Congressional Republicans and Trump administration officials were at odds Sunday over how close the Senate is to a deal on an Obamacare repeal package and what the legislation should look like — an indication that the upper chamber may be further from agreement than some politicians let on.
“We are getting close,” Marc Short, President Donald Trump’s director of legislative affairs, said on “Fox News Sunday.” The White House is making calls this weekend to “try and get the Senate package across the finish line,” Short added.
But Kentucky Sen. Rand Paul, a conservative who was one of the holdouts who doomed efforts to vote on health legislation last week, disagreed: “I don’t think we’re getting anywhere with the bill we have. We’re at an impasse,” Paul said on the same show.
Republicans have scrambled to put together a bill repealing President Barack Obama’s signature reform, but conservative and moderate lawmakers in the party remain at odds on how to do it. And on Sunday, Republicans appeared no closer to agreeing on how to deliver on years of promises to undo the 2010 legislation.
Among the issues they’ll have to grapple with when they return from the July 4th recess: Whether to approve a proposal by conservatives to dial back regulation on some insurance plans. Short said the bipartisan Congressional Budget Office had been asked to analyze two versions of Senate Majority Leader Mitch McConnell’s bill — one with and one without the conservatives’ proposal — to estimate their impact on the federal budget and on insurance coverage.
The proposal, from Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah), would create parallel health insurance markets in states. One market would contain protections for people with pre-existing conditions and coverage of essential health benefits like maternity care and mental health services, and the other would allow the sale of skimpier plans, likely without federal subsidies.
Short said the White House supports Cruz’s and Lee’s effort to come up with a conservative adjustment to the bill. He said he anticipated a vote on the Senate bill the week after the July 4th recess.
But their proposal could cost McConnell votes from more moderate senators who believe the two-market approach would lead to the collapse of the individual insurance market because all the older and sicker patients would be served by the highly regulated, more expensive system, separate from healthier and younger Americans.
Sen. Bill Cassidy (R-La.) argued on NBC’s "Meet the Press" that the way to make coverage more affordable is to keep everyone in the same insurance pool.
“Turns out to lower premiums, there’s ways you do that. You get more people into the risk pool so it’s healthier and younger, number one. Number two, for those who are lower income, they’re going to need some assistance. And so you need money for that assistance,” Cassidy said.
Ohio Republican Gov. John Kasich, who is seen as influential with Ohio Sen. Rob Portman, a Republican still on the fence about the Senate’s approach so far, said on ABC’s “This Week” that the bill needs more Medicaid funding, and he said its tax credits would not be enough to help people buy individual insurance plans.
Kasich, who faced off against Trump in the 2016 Republican presidential primaries, also said the bill doesn’t do enough to stem the opioid crisis. McConnell added an extra $45 billion in opioid funding to try to win over moderate Republicans who have argued that the bill’s cuts to Medicaid would hurt people struggling with addiction.
"It’s anemic," Kasich said. "As I said to Sen. Portman at one point, it’s like spitting in the ocean. It’s not enough."
Republicans are also rehashing an old argument about whether to simultaneously repeal Obamacare and approve its replacement, or whether they can wait to work out a new health care system until after they undo the 2010 law.
Trump disrupted the Senate’s efforts Friday morning by tweeting that Republicans could follow the latter course, which had been rejected by congressional leaders. “If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” he wrote on Twitter.
Health and Human Services Secretary Tom Price said on “Meet the Press” that despite Trump’s tweet, the administration’s official stance is not to repeal and replace Obamacare separately. McConnell has also rejected that approach.
But Paul pushed for separate tracks Sunday, saying the only thing a majority of Republicans agreed on was repealing Obamacare. Fellow Republicans Ben Sasse (R-Neb.) and Lee also said lawmakers could pass repeal legislation by itself but delay the implementation to give themselves time to craft a replacement.
Kasich said repealing Obamacare without an idea of what would take its place could cause people to lose insurance coverage.
“You can’t just get rid of this, because you can’t leave people without what they need,” he said.