevada.
While negotiations between moderates and conservatives were supposed to bring more Republicans on board, they have effectively worked to isolate lawmakers and stymie what little progress was made in recent weeks. An amendment introduced by Sens. Mike Lee of Utah and Ted Cruz is at the front and center of the divide between conservative and moderate senators.
The amendment, known as “Consumer Choice,” allows insurers to sell plans that do not follow regulations created under Obamacare for patients with pre-existing conditions, with the caveat that insurers have to sell at least one plan that adheres to Obamacare’s mandates. Lee pledged Thursday afternoon that he will not vote for the Senate’s bill to repeal major portions of Obamacare unless the legislation includes the amendment.
Moderate Republicans are unwilling to support the amendment championed by Lee and some his conservative colleagues, claiming it would do away with Obamacare’s pre-existing mandate and would lead to a bifurcated insurance marketplace. (RELATED: GOP Senatore To Vote No On Senate Obamacare Repeal)
The Congressional Budget Office estimated in June that some 22 million Americans would go uninsured if the Senate passed its bill to repeal major portions of Obamacare. A significant portion of that number comes from consumers who obtained coverage under Obamacare’s Medicaid expansion program.
Conservatives continue to push for steeper cuts to Medicaid in what they believe to be a key step in helping the nation’s health care system curb federal spending on health care. Twenty Republican Senators currently sit in states that chose to expand Medicaid under Obamacare, and they fear retribution from voters if they roll back or institute cuts to the program’s funding.
Republicans originally intended to have sent a completed bill on President Donald Trump’s desk no later than April, but that deadline was upended after disagreements between moderate and conservative Republicans prevented the House bill from passing until early May. McConnell’s delay Tuesday makes things even trickier for Senate Republicans.
Senate leadership now has the goal of pushing the bill to a vote before the August recess–the time that Secretary of the Treasury Steve Mnuchin and Speaker of the House Paul Ryan have promised to focus on tax reform. If leadership fails to come to an agreement and has to delay the bill till after lawmakers head home in August, it could work to upend progress in Trump’s other key legislative initiatives of his first term, like infrastructure and tax and regulatory reform.
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