At 9:30 a.m., Republican senators gathered in a room just off the Senate floor to hear the long-awaited details of the health-care bill their leadership had crafted behind closed doors.
By 2 p.m., it was clear that Senate Majority Leader Mitch McConnell did not yet have the votes to pass it—and pushback was coming from all sides of his conference.
The ultimate fate of the bill, dubbed the Better Care Reconciliation Act, was unclear and will likely remain that way in the coming days as senators await a score on the legislation from the Congressional Budget Office, weigh the potential consequences by the changes that are made to the Affordable Care Act, and angle for deals to benefit their home states or policy goals.
But few in or around the Senate chamber expected widespread acceptance of the bill—aptly called “a discussion draft”—out of the gate. And it became clear that even some of those who came out against the legislation hinted that their “no” could change to a “yes” with a little love and attention.
“It has to look less like Obamacare lite, and it’s gotta look like what we promised,” said Sen. Rand Paul, who issued a statement in opposition to the current language with Sens. Mike Lee, Ted Cruz, and Ron Johnson.
“I think the bill can be made better. All four of us are saying that we can vote for it, but there’s got to be a negotiation now,” Paul added. “I don’t think there’s a realistic or a functioning negotiation unless we let people know that there’s not enough votes.”
During a Senate luncheon, the ever-helpful Cruz even passed out a flyer detailing several points that would earn his vote.
But while Cruz and Paul decried the bill as too much like Obamacare, others in the conference were concerned that the bill went too far in the other direction.
In a statement released about an hour after the bill was publicly released, Nevada Sen. Dean Heller—the most vulnerable Republican senator in the country—expressed skepticism about the impact it would have on his neediest constituents.
“At first glance, I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid,” he said.
Alaska Sen. Lisa Murkowski, a moderate, did not indicate whether she would be inclined to vote for the bill.
“Obviously, we’ve got a lot to look at,” Murkowski said with a laugh as she left the morning meeting.
Still, Murkowski—as well as Sen. Susan Collins of Maine—will likely be two of the most difficult Republicans to win over, due to the inclusion of a provision to strip funding for Planned Parenthood for one year as well as the deep cuts to Medicaid. Both the House and the Senate bill phase out Medicaid expansion, although the Senate’s version is a slower process.
McConnell can only lose two Republicans and still pass the bill, since Democrats have uniformly rejected the bill as a “mean” proposal that would have catastrophic repercussions for the American health-care system.
The Senate bill also ends the individual mandate, and as of its release did not include a provision to punish or incentivize individuals who went without continuous health-care coverage, Republican aides said Thursday.
Like the House bill, it repeals most of the taxes that fund the Affordable Care Act, resulting in large tax cuts for the wealthy.
Senators who are on the fence won’t have infinite time to pore over the details, as McConnell has indicated he would push for a vote before lawmakers head home for the July 4th recess at the end of next week.
That, of course, won’t be a problem for most of the Senate Republican Conference.
South Carolina Sen. Tim Scott said his first impression was that the bill was more “gracious” than the House version, the American Health Care Act—which Trump described as “mean” in a closed-door session with lawmakers last week.
“Americans with the lowest income will have more access to health insurance at a more affordable price,” Scott told reporters. The South Carolina Republican also disputed the idea that Medicaid was being cut.
“Medicaid is not actually being cut from our perspective. You look at—the expansion population is coming down over a long time, it appears… So what you’re actually seeing the impact on is the healthy Americans where you’re seeing our plan become more helpful for those folks who are low-income Americans,” Scott added.
Louisiana Sen. Bill Cassidy garnered national attention when he came out in support of the “Kimmel test”—named after late-night host Jimmy Kimmel, whose newborn son benefited from the Affordable Care Act.
Cassidy declined to definitively say whether the legislation meets the “Kimmel test” before he has a chance to read it.
“The issue is if your loved one gets sick, would they have adequate coverage. As best I can tell, it does. But I, again, need to read the text,” Cassidy told reporters.
“I do think there’s a lot of effort to lower premiums immediately and to provide certainty for insurance companies providing that coverage. I’m pleased about that,” he added.
Cassidy said that his staff plans on working through the weekend on reviewing the 142-page legislation so that he could reach a conclusion before a potential vote next week. At first glance, Cassidy added, the bill appears to be less “mean”—the Trump standard—than the House’s version.
Andy Slavitt, the former Acting Administrator of the Centers for Medicare and Medicaid Services for the Obama administration, said the Senate bill is worse than the House bill in part because some of the cuts are made deeper in order to appear as bargaining chips and give the illusion of a better bill when in fact the policy was still flawed.
“They are setting up to give gifts away at the end of the process,” he said. “Trump said he wanted a bill with a little more heart and that’s how they’ll do it.”