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Washington • Senate Majority Leader Mitch McConnell is aiming to send a revised version of his health-care bill to the Congressional Budget Office as soon as Friday as he continues to push for a vote before Congress's August recess.
The effort reflects the tight timeline McConnell faces in his attempt to hold a vote in July - and the pressure he is under to make changes to the bill that will garner enough support to pass. With both conservatives and centrists pushing different policy solutions, Senate leaders were still struggling to craft a rewrite of the Affordable Care Act that would attract votes without torpedoing the CBO's official score of how the legislation affects coverage levels and federal spending.
In between closed-door lunches and meetings with McConnell and his team, a number of Republicans flashed visible signs of of frustration Wednesday even as they expressed reluctant optimism that a vote was still possible.
"This has been way more difficult than it needs to be," said Sen. Ron Johnson, R-Wis., who was among five senators whose opposition to the bill prompted McConnell to postpone a vote this week. "I'm doing everything I can to discipline a problem-solving process."
With Vice President Mike Pence prepared to cast the tiebreaking vote, and all Democrats opposed to repealing the 2010 law known as Obamacare, Republicans need the support of all but two of their 52 senators.
The draft bill would cut $772 billion from the nation's Medicaid program over the next decade, along with reducing federal payments further by applying a lower inflation rate to federal reimbursements starting in 2025. It would also repeal or delay $541 billion in taxes, primarily on wealthy Americans and insurers.
Sen. Bill Cassidy, R-La., one of more than half a dozen GOP senators who have raised concerns the impact of proposed Medicaid cuts in their states, said Wednesday that it remained impossible to predict if a refashioned bill could change enough members' minds.
"That is an existential question, and it's very hard for me to answer existential questions," Cassidy said.
While the legislation is likely to undergo further revisions after this next update, McConnell is trying to move quickly to produce a new CBO score by the time lawmakers return to Washington in mid-July. That would give the Senate about two weeks to fulfill the majority leader's goal of voting before the August recess.
Sen. Rand Paul, R-Ky., suggested that Republicans hope to strike a new agreement by Aug. 1.
Asked whether a new bill could be finalized by Friday, Paul raised his eyebrows. "Of this week?" he said. "No, I think August 1 is the new deadline."
McConnell and his aides plan to continue negotiations through the end of the week and will be in frequent communication with the CBO, according to McConnell spokesman David Popp.
It remains unclear exactly what parts of the Better Care Reconciliation Act are being revised - or whether McConnell is trying to move the measure to the right, with greater savings or regulatory adjustments, or to the left, with more coverage protections. McConnell needs to bring on board about nine senators who have said they wouldn't vote for the bill in its current form. Moving to the right would appease conservatives in the Senate - but also in the House, where any Senate bill would also have to pass.
One Capitol Hill aide described the situation as akin to the weeks leading up to the draft bill's release, when McConnell presented chunks of the emerging legislation to the CBO to expedite the scoring process. The aide expected GOP leaders to present tweaks to the CBO for review as soon as this week.
Another staffer said that after Tuesday's meeting with President Donald Trump at the White House, Republicans have a better sense now of what everyone wants. A draft is not yet ready, but the reworking process has begun.
In a sign of how McConnell has only intensified negotiations in the past 24 hours, he huddled Wednesday afternoon with two GOP senators who have complained the proposal cuts Medicaid too deeply: Dean Heller (Nev.) and Shelley Moore Capito (W.Va.)
Heller left a weekly strategy lunch Wednesday and walked directly into McConnell's private office in the Capitol. The two huddled for nearly 45 minutes, eventually being joined by Capito, another skeptic of the bill. Heller darted out a back entrance and down a private hallway to evade reporters.
Republican leaders bowed to pressure from within their own ranks Tuesday and postponed a vote until after the Fourth of July recess. While they bought themselves more time to work out disagreements, the move also gave rise to new doubts about their ability to ever get to the point of a holding a final vote.
Trump is also trying to help, mainly by wooing skeptical conservatives, which he has struggled to do. He convened a meeting of all GOP senators at the White House on Tuesday after McConnell announced the vote would be delayed.
But the White House appears less involved in crafting specific policy tweaks. From the outset of the effort, McConnell and a small clutch of aides have controlled that process.
GOP leaders are exploring whether they can use some of the nearly $200 billion the CBO has determined that they can spend without violating Senate budget rules to address the priorities of the bill's conservative and centrist critics.
On one hand, according to two people briefed on the process, the new measure was likely to provide greater financial incentives to invest in the private Health Savings Accounts favored by Sen. Ted Cruz, R-Texas, and others on the right.
But centrists such as Cassidy were also pressing for Republicans to delay the phase-out of generous federal Medicaid funding for able-bodied adults earning up to 138 percent of the federal poverty level, which under the Senate draft starts in 2021.
Cassidy hoped to see a revision that would send more Medicaid funding to the states. "But I can't speak for the leader," he said. "It's the leader's staff that's drafting this."
In addition, Cassidy and others have objected to the fact that starting in 2025 the federal government would apply a lower inflation rate to Medicaid payments. Instead of relying on the Consumer Price Index (CPI) for medical costs, it would use the CPI for urban consumers, which would reduce federal payments to the states by billions of dollars over time.
Paul, who has repeatedly complained that the Senate proposal does not do enough to dismantle Obama's signature law, complained that "there is frustration" that even though the chamber's leaders say they're soliciting input, some changes may not be actually considered.
"I think we're a long ways to go," he said. "For example, we're told we can amend the bill, but you can only amend the bill with things that are scored by the CBO. We're being told it's too late to score things by the CBO."