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Senate GOP revises health bill in hunt for votes

Senate Majority Leader Mitch McConnell walks on to the Senate floor on June 22 following a meeting with Senate Republicans on a health reform bill. | AP Photo

Republicans are tweaking their plan to repeal Obamacare to try to curb dissent in the party.

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Senate Republicans released a revised version of their bill to repeal Obamacare Monday and are preparing further changes to overcome deep opposition in the party toward last week’s initial effort, according to people familiar with the matter.

The updated text is intended to promote continuous health coverage, which was left out of the discussion draft released Thursday and is designed to encourage people to buy insurance ahead of an emergency.

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The Republican leadership and its allies as well, as President Donald Trump, are working furiously to tamp down criticism of the legislation and a voting timetable that will provide perhaps just a couple a days for senators to review the final product. Trump called undecided GOP senators including Ron Johnson of Wisconsin, Rand Paul of Kentucky, Ted Cruz of Texas and Shelley Moore Capito of West Virginia to feel them out on healthcare, said White House press secretary Sean Spicer on Monday afternoon.

Johnson said in an interview late Monday that he made the argument to Trump that “this bill doesn’t do anything near enough to address the price of premiums.” And the president, Johnson said, was “sympathetic” to his argument.

The conservative Wisconsinite said Senate Majority Leader Mitch McConnell (R-Ky.) should delay the vote for two weeks and also complained that conservatives’ suggestions to alter the bill in the Senate’s working group were mostly ignored. He also said he may oppose even bringing the bill up later this week on a procedural vote.

“I’ve been very upfront with leadership for some time: Don’t jam us, don’t jam the American public,” Johnson said. “I have a hard time believing I’m going to have the information to vote for a motion to proceed.”

Despite the complaints, Republicans are still expecting a vote this week as McConnell aims to reach a conclusion before the July 4 recess.

After previously leaving the door open to a vote next month, party whip John Cornyn of Texas said on Twitter that “we need to do it this week before double digit premium increases are announced for next year.”

Most people in the party’s leadership believe that letting the bill hang out over a recess will result in more “no” votes and hurt the GOP’s momentum. Earlier on Monday, the president also suggested that the party could let insurance markets collapse if the bill fails this week.

“Republican Senators are working very hard to get there, with no help from the Democrats. Not easy! Perhaps just let OCare crash & burn!” Trump said in a tweet.

Adding to the GOP’s problems, the American Medical Association — the nation’s largest trade group of physicians — announced its opposition to the Republican bill Monday because it would violate medicine’s standard to “first, do no harm.” The medical group supported the passage of Obamacare, an endorsement Republicans have long held against the organization

Republicans did get one nod of approval. Insurance company Anthem said the Senate bill “will markedly improve the stability of the individual market and moderate premium increases” but acknowledged the company is still reviewing the “challenges the current bill proposes” to Medicaid.

A number of Republican senators have balked at the initial draft of the bill, with several more moderate members blasting it from the center for its strict future Medicaid spending constraints and more conservative senators like Johnson railing against the bill as only a partial repeal of Obamacare.

The revised Senate bill would include a six-month “lock out” period in which people who don’t have insurance have to wait before their policy takes effect. The lock out would apply to people who have been uninsured for at least 63 days; people would not have to pay their premiums during that time. The House bill would have allowed insurance companies to charge uninsured people up to 30 percent more for up to one year.

This proposal represents the GOP alternative to Obamacare’s individual mandate, which is deeply unpopular but helps keep insurance markets afloat.

A White House official said there will be big changes to the bill after the Congressional Budget Office score, which will determine “how much can be given to the moderates.”

Sen. Dean Heller (R-Nev.) shocked Republicans on Friday by strongly opposing the current draft of the bill for its Medicaid cuts, even after McConnell had implored senators not to take hard lines and remain open to continuing negotiations. A Trump-affiliated outside group has threatened him with attacks ads.

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Changing minds in the Senate may prove far more difficult than in the House.

Heller is the most vulnerable Republican senator up for reelection next year, and it may be politically helpful for him to oppose a bill that cuts benefits to low-income voters in his state. On the flip-side, Johnson, Paul and Mike Lee of Utah may feel less pressure from the president and McConnell to support a bill they view as imperfect because they were just reelected to six-year terms last fall.

CBO announced it will release its analysis on Monday, which could affect the positions of many Republicans. The CBO score is likely to reflect the revisions dealing with continuous coverage, which may help improve the bill’s coverage numbers.

Shortly after the bill text was released Thursday, senior Republican aides acknowledged the policy was missing from the bill and they were still trying to find legislative language that would get by the parliamentarian. If they can’t get anything through, they would rely on HHS Secretary Tom Price to tighten enrollment rules, according to a Republican source.

Because Republicans are keeping the requirement that insurance companies accept everyone regardless of their pre-existing conditions, which is expensive for insurance companies, the GOP needs some policy to encourage people to buy insurance. Without it, insurance companies would experience a death spiral of too many costs coming in and not enough healthy people to balance it out.

Josh Dawsey contributed to this story.

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