Republicans have very little room for error if they want to put an Obamacare repeal and replace bill on President Trump’s desk in the next week or two. And while it’s clear that both the White House and Senate Majority Leader Mitch McConnell are working overtime to get at least 50 Republicans on board with the newest iteration of the legislation, they are walking an extremely fine line between the concerns of the moderates and the despair of the conservatives. As perhaps the best illustration of that balancing act, the two Republicans who have thus far come out against the new bill are libertarian Rand Paul of Kentucky and centrist Susan Collins of Maine.
There may be nothing short of another “redo it from scratch” effort that will get either Paul or Collins on board, so McConnell is now focusing his attention on several moderate Republicans who remain on the fence. The most prominent of those moderates include Dean Heller of Nevada, Rob Portman of Ohio, Lisa Murkowski of Alaska, John Hoeven of North Dakota, and Shelley Moore Capito of West Virginia. They met with the Senate majority leader on Friday, hoping to convince him to rework some of the proposed changes the new bill makes in regards to Medicaid.
The senators, who want to tie Medicaid spending growth to the inflation rate, will ostensibly vote for the new bill if their concerns are met.
Thanks to an unforeseen leave of absence by Sen. John McCain, McConnell will have at least another week with which to work with Republican moderates on a plan that can earn their votes. McCain is recovering from blood clot surgery; assuming everything goes well with his convalescence, he should be back in the saddle the week after next. At that point, McConnell is expected to take a procedural vote on the bill. He needs 50 votes, and he has to get them from Republicans. Democrats, to say the least, are not on board. Vice President Mike Pence would cast the tie-breaking vote if it comes to that.
In the meantime, however, McConnell has to make sure that any changes he promises to Heller, et al., do not throw the conservatives off the bus. Already there has been some quiet bristling about an extra $70 billion McConnell threw into the bill to satisfy the moderates, to say nothing of the additional $45 billion he implemented towards solving the opioid crisis. With conservatives like Ted Cruz and Rand Paul arguing that the bill already retains far too much of Obamacare’s expensive taxes, he could meet with some resistance on the right if he gives Republican moderates any more money for their concerns.