Senate heads to new healthcare vote with no clear plan

Senators are hurtling toward an ObamaCare repeal vote early next week, even though they currently lack the votes for either option on the table.

Senators are unclear what they will be voting on next week, with just days to go before a critical vote to begin debate that’s expected to come on Tuesday.

The two leading options are a repeal-only bill or an updated version of the Senate’s repeal-and-replacement measure. But there has not been a breakthrough on either, despite senators holding a late-night meeting on Wednesday to try to revive the replacement bill.

GOP leaders are pressuring members to just vote to start debate through what is known as the “motion to proceed,” even if they don’t know what bill they are proceeding to. Leaders stress that there will be an open amendment process, so lawmakers can try to address their concerns on the Senate floor.

Amid the confusion over what is being voted on, there was at least one step in GOP leaders’ favor. That came when Sen. Rand Paul (R-Ky.), previously a firm no on the motion to proceed, cracked the door open by saying he could vote for the motion if he is guaranteed a subsequent vote on the repeal-only measure.

There had previously been three GOP no votes — enough to defeat a measure — on both proceeding to the repeal-only bill and to the latest replacement bill.

But that count has been thrown into uncertainty amid confusion on what bill is being brought up. Sen. Lisa Murkowski (R-Alaska), one of the no votes on repeal-only, said she did not know how she would vote on a motion to proceed because she didn’t know what was being proceeded to. 

Leaders are trying to revive their replacement bill, days after Senate Majority Leader Mitch McConnell (R-Ky.) acknowledged that it lacked the votes to pass.

The Trump administration’s Medicaid chief, Seema Verma, is pitching moderates on a Medicaid “wraparound” idea, which would allow states to use Medicaid dollars to help people afford private coverage.

That idea was discussed at the late-night meeting of senators on Wednesday night, but it has so far not yielded any senators flipping from no to yes, sources said.

Some moderates want more money added to the bill.

One possibility is adding as much as $200 billion back into the bill to try to assuage moderates worried about Medicaid cuts. But it is unclear whether that would be enough to win votes. Critics point out that the bill overall cuts Medicaid by more than $700 billion.

Amid the last minute jockeying for votes, Sen. Bob Corker (R-Tenn.) said he is worried about the process.

“I’m becoming concerned that it’s starting to feel like a bazaar,” he said. “It’s beginning to feel like there’s a lack of coherency in what we’re doing and it’s almost becoming a bidding process, you know, spend $50 billion here, let’s throw $100 billion there.”

The Congressional Budget Office released its analysis of the updated replacement bill on Thursday, finding that 22 million more people would become uninsured over a decade, similar to previous versions of the bill.

However, the CBO did not score a controversial amendment from Sen. Ted Cruz (R-Texas) included in the bill because it did not have time.

That amendment would allow insurers to sell plans that don’t meet ObamaCare regulations, including protections for people with pre-existing conditions, if they also sold plans that do meet the requirements.

{mosads}Moderate senators previously expressed concern the provision would spike premiums for sick people. But senators say it could take “weeks” for the CBO to score the provision.

That means senators could vote next week without a CBO analysis of the controversial provision, breaking with precedent.

Instead, some senators have pointed to a Department of Health and Human Services analysis that found the provision would lower premiums. But that analysis has come under fire from outside experts, who question its methodology.

Sen. John Cornyn (Texas), the No. 2 Senate Republican, argued that senators should just vote to take up the bill.

“You can’t debate something that you don’t initiate the debate on,” Cornyn said, noting that there would be opportunities to offer amendments on the Senate floor.

But some senators want to know what the bill will be before voting to proceed to it.

“I will only vote to proceed to repeal legislation if I am confident there is a replacement plan that addresses my concerns,” Sen. Shelley Moore Capito (R-W.Va.) tweeted Tuesday.

Asked about those concerns, Cornyn said, “Yeah, but it’s a luxury we don’t have.”

Cornyn later tweeted that he meant the open amendment process means that the final bill is undetermined.

There is still a question, though, about whether the initial bill being offered will be the repeal-only measure or the Senate’s replacement bill.

Sen. John Thune (R-S.D.) said that is still up in the air.

“It’s a judgment call the leader will make at some point,” he said.

The uncertainty has left some lawmakers with questions.

“We don’t even know what we’re proceeding to next week,” said Sen. Susan Collins (R-Maine), who is opposed to both leading options and is pushing to start over and work with Democrats.

“I don’t know whether we’re proceeding to the House bill, a new version of the Senate bill, the old version of the Senate bill, the 2015 repeal and hope that we come up with something in two years bill, I truly don’t.”

Rachel Roubein contributed.