Senate leaders work to unite GOP to approve health care bill

Senate leaders scrambled Tuesday to rescue their health care bill, in deepening jeopardy as opposition from rebellious Republicans intensified. The defections loomed as Congress' nonpartisan budget referee said the measure would leave 22 million more people uninsured by 2026 than President Barack Obama's law.

Majority Leader Mitch McConnell (R) of Kentucky was hoping to staunch his party's rebellion a day after the Congressional Budget Office (CBO) released its report. He's been aiming at winning Senate passage this week before a weeklong July 4 recess that leaders worry opponents will use to weaken support for the legislation.

The CBO analysis suggested some ammunition GOP leaders could use, saying the Senate bill would cut federal deficits by $202 billion more over the coming decade than the version the House approved in May. Senate leaders could use some of those additional savings to attract moderate votes by making Medicaid and other provisions more generous, though conservatives would rather use that money to reduce red ink.

"You don't want to bring something up unless you know you have the votes to pass it. But I also think we may not know if we have the votes to pass it until we bring it up," said No. 3 GOP Senate leader John Thune (R) of South Dakota.

The projected boost in uninsured people fed concerns by moderate Republican lawmakers that the Senate measure, annulling parts of Obama's 2010 overhaul, was too drastic. Yet conservatives were unhappy that it didn't do enough to dismantle Obama's law and lower premiums by repealing coverage requirements, leaving Mr. McConnell with little margin for error – the bill fails if three of the 52 GOP senators vote no.

The 22 million extra Americans were just 1 million fewer than the number the budget office estimated would become uninsured under the House version. President Trump has called the House bill "mean" and prodded senators to produce a package with more "heart."

Minutes after the report's release, three GOP senators threatened to oppose a procedural vote to begin debate expected Wednesday – enough to derail the legislation.

Moderate Sen. Susan Collins (R) of Maine said she would vote no. She tweeted that she favors a bipartisan effort to fix Obama's statute but added, "CBO analysis shows Senate bill won't do it."

Conservative Sen. Rand Paul (R) of Kentucky said he would oppose that motion unless the bill was changed. And fellow conservative Ron Johnson (R) of Wisconsin said he had "a hard time believing" he'd have enough information to back that motion this week.

Moderate Sen. Dean Heller (R) of Nevada on Friday said he'd oppose the procedural motion without alterations.

Those rebels were just part of McConnell's problem. Two other conservatives – Sen. Ted Cruz (R) of Texas and Sen. Mike Lee (R) of Utah – have also said they'd vote no without revisions, and several other moderates have expressed worries about the bill's Medicaid cuts and reductions in people with coverage.

The budget office report said the Senate bill's coverage losses would especially affect people between ages 50 and 64, before they qualify for Medicare, and with incomes below 200 percent of poverty level, or around $30,300 for an individual.

In one example, the report says that in 2026 under Obama's law, a 64-year-old earning $26,500 would pay premiums amounting to $1,700 a year, after subsidies. Under the Senate bill, that person would pay $6,500, partly because insurers would be able to charge older adults more.

The Senate plan would end the tax penalty that law imposes on people who don't buy insurance, in effect erasing Obama's so-called individual mandate, and on larger businesses that don't offer coverage to workers.

It would let states ease Obama's requirements that insurers cover certain specified services like substance abuse treatments, and eliminate $700 billion worth of taxes over a decade, CBO said, largely on wealthier people and medical companies that Obama's law used to expand coverage.

It would cut Medicaid, which provides health insurance to over 70 million poor and disabled people, by $772 billion through 2026 by capping its overall spending and phasing out Obama's expansion of the program. Of the 22 million people losing health coverage, 15 million would be Medicaid recipients.

CBO said that under the bill, most insurance markets around the country would be stable before 2020. It said that similar to the House bill, average premiums around the country would be higher over the next two years – including about 20 percent higher in 2018 than under Obama's statute – but lower beginning in 2020.

But the office said that overall, the Senate legislation would increase out of pocket costs for deductibles and copayments. That's because standard policies would be skimpier than currently offered under Obama's law, covering a smaller share of expected medical costs.

In another troublesome finding for the legislation, the budget office warned that in some rural areas, either no insurer would be willing participate in the individual market or the policies offered would be prohibitively expensive. Rural America was a stronghold for Trump in the 2016 presidential election.

Vice President Mike Pence invited four senators to dinner Tuesday to discuss the bill, his office said: Senator Lee, Sen. James Lankford (R) of Oklahoma, Sen. Tom Cotton (R) of Arkansas, and Sen. Ben Sasse (R) of Nebraska.