Senate Health Bill Fails to Pick Up Support After Week of Recess

The aide said a revised bill probably will boost proposed spending to stabilize premium costs in the Affordable Care Act public health insurance exchanges, where those without employer-or government-provided coverage can buy individual policies. McConnell's earlier legislation includes $50 billion over four years to bolster insurance markets, in addition to added cost-sharing subsidies. It also includes a state innovation pool of $62 billion over eight years that would allow jurisdictions funding for high-risk pools, reinsurance and other items.

During the week-long congressional recess, Republican lawmakers who held public appearances got an earful on the GOP's bill, which polls show has attracted little public support.

'Stepping on the Necks'

At a town hall meeting in Baton Rouge, one Louisiana man told Cassidy that cutting health care for 22 million Americans is akin to "stepping on the necks" of his constituents.

Sen. Jerry Moran of Kansas told constituents who expressed opposition to the GOP health plan at a gathering in Palco that he would demand the bill address the needs of people with pre-existing conditions and lower premium costs. "That's not where we are with the legislation pending in the Senate," he said.

Sen. Susan Collins of Maine told the Washington Post after a July 4 parade that people were encouraging her to stand against the Senate bill and the House's version of health legislation that passed in May.

"People were thanking me, over and over again," she told the Post. "'Thank you, Susan!' 'Stay strong, Susan!'"

Opioid Epidemic

McConnell's early attempts to win over opponents haven't worked. GOP leaders agreed more than a week ago to add $45 billion in spending to address the opioid epidemic, a key demand of moderates like Rob Portman of Ohio and Shelley Moore Capito of West Virginia.

After a tour of a suburban Cincinnati drug recovery center last week, Portman told an Associated Press reporter that the addition of those funds is but a first step. "I'm still concerned about the way in which Medicaid is dealt with in the proposal," Portman said.

Republican leaders are considering a provision proposed by Sen. Ted Cruz, a Texas Republican, that a group of conservative GOP senators say could help gain their support. Cruz wants to allow insurers to offer cheap, bare-bones plans alongside those that meet the more comprehensive coverage requirements of the Affordable Care Act. Critics in both parties say the proposal would destroyed the Affordable Care Act major medical insurance pool, by pushing people with pre-existing conditions into the major medical insurance pool and pushing young, healthy people to buy the cheaper, bare-bones plans.

Two Republican aides said GOP leaders asked the CBO to examine the impact of Cruz's plan alongside a companion piece that would boost money to stabilize the exchanges.

The conservative Club for Growth is calling on McConnell to include Cruz's insurance proposal, and to also repeal the Affordable Care Act net investment income tax. Without those two demands, the best result would be for McConnell to simply seek to repeal the Affordable Care Act, Club for Growth President David McIntosh said in a statement.

If McConnell can't salvage his legislation, "the next best option would be to pass a real repeal bill as a standalone," McIntosh said.

One possible obstacle is that traditional Senate procedural rules would normally require a bill with provisions that are "not germane to the budget" to have at least 60 votes to pass. The Senate parliamentarian, an official hired by the Senate majority leader, is in charge of deciding which provisions in a bill are germane to the budget. If traditional Senate rules apply, Republicans might be able to repeal all Affordable Care Act taxes, penalties and major spending provisions, but they probably would not be able to repeal provisions not directly related to the budget, such as the mandate that plans provide standard summary of benefits and coverage notices.

Some senators, including Cruz, have argued that Senate Republicans may be able to find ways around those procedure obstacles and pass a true Affordable Care Act repeal bill with just 51 votes.

— Read 7 Consumer Coverage Gaps You Could Fill Today on ThinkAdvisor.