With the public release on Thursday of an updated health care bill from Senate Republicans, the focus on Capitol Hill quickly shifted from what is in the measure to how many votes the GOP could muster, as separate groups of moderates and conservatives expressed concern about some of the details, even as the Senate Majority Leader was aiming to hold a vote late next week.
Here's some of the back story on who is not on board in the Senate:
1. Sen. Ted Cruz (R-TX) - A negotiator on the fence. Cruz was one of the 13 GOP Senators who spent weeks behind closed doors trying to forge a deal on health care. But when the text of the Republican bill was publicly released, the Texas Republican was not supporting the plan, as he stressed that it was just a "draft," saying the GOP plan "does not do nearly enough to lower premiums. That should be the central issue for Republicans – repealing Obamacare and making healthcare more affordable." Cruz as of now says, "I cannot support it as currently drafted, and I do not believe it has the votes to pass the Senate."
2. Along with Cruz - Lee, Paul and Johnson. Three other more conservative Republicans also expressed public reservations about the plan, Sen. Mike Lee (R-UT), Sen. Rand Paul (R-KY), and Sen. Ron Johnson (R-WI). Hours after the bill was made public, the four of them issued a joint statement, which indicated they were ready to keep negotiating for a better deal:
"Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor. There are provisions in this draft that represent an improvement to our current healthcare system but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their healthcare costs.” The most outspoken of this foursome has been Paul.
3. Sen. Susan Collins (R-ME): Waiting on the CBO. On the other side of the Republican coin, more moderate GOP Sen. Susan Collins of Maine indicated that she liked some of the provisions in the new draft bill, and said she was open to supporting it. But she told reporters who mobbed her just off the Senate floor that she would not commit to voting for the new Republican health measure until she has seen the review by the Congressional Budget Office that is expected out early next week. "I'm still reviewing the text of the bill," Collins said. "I very much want to see the CBO assessment."
4. From the heartland - worries about opiod funding. One vote to watch is that of Sen. Rob Portman of Ohio, who has made no bones about his concerns that Medicaid funding to the states is being restricted too much by GOP plans, especially when it comes to funding for programs to deal with the opiod crisis. Portman made clear he likes some of the changes in the bill "to reduce premiums in the individual insurance market, but I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic." Like Cruz, Portman helped develop this bill, but he's not voting for it - yet.
5. Two very important votes from Alaska. The way that the GOP health plan impacts health care in The Last Frontier could play a big role in how this bill does in the Senate. While Sen. Dan Sullivan (R-AK) is seen as a more likely vote for the Republican plan, Sen. Lisa Murkowski (R-AK) has repeatedly made clear her concerns with how the numbers get crunched for Alaska taxpayers. Murkowski said she will work with officials back in her state to analyze the new GOP bill. One other hangup for her is how the bill blocks money for Planned Parenthood, a move that's been opposed both by Murkowski and Sen. Susan Collins.
6. Others say they're "studying" the bill. A number of reports added more names to the list of possible GOP opponents, but I'm not so sold on them being the deciding vote against the plan. These names include Dean Heller of Nevada, Ben Sasse of Nebraska, Corey Gardner of Colorado, Jeff Flake of Arizona, and Shelley Moore Capito of West Virginia. For several of them, especially Capito and Heller, the issue of Medicaid funding is a big deal in this bill. The problem for Republicans is that if you ease up on spending restrictions to Medicaid, then you probably lose some conservatives because of that. GOP leaders hope to find a sweet spot in between.
7. Does the GOP bill pass the Jimmy Kimmel test? Sen. Bill Cassidy (R-LA) has talked a lot about devising a health care plan that where "no family should be denied medical care, emergency or otherwise, because they can't afford it" - something that caught fire after late night TV host Jimmy Kimmel told of his child's medical troubles. Cassidy was part of the group that designed the GOP plan, and while some people see him as a fence-sitter, he seemed to be giving some good signs about his feelings on the bill, telling Fox News on Thursday evening that the plan would push insurance premiums down.
8. Does this pass? Can the Senate get the job done? While this blog has shown there are a number of GOP Senators who might have issues with the health care bill, will they really not support the plan if it comes to a vote next week? That's the million dollar question right now. Senate Majority Leader Mitch McConnell has made clear that he wants to force a vote - but he has also left the door open for legislative changes to the plan in coming days. Congressional leaders don't usually roll the dice on major legislation. We'll see in coming days if McConnell can muster the votes to pass this plan before lawmakers go home for the July Fourth break.
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