The Republican House spent Thursday afternoon celebrating the passage of a Healthcare bill that nobody has scored, let alone read, and already the Senate has poured cold water over the first and so far only achievement of the Trump administration.
The reason, as we reported this morning, and as Bloomberg and The Hill confirm, several key Senate Republicans have said they will set aside the narrowly passed House health-care bill and write their own version instead, a sign of how difficult it will be to deliver on seven years of promises to repeal Obamacare. In the wake of the House’s razor-thin 217-213 vote, the Senate made clear it was going in a different direction.
It started with GOP Senator Dean Heller, who is up for reelection in 2018 and is considered one of the most vulnerable. Heller said he wouldn’t support the House’s bill in its current form. “We cannot pull the rug out from under states like Nevada that expanded Medicaid and we need assurances that people with pre-existing conditions will be protected,” he said in a statement.
A second senator, Rob Portman, made clear his concerns over how the House bill treats Medicaid. While ObamaCare expanded the healthcare program to more low-income Americans, the House bill would eliminate that expansion in 2020. “I’ve already made clear that I don’t support the House bill as currently constructed,” Portman said in a statement, “because I continue to have concerns that this bill does not do enough to protect Ohio's Medicaid expansion population, especially those who are receiving treatment for heroin and prescription drug abuse.”
Senator Lamar Alexander pointed to the difficulties to come. He highlighted his three priorities for the bill, which include rescuing Americans in areas where their health marketplaces may not have any insurers offering plans in 2018. "The Senate will now finish work on our bill, but will take the time to get it right,” Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, said in a statement.
Senator Lindsey Graham tweeted that “A bill — finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate — should be viewed with caution.”
Finally, Alaska’s Lisa Murkowski, who has been very critical of the House bill, said Thursday she hopes they start with "a clean slate" in the Senate.
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With as many as five (tentative) holdouts already, the bill - in its current form - is effectively dead in the Senate. To get a bill through his chamber, Mitch McConnell will need to unite moderate and conservative wings of the party that want to pull the measure in entirely different directions. Since the GOP controls the chamber 52-48, he can lose no more than two Republicans and still pass it, given the united Democratic opposition.
Senate Finance Chairman Orrin Hatch of Utah said Republicans’ goal will be to craft a measure that can get 51 votes. “Coupled with the constraints imposed by the budget reconciliation process, we must manage expectations and remain focused on the art of the doable as we move forward,” he said in a statement after the House vote Thursday.
Likely changes could focus on Medicaid and adding increased financial assistance, in the form of tax credits, to help low-income Americans afford health insurance.
It’s possible the Senate could run into the same problem the House toiled over for almost two months. Move the bill to right, and moderates will defect. Move the bill to the center, and the measure will lose conservative votes.
An eleventh-hour amendment to the House bill from Rep. Fred Upton (R-Mich.) — a former chair of the House Energy and Commerce Committee who came out against the bill earlier this week — helped secure the support of enough House moderates to pass the bill.
Finally, recall that prior to the March debacle, it was widely accepted that the biggest bottleneck for Obamacare repeal will be not in the House, but the Senate.
Still, despite the mounting hurdles, Trump was optimistic, and predicted he’ll be able to ultimately sign the bill into law. "I went through two years of campaigning and I'm telling you: No matter where I went, people are suffering so badly with the ravages of ObamaCare," he said. "We're going to get this passed through the Senate, I feel so confident."
The market, however, did not share his enthusiasm and while hospital stocks dipped on the House vote, they quickly bounced back on the news the Senate would start over with its own version, with the Bloomberg North America Hospitals Index up 0.9 percent at 2:39 p.m. Hospitals fear the winding-down of Obamacare’s Medicaid expansion will leave them with more customers who can’t afford to pay.