The national spotlight is trained on House Republicans’ furious efforts to pass a healthcare bill this week, but the measure faces an even more difficult path in the Senate, where just three GOP senators could sink it.
As it stands, there are eight senators who have expressed serious reservations about the revised House bill aimed at repealing and replacing Obamacare – more than enough to torpedo its passage in the closely divided, 52-48 GOP majority Senate.
Senate Majority Leader Mitch McConnell, R-Ky., said the Senate is plowing ahead with a vote on the measure next week if it passes, as planned, in the House by Friday.
“We are not slowing down,” McConnell told reporters after a closed-door meeting with the Senate GOP Tuesday. “We are going forward.”
Despite the public confidence, McConnell is facing a difficult balancing act. He has repeatedly told fellow senators they have the ability to amend the Senate version of the bill when it comes to a vote on the floor. But if GOP centrists go too far in winning changes they want, the measure will lose essential conservative votes.
A trio of conservative Republicans have said they oppose the measure – Sens. Ted Cruz of Texas, Mike Lee of Utah, and Rand Paul of Kentucky. The senators have echoed the similar sentiments as those of the House Freedom Caucus, which has blasted the bill as “Obamacare-lite.”
Those conservatives want a more expansive repeal of Obamacare’s insurance mandates than the House version of the bill would provide, and Cruz is pushing Republican leaders to overrule the Senate parliamentarian if she rules that the changes go too far.
“Negotiations are ongoing,” Cruz told reporters Tuesday afternoon. He declined to say if the House revisions this week had brought him any closer to voting in favor of the bill.
House Republican leaders agreed to a number of changes in order to win over skeptical Republicans. The revisions include work requirements for Medicaid enrollment and more rapid tax phase-outs. In addition, to woo centrists, the House provided language allowing the Senate to provide more generous tax credits to help people between the ages of 50 and 64 guard against skyrocketing premiums.
Sen. Tom Cotton, R-Ark., on Tuesday also came out in opposition to the bill, telling House Republicans to scrap the current version and go back to work on it because the changes they are offering don’t address rising premiums and deductibles.
“It’s more important to finally get healthcare reform right than to get it fast,” he said in a statement.
Republican leaders also are watching their left flank with centrists expressing grave concerns about the provisions placing new limits on Medicaid.
Sen. Susan Collins, R-Maine, last week said she opposed the House version of the bill, and Tuesday, after the revisions, said she had yet to read the updated measure but signaled there was more work to be done to win her over.
“I have not seen the revised healthcare bill that the House has put out,” Collins told reporters Tuesday.
Asked whether she is writing amendments to address her concerns, she said: “I am making that decision that right now,” noting that “it’s hard to find [changes] that will pass muster with the reconciliation process.”
Republicans are using the budget reconciliation process, which requires just a simple 51-vote majority to pass, but all elements of the bill must impact taxes or revenues in some way or the Senate parliamentarian can rule them out of order.
Sen. Lisa Murkowski, R-Alaska, is deeply concerned about projections that the House measure would raise premiums in her rural state. Murkowski and Collins also oppose the bill’s language defunding Planned Parenthood.
In addition, Sen. Dean Heller, R-Nev., said Friday that he too would oppose the House version of the bill because of its Medicaid provisions, a similar view expressed by Nevada’s GOP Gov. Brian Sandoval. Heller is the Democrats prime target in the 2018 midterm elections in a state that Hillary Clinton carried in the 2016 election.
Sen. Bill Cassidy, R-La., is another aggressive opponent of the House bill for several reasons, including the Congressional Budget Office projections that it would result in 24 million fewer people insured over the next 10 years.
Cassidy and Collins teamed up to produce their own bill that would give states greater flexibility, allowing them to keep Obamacare or choose a new healthcare insurance system.
Sen. Rob Portman, R-Ohio, another Republican who has expressed concerns about the House version of the bill said the new Medicaid tax credits for seniors was a step in the right direction.
“I haven’t seen all the details of the House manager’s amendment,” he told reporters. But tax credits for Medicaid move it “in a better direction, in my point of view, because we have an issue in Ohio with Medicaid expansion being so important for coverage especially with our opioid issue.”
This post originally appeared on Washington Examiner