A frantic scramble before possible healthcare vote next week

A frantic scramble to influence the Senate’s healthcare legislation intensified on Monday, with House conservatives pressuring their allies in the Senate and Democrats mounting a furious public relations blitz to kill the bill.

The pace of activity is picking up ahead of the informal July 4 deadline set by Senate Majority Leader Mitch McConnell (R-Ky.) for a vote.

McConnell does not want the ObamaCare debate to eat up more precious legislative time, with nearly half the year gone and congressional Republicans and President Trump still looking for a major legislative victory.

Senate Republican Policy Committee Chairman John Barrasso (Wyo.) told reporters that he expects a Senate vote on the bill as soon as next week, underlining the importance of the next two weeks.

McConnell is walking a tightrope in seeking to win over centrists and conservatives for a Senate version of the House-passed American Health Care Act — which is being negotiated entirely behind closed doors.

{mosads}Much of the focus has been on winning over moderates in the 52-member conference, a strategy that risks losing conservative Sens. Rand Paul (R-Ky.), Mike Lee (R-Utah) and Ted Cruz (R-Texas). McConnell can only afford two defections, with every Senate Democrat expected to be a “no” vote.

In an effort to buck up the conservatives, the Republican Study Committee (RSC) — the largest group of conservatives in the House — warned that the Senate risks seeing its bill die in the House if it drifts too far to the center.

The RSC specifically warned that the bill would lose support in the House if it did not keep four provisions, including the phasing out of extra federal funding for Medicaid in 2020. They also warned McConnell against preserving ObamaCare’s tax increases, removing language defunding Planned Parenthood or barring refundable tax credits from being used to “federally fund abortions.”  

In a bid to keep moderate Republicans on board, McConnell has proposed phasing out enhanced federal funding for Medicaid expansion in 2023.

GOP senators have also discussed keeping ObamaCare taxes to help pay for the costs of the bill, and language on Planned Parenthood in the House bill may be struck down by the Senate parliamentarian. The Senate plans to use special budgetary rules to prevent Democrats from filibustering the healthcare bill, but this makes certain provisions vulnerable under other Senate rules.

James Wallner, a former aide to Lee and Sen. Pat Toomey (R-Pa.), who are both playing active roles in the healthcare talks, said the RSC letter shows that conservatives are laying down their markers before it’s too late.

“To the extent that the bulk of the party wants to pass the House-passed bill or a modified version of the House-passed bill, individual members need to take steps to give themselves leverage heading into that kind of high-stakes showdown,” he said.

Senate Democrats are hoping to have an impact, too. They threatened Monday to grind the Senate to a halt to protest Republicans’ decision to craft the bill in private meetings, skipping the regular order of holding hearings and marking it up in public committee sessions.

“If Republicans won’t relent and debate their healthcare bill in the open for the American people to see, then they shouldn’t expect business as usual in the Senate,” said Senate Democratic Leader Charles Schumer (N.Y.).

Democrats planned to hold a late-night talk-a-thon on the Senate floor Monday night to put the spotlight on the GOP’s secretive tactics — a strategy Democrats used earlier this year to protest some of Trump’s controversial Cabinet picks.

The three conservatives are pressing different issues on healthcare.

Paul has made clear to colleagues that he will not support legislation that creates a new GOP-sponsored entitlement program in the form of refundable tax credits to help low-income people buy private insurance plans.

Lee and Cruz are pressing GOP leaders to allow states to get out of two major regulatory requirements under ObamaCare.

One, known as guaranteed issue, mandates that insurance companies sell insurance plans to people regardless of how sick they are, and another, known as community rating, prohibits insurance companies from pricing those plans to reflect the greater financial risk of insuring people with pre-existing medical conditions. 

A GOP source familiar with the negotiations said McConnell has so far refused to promise conservatives to let states opt out of the community rating requirement — which keeps health plans more affordable for sick people but sends premiums soaring — or to exempt states altogether from the regulatory mandate and allow them to opt in.

McConnell, however, is worried that if he effectively guts ObamaCare’s popular prohibition against insurers charging higher prices for sick people, he would lose moderate votes.  

Conservatives are stepping up their efforts to mold the bill, as it’s become apparent that Trump is primarily interested in a political victory and is willing to cater to moderates to get one.

At a meeting at the White House last week with prominent centrists such as Sens. Lisa Murkowski (R-Alaska), Rob Portman (R-Ohio) and Susan Collins (R-Maine), Trump criticized the House-passed bill as “mean” and urged Senate Republicans to craft legislation that is “generous, kind [and] with heart.”

“That may be adding additional money into it,” the president said at the start of the meeting. 

Moderate Republicans have sought to put their imprint on the legislation by pushing it further to the center.

A group led by Portman wants to extend the phase-out of extra federal funding for the Medicaid expansion to 2027 but would likely accept 2025 as a split-the-difference compromise with McConnell’s proposed end date of 2023.

Murkowski and Collins have also emphasized the importance of preserving funding for Planned Parenthood.

Murkowski wrote in a recent letter to a constituent that she is committed to providing insurance coverage to people with pre-existing conditions, continuing support for Medicaid expansion and preserving funding for Planned Parenthood.

— Jordain Carney and Rachel Roubein contributed.