By Alexander Bolton - 03-07-17 19:13 PM EST
Senate Majority Leader Mitch McConnell (R-Ky.) has only three weeks to unify conservatives and moderates in his conference behind an ObamaCare repeal and replacement bill.
The American Health Care Act, which Vice President Pence on Tuesday declared "the framework for reform," will move first in the House, but it faces perhaps an even steeper climb in the Senate.
Republicans control 52 seats in the upper chamber and can only afford to lose two votes, since Pence can vote to break a 50-50 tie. So far, at least eight Republican senators have voiced concerns with aspects of the legislation.
McConnell, a master tactician, will have his work cut out for him.
Three conservatives, Sens. Mike Lee (R-Utah), Ted Cruz (R-Texas) and Rand Paul (R-Ky.), are unhappy with parts of the House bill, which allied conservative groups have panned as not going far enough.
Lee blasted the House bill as "a missed opportunity" and "a step in the wrong direction."
He warned that policymakers don't know how much tax credits proposed in the House legislation to help Americans buy insurance would wind up costing the federal government.
Paul dismissed the legislation as "dead on arrival" and "a bailout for the insurance companies."
Cruz has been less vocal about his views on the bill. He skipped a press conference Tuesday afternoon that Paul and Lee held with House conservatives critical of the bill.
The Texas senator told reporters that he has a number of concerns but declined to say whether he would vote no.
"The proper way to address those concerns is working with colleagues in the House, the Senate and the administration, and that's what I'm doing right now," Cruz said.
Meanwhile, two influential Republican senators, Susan Collins (Maine) and Lisa Murkowski (Alaska), have objected to including language in the bill defunding Planned Parenthood - a top priority of House conservatives.
Collins and Murkowski told reporters Tuesday that they were reviewing the newly released legislation.
Three other Republican senators - Rob Portman (Ohio), Shelley Moore Capito (W.Va.) and Cory Gardner (Colo.) - along with Murkowski sent a letter to McConnell Monday warning him that a draft House healthcare plan that leaked last month failed to ensure stability for hundreds of thousands of people in their states who were newly enrolled in Medicaid under ObamaCare.
Sen. Dean Heller (R-Nev.), widely considered the most vulnerable Senate Republican incumbent in 2018, has also raised concerns about rolling back the Medicaid expansion. On Tuesday he said he hadn't yet reviewed the House bill.
Taken together, it's clear that there will be a large number Republican votes for McConnell to shore up by the week of March 27, when he plans to bring the American Health Care Act to the Senate floor, provided the legislation passes the House on schedule.
McConnell wants to get the bill done before the Senate begins debate on Supreme Court nominee Neil Gorsuch, who is scheduled to reach the floor the first week of April. Congress is scheduled to leave town April 7 for a two-week recess.
Democrats made clear Tuesday that GOP leaders shouldn't expect any votes from their side of the aisle.
Senate Democratic Leader Charles Schumer (N.Y.) vowed that his caucus would fight "tooth and nail" against "TrumpCare."
"TrumpCare means higher costs for less healthcare, plain and simple," he said. "TrumpCare cuts taxes on the very wealthy while forcing average Americans to pay more. Premiums are going to go up."
McConnell called in the heavy artillery Tuesday by inviting Pence to a Senate GOP lunch to persuade wavering colleagues to get behind the House bill.
Pence told lawmakers pointedly that Trump supports the legislation, and while he's open to making changes, he will not scrap it and start over, as some conservatives would prefer.
"We're certainly open to improvements and to recommendations in the legislative process," Pence told reporters after the meeting, though he emphasized that "this is the bill."
Over the next several weeks McConnell and his leadership team will argue to colleagues that voters are expecting action from Congress, and this month presents them with a historic opportunity to deliver on their campaign promises to repeal ObamaCare.
"The American people have given us an opportunity to govern. We're no longer floating ideas," McConnell said. "We have an obligation now to the American people to deliver a replacement for ObamaCare that is better than the status quo."
He noted ObamaCare was a "huge issue" in the 2010, 2012, 2014 and 2016 elections.
Pence tried to reassure Republicans nervous about capping the Medicaid expansion that the House bill would "return resources and flexibility to the states that will allow them to reform Medicaid so it can more effectively meet the needs of our most vulnerable citizens."
Gardner, who signed the letter to McConnell expressing concerns about Medicaid, said Tuesday he's still trying to understand the details of how the House bill would impact low-income constituents.
"We're looking at it," he said.
Specifically, he wants to figure out whether new Medicaid enrollees starting in the year 2020 will still be eligible for the same federal subsidies that have covered the cost of expanding the program in 31 states under ObamaCare.
"You can add new people to the program. At least, that's the way we initially understand it," he said.
Centrist Democrats showed no signs of being inclined to back the House GOP bill.
Sen. Jon Tester (D-Mont.), who is up for reelection next year in a state Trump won by 20 points, said he has serious reservations.
"Some things they're doing with Medicaid [are] not going to be helpful. I'm not sure they're helping with lowering premiums for people who are really getting gouged with big premiums," he said. "On first blush, it's certainly got some issues. Major issues."
Sen. Joe Manchin (D-W.Va.), who is running next year in a state Trump won by nearly 42 points, said he was reviewing the bill.
Manchin said, however, that he would not vote for legislation he views as a straight repeal of ObamaCare.
Schumer told reporters that the House bill is an ObamaCare repeal, even though it will keep in place some of the law's reforms, such as allowing adults to stay on their parents' health plans until age 26.
Republicans say it would also bar insurance companies from discriminating against people with pre-existing medical conditions, but Democratic leaders are disputing that claim.
Jessie Hellmann contributed.