By Peter Sullivan - 06-06-17 20:31 PM EDT
Senate Republican leaders on Tuesday presented their caucus with a broad outline of a healthcare plan as the GOP - against the odds - looks to pass an ObamaCare repeal-and-replace bill this summer.
The party is fractured as the White House pushes for swift action and the GOP-led House grows increasingly restless with the Senate's lack of clear progress on healthcare.
It's also unclear when Senate Republicans will introduce legislative text, which reveals the devil in the details and will likely only spark more controversy and dissent. The initial Republican timetable on healthcare was for President Trump to sign a bill two months ago. At this rate, the prospects of passage in the upper chamber appear slim at best.
GOP senators, including Majority Leader Mitch McConnell (Ky.), have openly acknowledged that getting the votes to pass healthcare reform will be extremely difficult.
Senators said a PowerPoint presentation at Tuesday's Senate GOP lunch meeting left some key decisions unresolved. While aides said some details are starting to take shape, conservatives are already raising red flags.
Most importantly, staffers said the bill would allow states to waive ObamaCare rules requiring insurers to cover a range of healthcare services, known as essential health benefits. But the measure would not allow states to waive rules preventing people with pre-existing conditions from being charged more, a departure from the House-passed bill.
That move pleased some moderates but has sparked frustration among conservatives who want to allow states to repeal all of the ObamaCare regulations.
Speaking on background, an aide to a conservative senator said their office is "very disappointed" in the healthcare proposal as it currently stands and that its structure "absolutely" jeopardizes support on the right.
Sen. Bill Cassidy (R-La.), who has been vocal about protecting people with pre-existing health conditions, offered support for the bill.
"It's very cognizant of pre-existing conditions, which is a good thing," he said.
"We haven't seen the final details, but simple answer ... yes," Cassidy said when asked if he could support the proposal.
On Medicaid, Sen. John Barrasso (R-Wyo.), a member of leadership, said the legislation would still end the higher federal funding for ObamaCare's expansion of Medicaid, but on a slower phase-out than in the House, moving the end date past 2020.
"The House bill has kind of an abrupt cutoff, and we're having a good productive discussion about a glide path to help states get to a point where they can get back to [the lower funding levels] without an abrupt cutoff," Barrasso said.
Signs of intraparty strain emerged Tuesday after Sen. Lindsey Graham (R-S.C.) told reporters: "I'm very leery of a healthcare bill passing the Senate that can get through the House. We've already lost [Sen.] Rand Paul [R-Ky.], so we're down to 51."
Graham said Paul is "irretrievably gone," meaning GOP leaders can only afford one more defection and still pass legislation repealing and replacing ObamaCare.
Paul, who like Graham ran for president in 2016, quickly responded.
"While we do have a press assistant opening in the Communications Department, Senator Graham has not applied and should not make public statements on behalf of Senator Rand Paul," Paul spokesman Sergio Gor said in a statement. "Senator Paul remains optimistic the bill can be improved in the days ahead and is keeping an open mind."
And after the GOP meeting Tuesday, Graham sounded more optimistic, calling the options discussed "promising proposals."
Medicaid remains one of the thorniest issues for the Senate.
A few senators are wary of getting rid of the expansion at all, even on a slower timeline. On Monday, Sen. Shelley Moore Capito (R-W.Va.) said a slower phase-out would be "helpful" but added, "I'm not saying I support phasing it out."
Asked if she wanted to keep ObamaCare's Medicaid expansion, centrist Sen. Lisa Murkowski (R-Alaska) responded "yes" as elevator doors closed.
Pressed to elaborate, a spokesperson said: "Senator Murkowski has been hearing from people all over the state, including hospitals, providers, disability advocates, and the State legislature that it has been a large net positive for Alaska."
Democrats argue that ending the extra Medicaid expansion funds on a slower timetable, as the Senate bill appears poised to do, serves little purpose and will simply take away Medicaid coverage at a later date. No Democrat is expected to vote for the GOP plan.
Some healthcare experts also warn that pre-existing conditions would not be protected even if a state were only allowed to waive the essential health benefits. Sick people could be forced to pay exorbitant prices for a plan that covers their conditions under that scenario.
For example, pregnant women in states that waive the essential health benefits could pay more than $1,000 per month for maternity care coverage, according to a Congressional Budget Office (CBO) analysis of the House bill.
Senate GOP leaders say that the time has come to make decisions on the healthcare bill, but they are not setting a firm timeline. Leaders have said a vote by the end of June, before the July 4 congressional recess, would be ideal, and the end of July is the ultimate deadline.
Under that timetable, GOP members would have to send a bill to the CBO soon to meet the end-of-June target. Lawmakers said preliminary discussions with the CBO have already begun.
McConnell wouldn't commit to a certain date for a vote on an ObamaCare repeal-and-replace bill Tuesday, saying one would be brought to the floor "in the near future."
"We've had plenty of time to discuss this issue," McConnell said. "We're getting close to having a proposal to whip and take to the floor."
Senate leaders have said they will bring up a bill for a vote even it lacks the support to pass.
- Rachel Roubein, Jessie Hellmann and Nathaniel Weixel contributed.