Top Republicans have agreed to add $45 billion for battling opioid abuse to their struggling healthcare bill, but the measure's fate remained uncertain Thursday as leaders confront an expanding chorus of GOP detractors.
Senate Majority Leader Mitch McConnell is hoping the added money will help win over moderate GOP senators like Rob Portman of Ohio and Shelley Moore Capito of West Virginia. Their states are among many battered by rising death tolls from illegal drug use and they've been pushing for the additional funds.
Those same senators are also insisting on easing cuts the GOP legislation would impose on Medicaid, the health insurance program for low-income and disabled people that their states also rely upon. There's no indication an agreement has been reached to pull back on those reductions.
That leaves McConnell still short of the votes he needs to push legislation through the Senate repealing much of President Barack Obama's healthcare overhaul. The measure would fail if three of the chamber's 52 Republicans vote no, since all Democrats are opposed.
McConnell wants agreement on revisions by Friday so the Senate can approve it shortly after returning in mid-July from an Independence Day recess. Several senators have scoffed at that timetable, with John McCain of Arizona saying, "Pigs could fly."
The added opioid funds, which would be provided over a decade, were described by people who spoke on condition of anonymity to discuss private negotiations.
On Wednesday—a day after McConnell unexpectedly abandoned plans to whisk the measure through his chamber this week—fresh GOP critics came forward. Some senators emerged from a party lunch saying potential amendments were beyond cosmetic, with changes to Medicaid and Obama's consumer-friendly insurance coverage requirements among the items in play.
"There's a whole raft of things that people are talking about, and some of it's trimming around the edges and some of it's more fundamental," said Sen. Bill Cassidy of Louisiana. "Right now, they're still kind of, 'Can we do it?' and I can't answer that."
Yet while this week's retreat on a measure McConnell wrote behind closed doors dented his reputation as a consummate legislative seer, no one was counting him out.
"Once in Glacier National Park I saw two porcupines making love," said Sen. Pat Roberts of Kansas. "I'm assuming they produced smaller porcupines. They produced something. It has to be done carefully. That's what we're doing now."
Having seen the House approve its healthcare package in May six weeks after an earlier version collapsed, Democrats were far from a victory dance.
"I expect to see buyouts and bailouts, backroom deals and kickbacks to individual senators to try and buy their vote," said Senate Minority Leader Chuck Schumer (D-N.Y.)
The list of Republicans who've publicly complained about the legislation has reached double digits, though many were expected to eventually relent. McCain said "of course" his support was uncertain because he wants to ease some of the measure's Medicaid cuts, and Sen. Ben Sasse of Nebraska told the Omaha World-Herald that the bill was not a full repeal, adding, "Nebraskans are dissatisfied with it and so am I."
At the White House, Trump continued his peculiar pattern of interspersing encouragement to GOP senators trying to tear down Obama's 2010 statute with more elusive remarks.
Trump told reporters that Republicans have "a great healthcare package" but said there would be "a great, great surprise," a comment that went without explanation. On Tuesday, he said it would be "great if we get it done" but "OK" if they don't, and two weeks ago he slammed as "mean" the House version of the bill that he'd previously lionized with a Rose Garden ceremony.
GOP support for the measure sagged this week after a report by the nonpartisan Congressional Budget Office estimated that it would lead to 22 million fewer insured people by 2026 while making coverage less affordable for many, especially older and poorer Americans. It wasn't helped when an NPR/PBS NewsHour/Marist Poll said that only 17% of people approved of the Senate bill.
To succeed, McConnell must balance demands from his party's two wings. It's a challenge that's intricate but not impossible, with some saying an eventual compromise could include elements both want.
Centrists from states that expanded Medicaid coverage for the poor under Obamacare are battling to ease the bill's cutoff of that expansion, and to make the measure's federal subsidies more generous for people losing Medicaid coverage. These senators, including Ohio's Portman and West Virginia's Moore Capito, also want expanded funds to ease the death toll from the abuse of drugs like opioids.
Conservatives including Ted Cruz of Texas, Utah's Mike Lee and Kentucky's Rand Paul want to let insurers sell policies with fewer benefits. Some would further trim Medicaid spending and the healthcare tax credits, with Paul seeking to erase the package's billions to help insurers contain costs for lower-earning customers and protect the companies against potential losses.