GOP has hope for Obamacare repeal bill, but obstacles remain

WASHINGTON, DC - SEPTEMBER 13: (L-R) U.S. Sen. Bill Cassidy (R-LA) speaks as Sen. Ron Johnson (R-WI) and Sen. Lindsey Graham (R-SC) talk to each other during a news conference on health care September 13, 2017 on Capitol Hill in Washington, DC. Senators Graham, Cassidy, Heller and Johnson unveiled a proposed legislation to repeal and replace the Obamacare.

Alex Wong / Getty Images

Top Senate Republicans say their last-ditch push to uproot former President Barack Obama's health care law is gaining momentum. But they have less than two weeks to succeed and face a tough fight to win enough GOP support to reverse the summer's self-inflicted defeat on the party's high-priority issue.

"We feel pretty good about it," Sen. Bill Cassidy, R-La., a leader of the effort along with Sen. Lindsey Graham, R-S.C., said Monday.

"He's the grave robber," No. 3 Senate GOP leader John Thune of South Dakota said of Cassidy. "This thing was six feet under" but now has "a lot of very positive buzz," Thune said.

With Democrats unanimously against the bill, Republicans commanding the Senate 52-48 would lose if just three GOP senators are opposed. That proved a bridge too far in July, when three attempts for passage of similar measures fell short and delivered an embarrassing defeat to President Donald Trump and Senate Majority Leader Mitch McConnell, R-Ky.

McConnell said he'd not bring another alternative to the Senate floor unless he knew he had the 50 votes needed. Vice President Mike Pence would cast the tie-breaking vote.

A victory would let Senate Republican leaders claim redemption on their "repeal and replace" effort. The House approved its version of the bill in May.

The 140-page bill would replace much of Obama's law with block grants to states, giving them wide leeway on spending the money. It would let states set their own coverage requirements, allow insurers to boost prices on people with serious medical conditions, end Obama's mandates that most Americans buy insurance and that companies offer coverage to workers, and cut and reshape Medicaid.

Democrats backed by doctors, hospitals, and patients' groups mustered an all-out effort to finally smother the GOP drive, warning of millions losing coverage and others facing skimpier policies. Sixteen patients groups including the American Heart Association and the March of Dimes said they opposed it, as did the American College of Physicians and the Children's Hospital Association.

Potentially complicating the GOP drive, the Congressional Budget Office said it won't have crucial estimates on the bill's impact on coverage ready for several weeks.

Special procedures protecting the GOP bill from filibusters — which take 60 votes to block — expire Sept. 30, and after that Democratic opposition would guarantee its defeat. Some wavering Republican senators could want the nonpartisan budget office's analysis before feeling comfortable about the measure's impact back home.

All but daring Republicans to vote without the budget office figures, Senate Minority Leader Chuck Schumer, D-N.Y., said voting without that information would be "legislative malpractice at the highest."

The budget agency's evaluations of past GOP repeal plans concluded they would have caused millions of Americans to lose insurance coverage.

Pence was calling senators to seek support, White House officials said. House Speaker Paul Ryan, R-Wis., said the House would vote on the bill if it passes the Senate. Speaking in Menomonee Falls, Wisconsin, Ryan called it "our best, last chance to get repeal and replace done."

The sponsors say their proposal would let states decide what health care programs work best for their residents.

The bill would reduce spending gaps between states that expanded Medicaid under Obama's law and the mostly GOP states that did not. Details on the measure's exact state-by-state impact were murky.

Conservative Sen. Rand Paul, R-Ky., has said he'll oppose the measure because it doesn't do enough to erase Obama's law. Sen. Susan Collins, R-Maine, said she was concerned the bill would make "fundamental changes" in Medicaid.

Other Republicans who've not yet lined up behind the bill include Alaska's Lisa Murkowski, Shelley Moore Capito of West Virginia, John McCain of Arizona and Ohio's Rob Portman.

Collins, Murkowski and McCain provided the decisive votes against the last measure Republicans tried to push through the Senate in July.

"It's better but it's not what the Senate is supposed to be doing," McCain told reporters about the new package.

Arizona GOP Gov. Doug Ducey said he backed the new bill, putting pressure on McCain.

The revived drive comes as Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., work toward a bipartisan deal to continue federal subsidies to insurers that are used to ease some costs for lower-earning customers. Trump has threatened to block the subsidies.

Murray spokeswoman Helen Hare said Murray is "hopeful and optimistic" a deal could come soon, a statement that came as Democrats tried peeling away GOP support from the Graham-Cassidy bill.