By Sean Sullivan and Juliet Eilperin,
President Trump predicted Tuesday morning that Republicans may wait for the federal insurance market to collapse and then work to broker a deal to rewrite the nation’s landmark health-care law.
In a series of tweets, Trump blamed the demise of a months-long effort to rewrite the Affordable Care Act on Democrats “and a few Republicans,” but he suggested that the drive to overhaul the law was not completely over.
“We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!” he tweeted. He added in a separate tweet: “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!”
Trump’s latest comments appeared likely to intensify the current political uncertainty on Capitol Hill, where GOP leaders were debating what to do next, as well as raise anxiety among insurers that must commit to staying on the federal health exchange within a matter of weeks.
Republicans are reeling after two more GOP senators declared their opposition Monday to the party’s plan to overhaul the nation’s health-care system, likely ending their quest to make good on a GOP promise that has defined the party for nearly a decade and has been one of Trump’s top priorities.
Senate Majority Leader Mitch McConnell (R-Ky.) opened the Senate on Tuesday morning touting his latest plan — to vote on a pure repeal, with a two-year delay, by taking up the House’s health-care bill. But while conservatives and Trump have been pushing for such a repeal as a last resort, it appeared unlikely that the vote would succeed.
Two Republican senators, Susan Collins (Maine) and Shelley Moore Capito (W.Va.), expressed opposition Tuesday to the repeal-only option, apparently burying it.
“I did not come to Washington to hurt people,” Capito said on Twitter. “I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.”
“This doesn’t have to be the end of the story,” McConnell said. “Passing the repeal legislation will allow us to accomplish what we need to do on behalf our people.”
McConnell said the Senate would next take up “a repeal of Obamacare combined with a stable two-year transition period.” He said that President Barack Obama had vetoed such legislation before but that “President Trump will sign it now.”
While he noted that the measure had overwhelming support among Republican senators in 2015, the Senate leader also acknowledged that his party has suffered a political setback.
“I regret that the effort to repeal and immediately replace the failures of Obamacare will not be successful,” he said. “We will now try a different way to bring the American people relief from Obamacare.”
Republican Sens. Mike Lee (Utah) and Jerry Moran (Kan.) issued statements Monday declaring that they would not vote for the revamped measure. The sudden breaks by Lee, a staunch conservative, and Moran, a McConnell ally, rocked the GOP leadership and effectively closed what already had been an increasingly narrow path to passage for the bill.
They joined Sens. Rand Paul (Ky.) and Collins, who also oppose the latest health-care bill. With just 52 seats, Republicans can afford to lose only two votes to pass their proposed rewrite of the ACA. All 46 Democrats and two independents are expected to vote against it.
Lee supports the idea of moving ahead with a straight repeal of the existing law, and his spokesman, Conn Carroll, said Tuesday he would back a motion to proceed on a bill that would achieve that aim. But many centrist Republican senators have said they oppose dismantling key aspects of the ACA without an immediate replacement, given that roughly 20 million Americans have gained coverage under the law.
The confusion over next steps highlights the predicament now faced by Republicans, who have made rallying cries against Obama’s 2010 health-care law a pillar of the party’s identity. They may be forced to grapple with the law’s shift from a perennial GOP target to an accepted, even popular, provider of services and funding in many states, which could make further repeal revivals difficult.
Meanwhile, Trump and other Republicans will confront a Republican base that, despite fervent support for the president, still seeks a smaller federal government and fewer regulations.
All of these forces remained vexing factors Monday as senators bailed on the bill. And no evident solution was offered by the White House — which has been limited in its sale of the GOP plan — or from McConnell, for how to bring together a party in which moderates and conservatives are still deeply divided over the scope of federal health-care funding and regulations.
In many ways, the leadership plan did not go far enough for those on the right, but was too radical for GOP centrists. It scaled back some key ACA requirements and made deep cuts over time in Medicaid, but preserved popular provisions of the law such as a ban on denying coverage to consumers with costly medical conditions.
But the fact that it would reduce federal Medicaid funding and phase out the program’s expansion in 31 states and the District of Columbia rankled several key GOP governors and senators, who feared that their states would be saddled with the unpalatable choice of either cutting off constituents’ health coverage or facing a massive new financial burden.
