GOP leaders close to securing 50 votes on key health-care vote

WASHINGTON – Senate Republican leaders appeared close to getting the support they needed Tuesday to begin debate on their plan to rewrite the Affordable Care Act, according to lawmakers and aides, though the proposal they would consider could change dramatically once senators began voting.

Sen. John McCain (R., Ariz.) will return to Washington for the key procedural vote, which will allow the Senate to move forward with health care legislation, and a longtime holdout, conservative Sen. Rand Paul (R., Ky.) indicated on Twitter that he was now open to the idea. That puts the leadership within range of the votes it needs, as Senate Majority Leader Mitch Connell (R., Ky.) negotiated with centrists by promising that they would ultimately like the final product.

Republican leaders now see a scaled-down version of the bill as perhaps their best chance of winning final passage. That would set up a House-Senate conference to resolve the differences between the two proposals, buying Republicans more time.

McCain, who was recently diagnosed with an aggressive form of brain cancer, was to arrive at the Capitol at 2:45 p.m., according to his office. The senator, who had been recuperating from surgery and exploring treatment options in Arizona, will later deliver remarks on the Senate floor after the vote.

President Trump praised the senator for returning in an early-morning tweet Tuesday before exhorting Republicans to back the measure.

Republican senators braced Tuesday for a long day in the Capitol. The Senate was scheduled to gavel at noon and GOP senators will spend the early afternoon inside a weekly policy luncheon where many are hoping to gain more clarity from McConnell on what they will be asked to vote for in the afternoon or evening.

On the Senate floor, McConnell called the 2:15 pm procedural vote "a critical first step" in unwinding the landmark 2010 health care law.

As the scheduled vote neared, McConnell said Republican senators had a chance to follow through on a seven-year promise to repeal the Affordable Care Act. He also repeated the thinly veiled threat Trump leveled in a speech a day earlier: a vote to block debate on repeal is a vote to save Obamacare.

"Any senator who votes against starting debate is telling America that you're just fine with the Obamacare nightmare," McConnell said. "I would urge them to remember the families who are hurting under this collapsing law."

McConnell is currently planning to file motions to bring up a version of a 2015 bill repealing the law outright, according to several individuals briefed on the plan who asked for anonymity to discuss private conversations, with several degrees of amendments. These amendments would include some version of a more recent Senate health care bill and proposals by both Sen. Ted Cruz (R., Texas) and Sen. Rob Portman (R., Ohio).

The Cruz amendment would allow insurers to offer coverage on the ACA market that does not include all the benefits currently required under the law, as long as they provided one fully-compliant plan. The Portman amendment would add an additional $100 billion in flexible spending under Medicaid, according to these individuals.

Even with McCain in the Capitol and voting to proceed to the bill – and it's not yet certain he will support it – McConnell can only lose two of the other 50 Republican senators. All 48 Democrats plan to vote no.

To win over a handful of centrist senators, who have expressed concern about the bill's deep cuts to Medicaid and its phaseout of the program's expansion under the ACA, top administration officials have promised lawmakers more flexibility and extra funding to help transition millions of low-income Americans onto private insurance.

McConnell and his deputies were still bartering with a handful of GOP holdouts throughout Monday evening and into Tuesday morning, according to several GOP aides. Leaders argued skeptics should vote to start debate on the grounds that they would be happy with the final bill, without revealing exact details of what the legislation would include.

Seema Verma, director of the Health and Human Services Department's Centers for Medicare and Medicaid Services, has provided some Republicans an analysis of how the bill would affect people covered by the expansion in their states, according to individuals briefed on the matter. They said Verma has suggested that money in the bill could help state residents pay premiums to obtain the lowest-level plans on the ACA-market, known as "bronze" plans and has promised up to $100 billion in flexible Medicaid funding.

Several of these Medicaid expansion-state GOP senators, including Lisa Murkowski, Alaska, Cory Gardner, Colo., Todd Young, Ind., and Rob Portman, Ohio, held one of their regular meetings on Monday night. Portman left the session and headed straight to McConnell's office to discuss the health-care proposal.

Vice President Mike Pence and White House legislative affairs director Marc Short plan to attend Tuesday's lunch, Short said Tuesday. He said the president has been placing calls "to a couple of members" in hopes of rounding up the votes to proceed to the bill. He said the administration has also serves as a resource to provide "technical assistance" to senators looking to get policy questions answered as they make up their minds.

On Tuesday a coalition of medical and consumer groups reiterated their intense opposition to all the health-care plans Senate Republicans have been considering, calling on them to drop those bills and begin anew with a bipartisan process that includes standard committee hearings.

In a conference call, David Barbe, the president of the American Medical Association and part of the coalition, challenged the claims Senate GOP leaders have made about their main legislation to dismantle large parts of the Affordable Care Act.

"It does not make care more affordable to low-income Americans," Barbe said. "It does not reduce out-of-pocket costs. It could trigger substantial increases for patients with preexisting conditions."

Only one senator, centrist Susan Collins, Maine, has said publicly she would not vote "yes" to move forward on any of the plans that have been floated so far.

On Twitter Tuesday morning the president described the procedural vote that would allow debate on health-care legislation to begin as a crucial litmus test for his party.

"After 7 years of talking, we will soon see whether or not Republicans are willing to step up to the plate!" Trump wrote, adding in another, "ObamaCare is torturing the American People.The Democrats have fooled the people long enough. Repeal or Repeal & Replace! I have pen in hand."