Senate healthcare bill suffers swift blow as four GOP senators voice opposition

• Rand Paul and other conservatives say bill resembles Obamacare too closely
  

• Decision of quartet puts Republicans’ healthcare overhaul in jeopardy

Four Republican senators are preparing to announce their opposition to the new Senate healthcare bill, putting the GOP’s attempt to overhaul Barack Obama’s signature legislation in jeopardy.

Rand Paul of Kentucky told the Associated Press that the draft bill released on Thursday resembled Obamacare too closely and did not go far enough in repealing the former president’s Affordable Care Act.

Paul, a conservative Republican, said he and the other senators were “definitely open to negotiation” but that they needed to make their opposition clear in order to ensure negotiations happened. The other three senators are Mike Lee of Utah, Ted Cruz of Texas and Ron Johnson of Wisconsin.

“The current bill does not repeal Obamacare,” Paul said in a statement. “It does not keep our promises to the American people. I will oppose it coming to the floor in its current form, but I remain open to negotiations.”

Cruz echoed those concerns in his own statement. “This bill draft does not do nearly enough to lower premiums,” said the Texas Republican. “That should be the central issue for Republicans – repealing Obamacare and making healthcare more affordable. Because of this, I cannot support it as currently drafted, and I do not believe it has the votes to pass the Senate.”

The draft bill unveiled by Senate majority leader Mitch McConnell met a mixed reaction on Capitol Hill from his own party and severe criticism from Democrats.

The bill, which was the Senate response to the American Health Care Act (AHCA) passed by the House of Representatives in May, made several changes to the controversial House legislation.

Like their counterparts in the House, Republican senators want to give middle-class Americans tax credits to buy insurance, but those subsidies would still be worth less than those currently provided by the Affordable Care Act (ACA), popularly known as Obamacare, and people would also need to earn less money to quality for them.

Additionally, the Senate’s bill, like the one passed by the House, would allow states to decide which benefits insurance must cover. This could herald a return to pre-ACA days, when Americans who bought their own insurance faced expensive riders for coverage such as mental health care, maternity care and addiction treatment.

The bill would also slash Medicaid, which provides health insurance to one in five Americans.

Sarah Huckabee Sanders, deputy press secretary at the White House, declined to comment on Trump’s reaction to proposed cuts to Planned Parenthood and Medicaid.

Pressed on whether Trump still believes in his campaign pledge not to cut Medicaid, Sanders replied: “I haven’t had a specific conversation to see if there is an update to that but I do know that he wants to protect that as much as possible.”

The AHCA narrowly passed the House in May despite Republican opposition from moderates, who found its cuts to Obamacare too draconian, and conservatives, who thought it still gave government too large a role in healthcare.

The Senate bill met similar concerns from both wings of the GOP caucus on Thursday.

With the expectation that all 48 Democrats will vote against the bill, the Senate leadership can afford only two defections, which would still require a tie-breaking vote from Mike Pence, the vice-president, for the bill to pass.

A spokesman for Susan Collins, a leading GOP moderate, said she had a “number of concerns” and was particularly interested in what the analysis by the Congressional Budget Office due next week would say about “the impact on insurance coverage, the effect on insurance premiums, and the changes in the Medicaid program”.

Senator Dean Heller, a Republican from the Democratic-leaning state of Nevada who is up for re-election next year, said he had “serious concerns” with the way the legislation would dramatically restructure and scale back Medicaid.

“Throughout the healthcare debate, I have made clear that I want to make sure the rug is not pulled out from under Nevada or the more than 200,000 Nevadans who received insurance for the first time under Medicaid expansion,” Heller said. “At first glance, I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid.”

On a conference call with reporters, Republican staff said the draft did not include a continuous coverage provision, which was the House bill’s replacement for the individual mandate, the ACA’s controversial provision requiring Americans to have health insurance or pay a fine.

The provision as drafted in the House plan would allow states to apply for waivers to opt out of the law’s insurance rules for those who have not maintained continuous coverage. A Republican staffer on the call said the party was exploring options to include a similar piece in the Senate bill, though it was not clear if such language was permissible under budget rules.

McConnell is hoping to put the bill on an expedited timeline in order to ensure a vote in the next week, but his colleagues were skeptical about that rapid turnaround, considering the number of amendments that are likely to be offered in the coming days.

Senator Bob Corker of Tennessee said: “It’s truly a draft ... I’m not that superficial to say I support or don’t support a bill I haven’t read.”

Senator Lindsey Graham of South Carolina added: “I think we’re probably gonna get a lot of pushback from people from the right in the House.”

However, John Cornyn of Texas, the Senate majority whip, told reporters that McConnell could file the final bill “as late as Tuesday” and that “it would encompass additional conversations and ideas between now and then”.