By Alexander Bolton - 07-11-17 06:00 AM EDT
Senate Republican leaders are moving forward this week on legislation to repeal and replace major parts of ObamaCare despite divisions within their conference.
Leaders will brief rank-and-file Republican senators Tuesday during their weekly lunch on the revisions they have made to the legislation in an effort to bridge the gap between moderates and conservatives.
They expect to make the revised bill public later in the week and get a score from the Congressional Budget Office (CBO) before bringing it to the floor for a vote.
Senate Republican Whip John Cornyn (Texas) on Monday said the legislation would likely be unveiled by the end of this week, setting up a vote for next week.
"I'm for getting our work done now. I don't think stringing it out any longer than next week helps us with the product," he told reporters. "My personal goal is to have it up on the floor ready to vote, have the vote-a-rama, next week."
But Senate Majority Leader Mitch McConnell (R-Ky.) faces an uphill battle to get enough votes to pass the legislation.
A total of 10 Republican senators have said they cannot support the Senate bill unveiled on June 22 without changes.
The CBO projected that legislation would result in 22 million more people being without insurance in 2026 compared to current law.
Republicans control 52 seats and can afford only two defections, as Vice President Pence would break a 50-50 tie.
GOP leaders say colleagues will get "an update" on Tuesday, but they still have a significant amount of work to do before unveiling the revised bill.
"I think there will be a revised bill later in the week. There's a constant conversation going on with CBO to evaluate different ideas and proposals that have been advanced by different members of our conference," said Senate Republican Conference Chairman John Thune (S.D.), the third-ranking member of the leadership.
"Nothing on this is final. These are all sort of, at this point, I think, just deliberations," he added.
President Trump increased the pressure on Senate Republicans by urging them to cancel the August recess if it's necessary to pass a healthcare bill.
"I cannot imagine that Congress would dare to leave Washington without a beautiful new HealthCare bill fully approved and ready to go!" he tweeted Monday.
GOP leaders have tried to woo both sides of their conference by promising $45 billion for opioid treatment, a high priority for moderates such as Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va.), and by looking at new regulatory reforms to entice conservative such as Sen. Ted Cruz (R-Texas).
They have also discussed adding tens of billions of dollars to a $62 billion long-term state innovation fund that is designed to help low-income people with high healthcare costs afford insurance.
But those changes might not be enough to save the bill, given how little room they have for error.
One prominent moderate, Sen. Susan Collins (R-Maine), told CNN, "I do need a complete overhaul to get to a yes."
Collins came under heavy pressure from constituents to hold out against the Senate bill when she was back home for the July Fourth recess.
GOP aides say Collins's vote is likely lost - but she's far from the only holdout.
Several other Republicans, including Sens. Dean Heller (Nev.), Lisa Murkowski (Alaska) and Capito are uneasy with Medicaid cuts in the legislation. Capito over the weekend said she's willing to take the bill down if necessary.
"I only see it through the lens of a vulnerable population who needs help, who I care about very deeply," Capito said during an interview with Politico that was published Sunday. "So that gives me strength. If I have to be that one person, I will be it."
Meanwhile, conservatives have their own problems with the bill.
Sen. Rand Paul (R-Ky.) has told colleagues he opposes giving low-income Americans refundable tax credits to buy health insurance, a core element of the Senate legislation that is unlikely to change.
Sen. Mike Lee (R-Utah), another conservative, says he will not vote for the legislation unless it includes an amendment he has sponsored with Cruz. That provision would allow insurance companies to sell plans that do not meet ObamaCare's regulatory requirements as long as they offer at least one plan that does.
Senate aides, however, say that proposal is a nonstarter with a majority of the GOP conference, who fear it would effectively gut the current law's protections for people with pre-existing conditions.
Thune said no decision has been made over whether to include the Cruz-Lee "Consumer Freedom" proposal in the substitute bill brought to the Senate floor, adding that a lot will depend on the CBO's analysis of it.
Sen. Pat Toomey (R-Pa.), a member of the special working group that McConnell convened to shape the bill, said Monday that leaders had added new incentives to build support.
"We're going to get the specifics of a $45 billion commitment for opioid funding," Toomey told CNBC's "Squawk Box" in an interview Monday, referring to extra funding to treat drug addiction that is a high priority of moderates.
"There's also a big push to have a change in the regulatory mandates, so that we can have the lower premiums that we're looking for," he added. "People can have more control and more choices that will appeal to the conservatives."
White House officials have told reporters the president is confident the legislation will pass before the August recess and include more money to treat opioid addiction and lower premiums.
But McConnell over the recess signaled that GOP leaders are already looking at a fallback plan: working with Democrats to shore up faltering insurance markets.
McConnell told constituents at a Rotary Club meeting in Kentucky, "If my side is unable to agree on an adequate replacement, then some kind of action with regard to private health insurance markets must occur."
That statement caught White House officials by surprise, raising concerns the GOP leader might be plotting a new strategy, according to CNN, which cited two anonymous officials.
McConnell's office later explained that the statement was no different from what he has stated before: that Republicans will have to work with Democrats if a GOP-only effort to reform ObamaCare falls short.
One tough decision McConnell will have to make is whether to keep in place ObamaCare's 23.8 percent tax on capital gains and dividends for high-income earners.
The previously released Senate bill would cut the rate to 20 percent, but some Republicans, such as Sen. Bob Corker (R-Tenn.), have called for keeping the tax in place to provide more money to lower the cost of premiums.
That suggestion has sparked a backlash from conservative groups such as the Club for Growth and Americans for Tax Reform.
Club for Growth President David McIntosh called it "anathema to conservatives as it suppresses economic growth and opportunity throughout our nation."