Senate GOP leaders said to aim for new health plan in two weeks

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(Bloomberg) — Senate Republican leaders trying to break a logjam on their proposed healthcare legislation are working with congressional budget officials to examine the impact of various changes they’re considering, a process that could take about two weeks, according to a GOP aide.

President Donald Trump complicated the delicate negotiations led by Senate Majority Leader Mitch McConnell early Friday, tweeting that if Republican senators can’t strike a deal on their health bill, they should immediately repeal Obamacare and replace it later. That’s a reversal of the president’s earlier position, and it comes as McConnell is trying to gain support from conservative senators, some of whom have wanted a full repeal all along.

McConnell of Kentucky is still trying to find a way to win enough support for legislation that repeals Obamacare and replaces it at the same time — after a measure he proposed last week failed to win enough support among Republican senators. For the bill to clear the Senate, Republicans can only afford to lose two GOP votes amid unanimous Democratic opposition.

Republican leaders are asking the non-partisan Congressional Budget Office to review conceptual changes to the legislation, beginning a two-week process of balancing the costs and policy outcomes of possible changes, said the Republican aide who asked for anonymity to discuss the matter. The budget office will provide estimates of the legislation’s impact on the federal budget and number of Americans who will lose coverage under a revised plan.

McConnell is planning to add $45 billion in spending to address the opioid epidemic, according to the aide, a top demand of moderate Republicans, including Senator Rob Portman of Ohio and Shelley Moore Capito of West Virginia.

Tax changes
Senator John Cornyn of Texas, the No. 2 Republican leader, said Thursday that the revised bill could be altered to keep Obamacare’s 3.8 percent tax on net investment income to bolster subsidies for low-income people in the law’s exchanges. Such a move would leave intact a revenue stream of $172 billion over a decade that could be used to boost health expenditures in the bill, including more-generous subsidies for those buying insurance on Obamacare’s exchanges.

Senator Bob Corker, a Tennessee Republican, said that based on a meeting he had with McConnell late Wednesday, he expects the party’s Senate leaders will scrap their effort to repeal that tax.

Leaders are also considering a proposal by Republican Senator Ted Cruz of Texas to allow health insurers to sell cheaper plans as long as they also sell policies that meet Obamacare standards —but that idea could run into moderate opposition or hurdles with the Senate parliamentarian.

GOP Senator Bill Cassidy of Louisiana said Thursday that even though he expected McConnell to take revisions to the CBO as early as Friday, there is still no sign that there’s enough backing to get it through the Senate.

“I’m not confident that that’s going to solve everybody’s concerns,” Cassidy told reporters.

Televised comments
Trump’s tweet about a full Obamacare repeal was posted after Senator Ben Sasse, a Nebraska Republican and frequent Trump critic, floated the idea on the "Fox and Friends" TV program Friday morning.

Sasse, in a separate statement, said if there isn’t a health deal by July 10, when the Senate returns to session, Trump should call on Congress to “immediately repeal as much of Obamacare as is possible under congressional budget reconciliation rules.”

With his tweet, Trump also appears to be aligning himself with at least one of the conservative holdouts, Senator Rand Paul of Kentucky.

Paul said Friday on Twitter that he’d spoken to Trump and “Senate leadership about this and agree. Let’s keep our word to repeal then work on replacing right away.”

It’s unclear how serious the White House is about possibly shifting tactics.

“The primary focus is repeal and replace through current Senate legislation,” White House spokeswoman Sarah Huckabee Sanders said Friday afternoon.

Republican leaders are struggling the manage the various demands of lawmakers in their party’s conservative and moderate wings.

Conservatives’ complaints
Some conservatives say McConnell’s initial legislation lacked an effective response to their toughest criticism of Obamacare: that it requires too many consumer protections of insurers selling in the individual market, driving up costs and limiting choices. Several more moderate Republicans also oppose McConnell’s bill, which the nonpartisan Congressional Budget Office said would result in 22 million fewer Americans having health insurance over 10 years.

McConnell delayed a vote he had planned to hold this week after five Republican senators said they’d vote against a key procedural motion. Several others said they opposed his bill after the vote was delayed.

The new suggestion by Trump, Paul and Sasse to do a repeal-only bill first could complicate GOP negotiations further.

Republican leaders had originally planned to bring up a lightning-strike repeal bill in January to get it to the president’s desk shortly after he took office, with replace to come later. But moderates and conservatives, including Paul, balked at the idea, for different reasons.

Trump also shot the idea down. Back on Nov. 13, right after winning the election. Trump said that "we’re going to do it simultaneously," speaking in an interview on CBS’s "60 Minutes."

“We’re not going to have a two-year period where there’s nothing,” he said. “It will be repealed and replaced.”

Yet White House spokeswoman Sarah Huckabee Sanders said Friday that the president’s position hasn’t changed. “We are focused on the end product here and that is repealing and replacing Obamacare,” she said.

Moderates’ demands
Moderates who had voted for earlier repeal bills when there was no chance of them becoming law suddenly wanted a replacement to be ready first, and feared pulling the rug out from millions of people who had gotten insurance under the Affordable Care Act. And conservatives wanted a broader repeal than the one President Barack Obama had vetoed a year earlier, which left in place the ACA’s regulatory framework but gutted its financial underpinnings.

The Congressional Budget Office scored that earlier bill three days before Trump took office, and the results were ugly: 32 million would lose insurance over a decade and premiums would double, the office said.

Even so, a key conservative in the House said he was open to the suggestion.

“Putting the repeal bill on the president’s desk that all current Republicans senators but one have already voted for would be a prudent first step,” House Freedom Caucus chairman Mark Meadows of North Carolina said Friday. “That said, I do think we still have an opportunity to do repeal and replace in one bill if Leader McConnell will keep members engaged.”

Sasse said in that scenario, Trump should also call on Congress to cancel its August recess and work “through regular order, six days per week” to write a health package that can be voted on by Labor Day in September.

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Healthcare reform Healthcare-related legislation Obamacare Donald Trump