(Bloomberg) — Two Republican senators immediately rejected the party's latest version of the Better Care Reconciliation Act health care bill Thursday, leaving the party no margin for additional defections as Majority Leader Mitch McConnell seeks a vote next week to change the Affordable Care Act.
Several holdouts the bill was designed to win over, including Rob Portman of Ohio, remain undecided and say they're waiting to see an analysis of the measure's impact by the nonpartisan Congressional Budget office, due next week.
"I'll review the text of this new legislation just like I did the last version, & I will review the CBO analysis," Portman wrote on Twitter.
Because of the GOP's narrow 52-48 majority, Republican leaders can lose no more than two votes in their party amid united Democratic opposition to efforts to repeal Obamacare.
In the new version released Thursday, McConnell added $70 billion to stabilize insurance exchanges on top of $112 billion for the same purpose in an earlier measure. McConnell of Kentucky hopes the modified bill will revive prospects for the embattled Affordable Care Act change effort, which stalled two weeks ago.
But Sens. Susan Collins of Maine and Rand Paul of Kentucky already say they'll vote no. Collins, a moderate, said she opposed the new measure because its cuts to Medicaid were too severe. Paul, a conservative who says he prefers a full repeal of Obamacare, announced his opposition on Wednesday and stood by his position after the bill was released.
Affordable Care Act Taxes
The new measure discards earlier plans to repeal three Affordable Care Act taxes on the wealthy, according to the summary. That move freed up about $230 billion in cash to bolster health expenditures.
The revised bill also would allow people for the first time to use health savings accounts to pay insurance premiums, according to the document.
John Thune of South Dakota, the No. 3 Senate Republican, said leaders plan to hold a key procedural vote in the middle of next week.
Separately, more than half a dozen Republican and Democratic senators have discussed alternatives to the GOP plan, which was developed without consulting Democrats.
Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana on Thursday morning released a summary of their own alternative health plan that would shift much of current federal funding for the Affordable Care Act insurance subsidy programs and future funding directly to states, according to a statement from Graham's office. Cassidy said he wants to offer his plan as an amendment to McConnell's bill.
But Graham also suggested he wouldn't try to block the McConnell version.
"It's definitely better. It was well-received," he told reporters after coming out of a closed-door GOP meeting.
Appeal to Moderates
The changes include provisions intended to appeal to moderates worried about premium spikes predicted by the CBO and others under the previous bill.
But while the bill omits a series of tax cuts for the wealthy in a nod to moderates, conservatives get major changes legalizing far skimpier plans that aren't part of the Affordable Care Act exchanges.
Republican Sen. Ron Johnson of Wisconsin, who had opposed plans to advance an earlier version of the bill in late June, said Thursday that he will support debating the current bill, although he isn't ready to give his full backing.
The new plan provides billions of dollars in subsidies to assuage moderates' fears of higher premiums for poorer, older, sicker people. Many have been skeptical or opposed to the idea of creating bare-bones plans that could siphon off healthy, young people and therefore cause premiums to rise in the exchanges. But, overall, the bill still has far less money going into Medicaid and health subsidies than the Affordable Care Act.
The revised draft would keep the earlier bill's language allowing people earning up to 350% of the poverty level to receive subsidies. And it would keep a skimpier benchmark for subsidies than the Affordable Care Act's silver plan, which would result in higher out-of-pocket expenses.
The new plan would also allow people to purchase a high-deductible catastrophic-coverage plan with federal tax credits, and prohibit plans eligible for tax credits from providing abortion coverage except in cases of rape or incest or to save the life of the mother.
