A Republican push to pass a sweeping health-care law experienced another setback as Senate leaders said they would delay a vote set for this week, sparking fresh doubts about whether congressional leaders can muster support for a marquee GOP policy priority.
Continue Reading Below
President Donald Trump and party leaders in Congress were hoping the Senate would vote this week on a plan to overturn parts of the 2010 Affordable Care Act and make other changes to the health system. But Senate leaders announced a delay after Sen. John McCain said he would recover in Arizona from surgery removing a blood clot above his left eye, leaving supporters short of the votes needed to move ahead with the bill.
The delay prolongs the uncertainty over the bill's prospects. GOP leaders have pursued a fast-paced timeline, as health-policy changes are often controversial. Sen. John Cornyn, a member of Senate GOP leadership, told reporters last month that passing the bill is "not going to get any easier" with time. Another GOP senator, Lindsey Graham of South Carolina, said the bill "is not like fine wine; it doesn't get better with age."
Meantime, insurance companies, state governors and congressional critics continued to line up against the bill, with their objections running the ideological gamut. Governors, including some Republicans, have said they are concerned about its proposed cuts to the growth of Medicaid spending, while two top insurance industry groups objected to a change to the GOP bill proposed by Sen. Ted Cruz of Texas as "unworkable."
Senate Majority Leader Mitch McConnell (R., Ky.), who can't afford more than two defections among the 52 GOP senators, has been balancing demands by more-centrist lawmakers for additional money for Medicaid and consumer subsidies with a push by conservatives to pare back requirements on insurers in order to lower premiums for younger, healthier people.
One centrist and one conservative GOP senator who have bucked their party before, Susan Collins of Maine and Rand Paul of Kentucky, have said they can't support the bill, for different reasons. But others have yet to commit, and one more defection would derail the legislation. Mr. McCain's absence means GOP leaders are short of the votes this week for a procedural motion to consider the bill.
Continue Reading Below
Ms. Collins, speaking on Sunday on ABC, said that eight to 10 Republicans had "deep concerns" about the bill, even after a new version was unveiled last week to address issues raised by some GOP senators. "I think it would be extremely close," she said when asked whether Mr. McConnell had the votes for passage.
Senate GOP leaders, spurred on by the White House, had been building toward a deadline of this week that had been intended to isolate and spotlight holdouts, warning them that they would pay a price for bucking their party and undermining its collective legislative goal of the past seven years. They have emphasized insurance-market woes under the ACA in some states as proof of the urgency of the cause.
Mr. McConnell had hoped to finish the health debate this week so the Senate could turn to the annual defense-policy bill, confirmation of more of Mr. Trump's nominees and raising the debt limit before adjourning in mid-August.
The McCain absence gives Mr. McConnell and the White House a chance to continue working on holdout senators without having to back down from a vote this week. But it also creates a window for the 2010 health law's supporters to continue a fight they believe is more likely to be successful the longer they wage it.
"A key factor is time: The longer the bill languishes, the less likely it will pass," said Greg Valliere, chief global strategist at Horizon Investments. "And there won't be much time left after Labor Day, as Congress shifts its focus to budget and tax issues. So, while McCain's absence complicates the health debate, it already was in deep trouble, even when he was healthy."
Prime targets for both sides are the remaining senators who had opposed an earlier version of the Senate bill but haven't taken a public stance on its latest iteration. Sen. Dean Heller (R., Nev.), up for re-election next year, is likely under the most pressure, due in part to concerns about the bill from the GOP governor of his state. Other Republicans from states that expanded Medicaid, including Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia, will be in the limelight this week.
The extra time also allows for more scrutiny of a measure from Mr. Cruz that would allow insurers to offer cheaper plans with less comprehensive coverage than required under the ACA, if they also offer plans that meet ACA coverage requirements. The proposal has alarmed insurers and centrist Republicans who say it would cause premiums to surge for sicker people, who would more likely buy more-comprehensive plans without the costs being offset by policies that younger and healthier people buy.
Senate leaders said they are confident they could hold the procedural vote to advance the bill as soon as Mr. McCain was back in the Senate. The White House declined to comment at length on the setback Sunday. "We wish Sen. McCain a speedy recovery," said spokeswoman Helen Aguirre Ferré.
The Trump administration has previously said a quick timeline on a health vote was best, particularly as Democrats and liberal organizers have stepped up their advocacy of preserving the ACA, which they see as former President Barack Obama's signature domestic achievement.
"The left, I think, has been more organized in their messaging on this than collectively Republicans have as far as advocating for the benefits of the bill," said Marc Short, the White House director of legislative affairs, last week.
The difficulty for many Republicans is that supporting the bill or opposing it both carry political risk. On the one hand, the party has for years vowed a full repeal of the ACA, known as Obamacare. "I think not being able to deliver on that promise would do serious and long-lasting damage to the credibility of Republicans," Mr. Cruz said in an interview.
Others are weighing the fallout over health policy and how its changes would affect some states, particularly rural ones. "This bill would make sweeping and deep cuts to the Medicaid program....It would also jeopardize the very existence of our rural hospitals and our nursing homes," Ms. Collins said on ABC. Conservative lawmakers say the financing for Medicaid as now configured is unsustainable.
Rep. Mark Amodei, a Republican representing a competitive district in Nevada, opposed an early draft of the House health bill but voted for the final version in May. He said that ultimately, he would expect GOP voters to be frustrated if Congress doesn't repeal the ACA, or large swaths of it, but he recognizes the political peril either way.
"If somebody's looking for safe harbor and no hard votes, this is going to be an awful year for them, because I think it's going to be hard vote after hard vote after hard vote," he said.
Jennifer Levitz contributed to this article
Write to Byron Tau at firstname.lastname@example.org, Louise Radnofsky at email@example.com and Kristina Peterson at firstname.lastname@example.org