By Peter Sullivan - 07-13-17 12:10 PM EDT
Senate Republican leaders on Thursday unveiled a revised version of their bill to repeal and replace ObamaCare as they race toward a high-stakes vote next week.
The measure includes changes intended to win over additional votes, with leadership making concessions aimed at bringing both conservatives and moderates on board. (READ THE BILL HERE.)
But Senate Majority Leader Mitch McConnell (R-Ky.) is facing a tough task in finding enough votes to pass the bill. Sens. Susan Collins (R-Maine) and Rand Paul (R-Ky.) appear to be firmly against the measure, and one other defection would kill the bill.
Overall, McConnell appears to have shifted the revised bill more toward the conservatives than the moderates.
Importantly, the bill largely keeps the Medicaid sections the same, meaning that deeper cuts to the program will still begin in 2025, and the funds for ObamaCare's expansion of Medicaid will still end in 2024.
The changes to Medicaid have emerged as a top concern for moderates such as Sens. Rob Portman (R-Ohio), Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).
The Congressional Budget Office (CBO) found that those Medicaid changes in the original bill would result in 15 million fewer people being enrolled in the program and cut spending by $772 billion over 10 years.
Collins said she still plans to vote against a motion to proceed to the bill, adding that the legislation should move through the normal committee process.
"My strong inclination and current intention is to vote no on the motion to proceed," Collins told reporters after leaving a briefing on the legislation.
"The only way I'd change my mind is if there's something in the new bill that wasn't discussed or that I didn't fully understand or the CBO estimate comes out and says they fixed the Medicaid cuts, which I don't think that's going to happen."
For the conservatives, the measure includes a version of an amendment from Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah) aimed at allowing insurers to offer plans that do not meet all of ObamaCare's regulations, including those protecting people with pre-existing conditions and mandating that plans cover certain services, such as maternity care and mental healthcare.
Conservatives argue the change would allow healthier people to buy cheaper plans, but moderates and many healthcare experts warn that premiums would spike for the sick people remaining in the more generous insurance plans.
Cruz said he will support the bill so long as the provisions he sees as a priority are not changed in amendment votes on the floor.
"If this is the bill, I will support this bill," Cruz told reporters after a meeting of GOP senators. "Now, if it's amended and we lose the protections that lower premiums, my view could well change."
Senate Republicans had vowed to not change the ObamaCare protections for people from being charged more based on their health in their bill, which is why the debate over the Cruz-Lee amendment has been heated.
A Senate GOP aide said Thursday it is possible that the Cruz amendment would not be analyzed by the CBO in time for the vote next week. It is possible the Department of Health and Human Services could provide an alternative analysis.
Lee cautioned that he was not involved in the changes to the proposal, including the amendment, and would have to review the new language before deciding whether to support it.
The bill does include new funding, $70 billion over seven years, aimed at easing costs for those sick people remaining in the ObamaCare plans.
In addition, another $70 billion has been added to the original $112 billion "stability fund" to help bring down insurance premiums.
However, the new measure does not boost the generosity of the tax credits, as some moderates wanted. It still replaces ObamaCare's tax credits to help people afford insurance with a smaller, scaled-down tax credit that provides less assistance.
The Kaiser Family Foundation found premium costs would increase an average of 74 percent for the most popular healthcare plan, given the reduced assistance in the GOP bill.
The new measure will leave in place two ObamaCare taxes on the wealthy, in a departure from the initial bill.
That original measure lacked the support to pass, as more moderate members pointed to the CBO's finding that 22 million fewer people would have insurance over a decade.
Senate Republicans are now awaiting a new score of the revised legislation from the CBO, which could come early next week.
The new bill does include $45 billion to fight opioid addiction, but moderates such as Capito and Portman who hail from states where the problem is rampant have said they also want changes to the Medicaid portion of the legislation.
Portman said his position on the bill had not changed, but he did not give a clear answer on whether he'd back his party on the procedural vote.
"I'm the same position I've been in. I'm looking at the language," he said.
Capito also said she doesn't know whether she'll vote to proceed to the bill.
"We have another meeting this afternoon on the Medicaid cuts," she told reporters. "I need to really look at it, look at the score; I still have concerns."
Asked if she would vote for the motion to proceed next week, she said, "Wait and see."
In a change that could appeal to Murkowski, the bill sets aside 1 percent of the stability funds for states with costs that are 75 percent above the national average, which would benefit high-cost states like Alaska.
- This story was updated at 1:55 p.m. Alexander Bolton contributed.