WASHINGTON -- President Donald Trump and other administration officials lobbied Republicans on Friday to support the Senate GOP's reworked health care bill, with the president saying wavering senators "must come through" to keep the measure from collapsing.
But the bill, repealing much of the 2010 Patient Protection and Affordable Care Act, remained on tenuous ground as Senate Majority Leader Mitch McConnell worked to keep more Republicans from deserting. Complicating the effort, Ohio GOP Gov. John Kasich called the revised measure "still unacceptable," largely because of its cuts to Medicaid, the same concern that's been voiced by holdout Ohio Republican Sen. Rob Portman.
"It also doesn't do enough to stabilize the insurance market, where costs are rising unsustainably and companies are simply dropping coverage," Kasich added.
Kasich and other GOP governors from states that expanded Medicaid coverage under the Affordable Care Act -- such as Asa Hutchinson of Arkansas, Brian Sandoval of Nevada, Doug Ducey of Arizona -- have expressed concern that the measure's proposed cuts could leave tens of thousands uninsured. Several key senators from these states, in turn, are currently withholding their support for the measure.
[INTERACTIVE: Compare House, Senate bills with Affordable Care Act]
McConnell, R-Ky., released the measure Thursday, a plan that caps seven years of his party's promises to remove the health care law.
But two GOP senators immediately said they'd vote no on a crucial vote planned for next week. Facing uniform Democratic opposition, McConnell can't afford to lose any more votes in the chamber, where Republicans have a 52-48 majority and Vice President Mike Pence has tie-breaking power.
"After all of these years of suffering thru ObamaCare, Republican Senators must come through as they have promised!" the president tweeted from Paris, where he was attending Bastille Day ceremonies.
Hutchinson, who was in Providence, R.I., for a meeting of the National Governors Association, met with Pence on Friday afternoon at the vice president's request.
In a phone interview afterward, Hutchinson said he told the vice president that Arkansas' senators, John Boozman and Tom Cotton, had been helpful advocating for changes that Hutchinson had requested and that were adopted in the revised version of the bill.
But Hutchinson said he maintained his objection that the bill represents a "cost shift to the states."
"It's certainly moving in the right direction, but I expressed the additional concerns that I had," Hutchinson said.
He said he is scheduled to meet today with Tom Price, the health secretary, and Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, to continue the discussion.
Hutchinson has expressed opposition to the bill's phaseout of the Affordable Care Act's enhanced funding for Medicaid expansion, which covers more than 316,000 Arkansans.
On Friday, he said the impact of that cut could be mitigated by other funding, including grants to states and subsidies for private coverage.
"It's just going to take a lot more study and analysis to be able to compare the changes that are being proposed and its impact on Arkansas," he said.
In an interview earlier Friday on CNBC, Hutchinson credited the expanded part of the state's Medicaid program, known as Arkansas Works, with helping to hold down premiums in the market for individual insurance coverage.
He said the state decided to expand its Medicaid program in 2013 with the understanding that it would never have to pay more than 10 percent of the cost.
Under the current version of the Senate bill, the state's share would gradually rise after 2020 until it's the same as what the state pays for other Medicaid recipients' care. Arkansas' share would rise to 30 percent.
"I wish the federal government would keep its bargain," Hutchinson said. "That's the frustrating part."
Meanwhile, Sen. Dean Heller, R-Nev., was targeted as top administration officials were talking to his state's popular GOP governor, Sandoval. Republicans consider winning over Sandoval a key to gaining Heller's vote.
In an interview Friday, Sandoval said his initial understanding of McConnell's new bill was that it "really doesn't change the dynamic" about its Medicaid cuts, and "that's a big concern for me." Nevada added 200,000 beneficiaries under Obama's expansion of the health insurance program for the poor, disabled and nursing home patients.
Heller, who faces a tough re-election contest next year, has stood arm in arm with Sandoval in criticizing the proposed Medicaid cuts. Heller has said he would have opposed McConnell's original legislation, which the leader withdrew last month because it faced certain defeat.
Sandoval said he expected to meet privately with Pence and Price at the governors' meeting. He said he had already heard from both men.
AMA Opposes Bill
The nation's largest doctors' group dealt another blow to the measure Friday, saying the plan falls short on coverage and access, particularly for low-income people on Medicaid. The American Medical Association said Medicaid cuts and "inadequate subsidies" will lead to "millions of Americans losing health insurance coverage."
The association said GOP leaders took a "positive step" by adding $45 billion for treatment to help victims of the opioid epidemic. But it pointed out that people dealing with addiction also need regular health insurance and that many would lose it if Republicans succeed in rolling back Medicaid financing.
McConnell's reworked bill aims to win conservatives' support by letting insurers sell low-cost policies with minimal coverage. At the same time, he seeks to placate hesitant moderates by adding billions to combat opioid abuse and help consumers with skyrocketing insurance costs.
Moderate Republican Sen. Susan Collins of Maine told reporters she had informed McConnell she would be voting against beginning debate on the bill, citing in part cuts in the Medicaid program. Sen. Rand Paul of Kentucky, who has repeatedly complained that McConnell's efforts don't amount to a full-blown repeal of Obama's law, also announced he was a "no."
Sen. John Cornyn of Texas, the No. 2 Senate GOP leader, said in an interview he is hoping for the climactic vote Tuesday or Wednesday. "I'm optimistic we'll get there," he said of prevailing.
McConnell could cancel next week's vote if he's short of support. He and other GOP leaders are urging senators to at least vote in favor of opening debate, which would open the measure up to amendments.
Like legislation earlier passed by the House after struggles of its own, the Senate bill would get rid of the law's mandates for individuals to buy insurance and for companies to offer it, repeal taxes and unwind the Medicaid expansion created by the Affordable Care Act. Analyses by the Congressional Budget Office have found the House bill and the earlier Senate version both would eliminate insurance coverage for more than 20 million people over the next decade.
The new bill contains language demanded by conservative Sen. Ted Cruz of Texas letting insurers sell plans with minimal coverage, as long as they also sell policies that meet strict coverage requirements set by the 2010 statute.
The retooled measure retains McConnell's plan to phase out the extra money 31 states have used to expand Medicaid under the 2010 statute, and to tightly limit the overall program's future growth.
The rewritten package would add $70 billion to the $112 billion McConnell originally sought that states could use to help insurers curb the growth of premiums and consumers' other out-of-pocket costs.
Information for this article was contributed by Erica Werner, Alan Fram, Ricardo Alonso-Zaldivar, Mary Clare Jalonick, Julie Bykowicz, Matthew Daly, Kevin Freking, Jennifer McDermott, Julie Carr Smyth and Will Weissert of The Associated Press; by Juliet Eilperin and Sean Sullivan of The Washington Post; and by Andy Davis of the Arkansas Democrat-Gazette.
A Section on 07/15/2017