The new bill to replace Obama’s signature healthcare law attempts to placate moderate and conservative critics, but still a protracted battle may be ahead

Senate Republicans unveiled a revised healthcare plan on Thursday, seeking to bridge an intraparty divide that has thwarted efforts to make good on a seven-year pledge to dismantle the Affordable Care Act (ACA), Barack Obama’s signature healthcare law.

Mitch McConnell delays Senate recess to allow work on healthcare plan Read more

But the new bill, which includes provisions intended to woo moderate and conservative critics, was met with fresh skepticism and the prospect of a protracted battle to come.

The bill maintains some ACA taxes on the wealthy, as a way to address criticisms from moderates that Republicans are placing a substantial burden on the most sick and poor Americans. It also extends an olive branch to the hard right, adopting a controversial amendment by Ted Cruz of Texas and Mike Lee of Utah that moderates say could gut coverage for pre-existing conditions and lead to a spike in premiums.

Leaving a closed-door briefing, key senators were unmoved. Susan Collins of Maine, the first senator to voice opposition to the first plan, said she would vote against the motion to proceed to the bill.

“I don’t believe you that you make major changes in an entitlement program [Medicaid] upon which millions of Americans depend without having a single hearing in the Senate to evaluate the impact,” Collins told reporters.

Shelley Moore Capito, who has opposed efforts thus far due to the impact of Medicaid cuts West Virginia, said she was “very much undecided”.

“I still think there’s questions, particularly coming from a state that has a high percent of people with pre-existing conditions, I’m concerned about that,” Capito said, adding that she expected another meeting on Thursday afternoon to address the issue of Medicaid.

Dean Heller of Nevada, facing a tough re-election fight, said he was undecided. “Well, I’m going to take a look at the bill over the weekend and come up with a decision and see if there are any improvements,” he told reporters.



Asked if the opinion of his state’s popular Republican governor, Brian Sandoval, a vocal opponent of the Senate bill, would affect his decision, Heller said: “Everything matters.”

Supporting the bill would mark a sharp turnaround for Heller, who made a very public show of opposition to the previous proposal in a news conference with Sandoval by his side. At the time, Heller said it was a “lie” that the Republican plan would lower premiums and chastised its impact on the poor. Although the revised legislation contains minor tweaks to Medicaid funding, the core spending reductions are effectively the same.



Ohio’s Rob Portman, another senator opposed to drastic Medicaid cuts, was also asked if there was any way he could support the new bill. He said: “We’ll see.”

Underscoring the challenges facing leadership, John Cornyn, the Senate majority whip, refused to answer questions. “I’m not going to talk about the whip check,” he said, brushing past reporters.

The revised plan will channel at least $70bn to states, aimed at helping offset costs for low-income individuals. Much of that money would come from maintaining two ACA taxes on households earning more than $250,000 and individuals earning more than $200,000 – a 3.8% investment tax and a 0.9% payroll tax. There is also an additional $45bn in funding against the opioid crisis, a priority for some senators.

The Cruz-Lee amendment allows insurers to offer plans that do not meet ACA requirements. Aides said the language could be revised or dropped at a later stage. In a partial victory for Republican leaders, Cruz that he would vote in favor of taking up the bill in its current form. But, he said, “if it’s amended and we lose the protections that lower premiums, my vote could well change”.

Asked about the risk of a handful of Republicans joining Democrats to strip his amendment from the bill, Cruz referred to his so-called Consumer Freedom Option as “the key to bringing together 50 Republicans”. If the measure were stripped, he added, “it would do substantial damage, and I think it would likely cost the votes needed to pass the bill”.

Lee however said he was undecided, signaling a potential split among allies.

Last month, opposition to an initial healthcare plan forced Republican leaders back to the drawing board. Republicans in the House of Representatives passed their own bill in May. It was regarded by their counterparts in the Senate as dead on arrival.

Obstacles were evident even before Republicans met for their briefing on Thursday morning. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana touted an alternative proposal, which they said was not an effort to undercut negotiations but a plea to Republican leaders to “see which [plan] gets 50 votes”.

The Graham-Cassidy proposal, drafted with former Pennsylvania senator Rick Santorum, maintains taxes on the wealthy and sends resulting revenue directly to the states. It also repeals the ACA’s individual mandate, while keeping in place coverage requirements for pre-existing conditions.

Graham told reporters his focus was on trying to get governors on board. “Whether we got 50 votes or not, I don’t know,” he said. “But I know this: that if you’re a United States senator, and you’re a governor saying this bill hurts your state, and you’re a Republican and they’re a Republican, you’re pretty much in trouble.”

Graham said he would support the current bill if it came down to it, but criticized the plan as “Washington-centric”.Rand Paul of Kentucky, who had already launched a crusade against the revised bill, urged majority leader Mitch McConnell to repeal the ACA in its entirety.

“I don’t know that this is better than Obamacare,” Paul told Fox News, while reiterating his intention to oppose a vote to advance the legislation. “This isn’t repeal by any means, shape or form.”

“People forgot their promise,” Paul added, saying the revised plan amounted to a bailout of insurance companies. “This is not who we are as Republicans.”

Some Republicans countered that the current plan was simply the first stage in unraveling Obamacare. Ron Johnson of Wisconsin, who opposed the previous bill but was willing to advance and debate the revised legislation, said the ACA taxes could be done away with later in the year, through tax reform.

Florida’s Marco Rubio advocated similar tactics. He also said he wanted to see further changes to the bill but disagreed with those who vowed to block it. “I think the sooner we can get to the floor and start to debate … in front of the American people, the better it’s going to be for everybody,” he said.

Republican leaders are targeting a procedural vote to take up the bill by the end of next week, following a score from the nonpartisan Congressional Budget Office (CBO) that could arrive as early as Monday.

The CBO score was the biggest blow to Senate negotiations in June, with a projection that 22 million Americans would lose their health insurance over a 10-year period if the GOP plan became law. It would also have reduced the federal budget deficit by $321bn over that period, mostly due to cuts to Medicaid.

McConnell this week postponed the chamber’s August recess by three weeks, in an attempt to allow for more time to craft a new plan. Discussions have nonetheless been clouded by protesters who have swarmed Republican offices, and constituents who have pressured vulnerable senators by phone or at town halls. On the eve of the new bill’s rollout, a coalition of groups representing half a million doctors in the US stormed the Capitol as part of a last-ditch effort to persuade Republicans not to repeal the ACA.

Collins said healthcare was the only topic her constituents raised when she returned to Maine for the 4 July holiday. Most, she said, thanked her for taking a stand.

McConnell hints healthcare vote could fall short: 'I'm a guy with a Rubik's cube' Read more

.

Elsewhere on Thursday, attorney general Jeff Sessions and health secretary Tom Price revealed what they called the “largest healthcare fraud takedown operation in American history”. Federal and state officials charged 412 people, including 56 doctors, with writing unnecessary prescriptions.

The bust was part of a Republican strategy to crack down on fraud while also proposing revolutionary cuts to the programs concerned.

“Someone who instantly understands the importance of saving and strengthening Medicare and Medicaid for future generations is President Donald Trump,” said Price.

Trump weighed in from Air Force One, while on his way to France.

“I’d say the only thing more difficult than peace between Israel and the Palestinians is healthcare,” he said. “It’s like this narrow road that is about a quarter of an inch wide. You get a couple here and you say, ‘Great,’ and then you find out you just lost four over here.”

The president added: “Healthcare is tough.”

Additional reporting by Jamiles Lartey and Jessica Glenza

Sign up for the Minute email. Catch up on today’s US politics news in 60 seconds