The opposing pressures have left McConnell in a tough position as he has struggled to find a solution, which is why he has now thrown out the idea of moving to an immediate repeal.
Abolishing several of Obamacare’s central pillars — including the mandate that taxpayers buy coverage, federal subsidies for many consumers’ premiums and Medicaid coverage for roughly 11 million Americans — could wreak havoc in the insurance market. A Congressional Budget Office analysis in January estimated that premiums in the individual insurance market would rise between 20 and 25 percent next year and would roughly double by 2026.
At the same time, according to the CBO, the number of uninsured would spike by 18 million next year and rise to 32 million by 2026.
“For insurers, the worst possible outcome in this debate has always been a partial repeal with no replacement, which is exactly what Congress is about to take up,” said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, in an email. “Insurance companies would be on the hook for covering people with preexisting conditions, but with no individual mandate or premium subsidies to get healthy people to sign up as well.”
But GOP leaders had no choice but to shift gears after Lee and Moran declared they could not support the party’s current health plan.
“In addition to not repealing all of the Obamacare taxes, it doesn’t go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations,” Lee said in a statement.
Moran said the bill “fails to repeal the Affordable Care Act or address healthcare’s rising costs.”
The two senators timed the release of their statements and made clear that modest tinkering around the edges of the legislation drafted by McConnell would not be enough to meet their demands. They joined a pair of GOP colleagues in calling for a complete redrawing of the legislation that would take many months, short-circuiting McConnell’s wish to end the debate this month.
The news threw the effort to pass the legislation into turmoil, with additional Republicans weighing in on Twitter about a flawed process that must take a new direction. Trump tweeted late Monday that “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan.”
Sen. Lindsey O. Graham (S.C.) called for a “new approach” while Rep. Mark Meadows (N.C.) tweeted, “Time for full repeal.” White House aides, meanwhile, said they still plan to press ahead.
The setbacks appear to have left McConnell and House Speaker Paul D. Ryan (R-Wis.) with few good options. Conservatives have suggested moving a bill that would simply repeal the Affordable Care Act and set up a timeline of several years to figure out how to replace it, a politically risky move that also might lack support to pass.
Another move, which McConnell threatened recently, would be to work with Democrats to prop up the insurance exchange markets that have been imploding in some states — which probably would win passage but would infuriate the conservative base that has been calling for the end of the Affordable Care Act.
“Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful,” McConnell said in a statement released late Monday. He revealed plans to move forward with a vote in the coming days anyway, in some ways daring his Republican opponents to begin debate and open the legislation up to amendments.
Democrats quickly jumped at the opportunity to declare the effort dead.
“This second failure of Trumpcare is proof positive that the core of this bill is unworkable,” said Minority Leader Charles E. Schumer (N.Y.). “Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long-term stability to the markets and improves our health-care system.”
But Ryan showed little interest Tuesday in making common cause with Democrats, telling reporters that House leaders “would like to see the Senate move on something” to keep the repeal-and-replace process alive.
In a closed-door conference meeting, according to several members present, Ryan told colleagues that the ball remains in the Senate’s court and announced no plans for further action on health care in the House. He also urged House members to be patient and not to openly vent frustration with the Senate, the members said.
Publicly, he emphasized that the Senate had “a razor-thin majority” and that passing legislation is “a hard process.”
Republican leaders had returned to the Capitol on Monday still pledging to press ahead with plans to pass a far-reaching overhaul, but the day had begun with uncertainty as the health of Sen. John McCain (R-Ariz.) put the future of the flagging effort deeper in doubt.
In a speech on the Senate floor, McConnell said that he had spoken with McCain on Monday morning and that “he’ll be back with us soon.” The Arizonan is recovering from surgery to remove a blood clot above his left eye that involved opening his skull.
McConnell had delayed action on the health-care bill until McCain’s return in hopes that he could be persuaded to vote yes. That hope faded after Lee’s and Moran’s announcements, however, with McCain issuing a statement from Arizona calling for a fresh, bipartisan start.
Senate Republicans have been under self-imposed pressure to complete their work on health care. As they have struggled to show progress, McConnell has said he would keep the chamber in session through the first two weeks of August, postponing the start of the summer recess period to leave time to work on other matters.
Kelsey Snell, Mike DeBonis and Ed O’Keefe contributed to this report.