Senate Republicans appeared unlikely to hit a self-imposed Friday deadline for revising their health care bill, as negotiators considered scaling back promised tax cuts for the wealthy in order to provide more insurance assistance to the poor.
Vice President Mike Pence led a White House push by meeting Thursday with divided Republican senators, but conservatives and centrists have been unable to resolve their differences.
“We’re working,” Pence said as he dashed through the halls, followed by reporters shouting questions.
Meanwhile, an updated analysis from the nonpartisan Congressional Budget Office predicted the GOP plan would make even deeper long-term reductions to federal Medicaid funding.
By 2036, government spending on Medicaid would be 35% less than under the current law, up from the 26% reduction expected in 2026, the CBO said. The estimate is certain to further worry GOP moderates, who were already alarmed by CBO predictions that the Senate bill would leave 22 million additional Americans without insurance.
As Thursday afternoon dragged on, senators began leaving town for the long Fourth of July holiday, with no endgame in sight.
“I’m just shocked that we’re going home,” said Sen. Ron Johnson (R-Wis.), one of the conservatives opposing the bill as written. “I want to stick around here 24/7 to get this thing done.”
GOP aides downplayed missing Friday’s deadline, which was set by negotiators after Senate Majority Leader Mitch McConnell (R-Ky.) abruptly delayed a vote this week because he did not have enough support for passage.
McConnell and top lawmakers huddled behind closed doors, and some senators said they still had “momentum” toward Friday’s target to produce an agreement and reschedule a vote for the week of July 10.
“That’s our goal,” said Sen. John Cornyn of Texas, the majority whip, as he left the session. “We’re plowing ahead, inch by inch, yard by yard. We’re not there yet, but we continue to talk.”
Talks were expected to continue Thursday night and Friday.
“Some people think we have momentum forward, some not so sure,” said Republican Sen. Bill Cassidy of Louisiana, a physician. “I’m not confident that’s going to solve everybody’s concerns.”
Focus continued on how to lower insurance premium costs in the bill, perhaps by providing more money for subsidies to those who buy policies on the Obamacare exchanges and stabilization funds for the states.
To pay for those additional costs, Republicans may keep some of the Obamacare taxes on the wealthy.
Republicans have long promised to repeal Obamacare’s taxes, but they are now considering keeping a 3.8% investment income tax on wealthier households earning beyond $200,000 a year. That tax provides as much as $175 billion over the next decade, by some estimates.
Fiscal conservatives are bound to object, but other Republicans said keeping the investment income tax could shield the GOP from attacks by Democrats that the bill is a giveaway of tax breaks for the rich, coming at the expense of health care for others.
Also, a separate CBO report Thursday showed federal deficits are back on the rise, hitting $690 billion in 2017 — after years of decline — due largely to lower tax revenues.
“We’re going to have to spend some money to provide tax credits and innovation and stabilization plans, and we’re just going to have to make a collective decision about where that should come from,” Cornyn said. “And that could be a source.”
Other sticking points remain. Centrist senators continue to push to save Medicaid from severe cuts, especially in Ohio, West Virginia and Nevada, where hundreds of thousands of residents have newly enrolled in the safety net program those states expanded with Obamacare.
Those senators want a slower phase out of Medicaid’s expansion under Obamacare, to five or seven years rather than three years under the current bill. They also want Medicaid funding to be tied to the health care inflation rate, which is higher than standard inflation measures used in the Senate bill.
Polling shows the Senate bill, called the Better Care Reconciliation Act, has scant popular support, with less than 1 in 5 Americans favoring the GOP’s approach.
Frustrated that their party is taking so long, with so little consensus, after years of campaigning to end the Affordable Care Act, senators face enormous pressure from donors and voters to deliver.
But senators also face protesters camping out in their offices and rallying back home, leaving them divided over how much, and how quickly, to unravel Obamacare.
“I wouldn’t call it pressure, but I think just about everybody made some promises when they were running, and I think they ought to keep their word,” said Sen. Richard Shelby (R-Ala.)
House Speaker Paul D. Ryan said watching the Senate process produced a sense of déja vu.
“This is exactly what we did here in the House. We brought it to the floor, then we pulled it back, then we brought it and passed it,” Ryan said. “I do think they’re going to persevere through this because we have a promise to keep.”
