Republican senators are still working through some ideological disagreements before releasing their bill to dismantle the Affordable Care Act (ACA).
The details of the draft bill are being closely held, particularly until leaders have cost estimates for various provisions from the Congressional Budget Office (CBO). Senate Majority Leader Mitch McConnell wants to have the Senate vote on a bill before the July 4 recess but is trying to avoid hard deadlines on such a complex and politically charged issue.
President Trump told Republican senators earlier this week to improve the bill that the House passed last month, and even labeled the House bill as “mean” toward lower-income Americans in particular. Trump had celebrated the passage of the House bill with Republican leaders last month but has since acknowledged that news coverage of the House bill has been unfavorable and he wants a bill that is easier to defend publicly. He told Republican senators this week to find consensus soon.
“The message really was, ‘I know you have your differences, but work through them and let’s figure out a way to get it done,’” said Sen. John Thune (R-SD). “We have to get a product.”
Senate leaders say their bill will be more protective of people with preexisting conditions than the House bill and will likely slow the repeal of Medicaid expansion. The House bill would not only roll back the Affordable Care Act’s Medicaid expansion, it would cut more than $800 billion over 10 years from Medicaid and cap its federal funding for the first time. A group of moderate senators led by Sen. Rob Portman (R-OH) and Shelley Moore Capito (R-WV) wants a longer transition for states that expanded Medicaid under the ACA.
Without Democratic support, McConnell can afford to lose only two GOP votes on a bill. He faces a balancing act in appeasing conservative Republicans who are demanding a more complete repeal of Obamacare and moderates like Portman and Capito who are fighting to maintain some provisions and funding that help cover individuals and families in their states.