Lawmakers who fled the Capitol for the July 4th recess are struggling to make sense of a health care reform debate that was scrambled once again by President Trump late last week.
Senate Majority Leader Mitch McConnell’s desperate effort to win GOP consensus around his plan to repeal and replace the Affordable Care Act was rattled once again on Friday when Trump helped revive an old idea he previously rejected to repeal Obamacare now and then replace it down the road.
Sen. Ben Sasse (R-NE) first floated the idea last week as a backup plan until McConnell and the White House can forge a compromise that can attract at least 50 Republican votes – enough to enact the legislation without Democratic support.
Trump – who for months has insisted that repeal and replace must occur simultaneously – glommed onto Sasse’s idea in a tweet on Friday. McConnell has balked at this suggestion, but on Sunday Sasse and other key Republicans and the Trump administration’s chief lobbyist on Capitol Hill renewed support for the idea as a last-ditch effort.
McConnell had hoped to close the deal on Friday by offering a raft of sweeteners to conservatives and moderates alike, yet congressional Republicans departed for the week-long holiday no closer to a final agreement. Sasse said today that if McConnell fails to achieve agreement by July 10, then he should keep the Senate in session throughout the August recess to come up with a duel-track effort to first repeal and then replace Obamacare.
“It needs to be a good replace,” Sasse said on CNN’s “State of the Union,” outlining his strategy to repeal Obamacare with a delayed implementation date to give lawmakers in both Parties time to negotiate a plan to replace the 2010 Affordable Care Act. A majority of Senate and House Republicans approved a measure just like that in the twilight of the Obama administration, but it was vetoed by the former president in January 2016.
Sasse said that if Senate Republicans are unable to agree to a comprehensive measure that both repeals and replaces the existing law, “then there’s no reason to walk away. We should do repeal, with a delay.”
“I’d like to say let’s do the repeal and then let’s try to get 60 out of 100 senators,” the Nebraska Republican added. The Senate is split 52 Republicans to 48 Democrats. Senate Minority Leader Chuck Schumer (D-NY) has said Democrats are ready to work with the GOP on legislation to fix the worst problems of Obamacare, but they won’t go along with a bill to kill the government health insurance program outright.
Sen. Rand Paul (R-KY), another advocate of orchestrating separate votes on repealing and replacing the law, said “I don’t think we’re getting anywhere with the bill,” even as McConnell and other GOP leaders have been cutting deals with moderates and conservatives that add hundreds of billions of dollars to the cost and preserve key elements of Obamacare.
After postponing a scheduled vote on his plan last week, McConnell waged a behind the scenes charm offensive largely aimed at recalcitrant moderate Republicans, including a proposal to preserve one of the Obamacare law’s taxes on high-income people to free up $172 billion for Medicaid.
Republican leaders are also offering $45 billion over ten years to combat the opioid epidemic, and a new incentive for people to establish tax-free savings accounts for medical expenses.
On the other, he is also trying to please conservatives like Sens. Ted Cruz of Texas and Mike Lee of Utah who favor allowing Americans to opt out of government subsidized insurance altogether, if they please, and providing alternative coverage for older and sicker people with pre-existing medical conditions.
“So right now, this bill, which is not a repeal, has become the kitchen sink,” Paul complained today. “We have nearly $200 billion in insurance [industry] bailouts . . . There is $45 billion in here for opioid [addiction treatment]. So I mean the bill is just being lit up like a Christmas tree full of billion dollar ornaments, and it’s not repeal.”
Paul has submitted his own alternative approach to the White House and Senate leadership – one that would allow individuals to band together in groups to buy coverage and end government subsidies or “bailouts” for insurance companies that incur huge losses.
Meanwhile, Trump has done little other than to complicate the Republicans efforts to make good on a seven-year-old pledge to repeal and replace Obamacare. Last January, even before taking office, Trump insisted that repeal and replace legislation be approved almost simultaneously – within hours or days of each other -- despite a preference by many congressional leaders to pass repeal legislation but postpone its effective date for a year or more while a new approach is developed.
Later, in early May, Trump hailed a bill narrowly approved by House Republicans that the CBO said would leave 23 million Americans without insurance by 2026, only to spurn it recently as too “mean” to many Americans.
Trump subsequently anointed McConnell’s Senate version as much better and more humane. But then last Friday, in an early-morning tweet, Trump said that “If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!”
Marc Short, Trump’s director of legislative affairs, appearing on Fox News Sunday, said: “Our preference is to pass the bill the Senate has right now. That’s what we think needs to be done. We think that helps solve many of the problems that America faces.”
Health and Human Services Secretary Tom Price gave a similar assessment on NBC’s “Meet the Press” program. “We think that Leader McConnell and his senators are working and trying to get this piece of legislation on track,” he said. “Conversations are ongoing as we speak, so we look forward hopefully them coming back after this Fourth of July recess and getting the work done.”
Price also defended Trump’s commitment to passing a new health care law despite his latest spate of attacks on the news media, especially MSNBC “Morning Joe” host’s Mika Brzezinski and Joe Scarborough.
“The fact of the matter is that he can do more than one thing at a time,” Price snapped in response to a question by NBC’s Chuck Todd.