(CN) – The number of Republican senators who say they are not ready to vote for the new GOP health care bill rose to five on Friday, increasing the odds the measure will never be passed.
Four senators: Ted Cruz of Texas, Ron Johnson of Wisconsin, Mike Lee of Utah and Rand Paul of Kentucky announced their opposition to the bill on Thursday.
Sen. Dean Heller, of Nevada, joined the opposition on Friday, saying “it’s going to be very difficult for me to say yes.”
The first four senators to announce their opposition said in a statement Thursday that they are open to negotiation before the full Senate considers the measure.
The four said there are provisions that are an improvement to the current health care system. But they add that the measure fails to accomplish what they have promised to their constituents, “to repeal Obamacare and lower their health care costs.”
GOP leaders hope to vote on the bill next week but can only afford two defections from the 52 Senate Republicans.
“It just doesn’t sound conservative,” Paul told reporters on Thursday. “So really it is about the details. Somebody’s going to have to look at this bill and say we’re going to make it more like repeal and less like we’re keeping Obamacare.”
But if the four are at least willing to hold the door open to voting for the health care bill, Heller, who many consider the Senate Republican most at risk in the 2018 midterm election, doesn’t appear to have much latitude to change his mind.
“I cannot support a piece of legislation that takes insurance away from tens of millions of Americans and hundreds of thousands of Nevadans,” Heller said.
Despite the defections, Sen. John Cornyn, the Republican responsible for rounding up his party’s votes on bills, said party leadership still plans on holding a vote on the bill next week. He said Republicans may need to make changes to the bill to bring on board conservative defectors and that those changes could be offered in a new piece of legislation as late as Tuesday.
The Congressional Budget Office still needs to complete its analysis of the bill, which could happen on Monday, and offer “tweaks and changes” as needed to deal with new language in the legislation, Cornyn told reporters Thursday.
“This is hard, there’s no question about it,” Cornyn said of Republican holdouts on the bill. “It makes it even harder when you have to do it purely as a one-party exercise because of the reconciliation process. But that’s not an excuse for failure in my view.”
Senate Republicans released their long-awaited bill to repeal and replace the Affordable Care Act Thursday morning, proposing to cut Medicaid for low-income Americans and erase Obama-era tax increases the Democratic president imposed on the wealthy to finance his expansion of coverage.
The proposed bill would also provide less-generous tax credits to help people buy insurance and would allow states to get waivers for some of the coverage standards imposed by the Act.
And it would end the tax penalties the Act imposed on people who decided not to insurance and on large companies who don’t offer coverage to their employees.
However, the plan, drafted for weeks behind closed doors by GOP lawmakers, would also prevent insurance companies from increasing or denying coverage to those with preexisting conditions.
Although the Senate bill largely mirrors the House bill that narrowly passed last month, it differs in several significant ways.
First, like the Affordable Care Act, it ties federal insurance subsidies to income rather than age as the House bill had proposed. However, unlike the Act, it requires that those receiving subsides actually fit into a “low income” criteria.
Under the GOP plan, Beginning in 2021 states will be able to choose between a per capita allotment or a block grant to fund Medicaid, which will fundamentally restructure how the Act funds the program. Right now, the federal government matches state spending for anyone who qualifies.
Under block grants or a per capita cap system, states will receive a lump sum of money for Medicaid from the federal government.
The Senate version does provides more leeway in phasing out the Act’s anticipated Medicaid expansion, which would take effect after three years rather than next year, as the House bill proposes.
Under both bills, Medicaid spending and other cuts would help fund a tax cut for wealthy Americans and the health care industry.
The Senate bill also mirrors the House bill in other respects. It would allow states to determine what qualifies as an essential health benefit. Right now, insurers are required to cover certain categories of services, including hospital stays.
The Senate bill will also allow young adults to stay on their parents’ health insurance plans until they are 26, and according to the Senate budget committee, will guarantee coverage to children with medically complex disabilities.
The Senate version of the bill expedites an Affordable Care Act process that allows states to receive waivers on certain provisions of the law, including those that require insurance companies to provide basic levels of coverage in their policies, known as essential health benefits.
While states would be able to tinker with wide portions of the law if they obtain a waiver, a senior GOP Senate staff member said they could “absolutely not, categorically not, completely not” waive requirements for insurers to cover people with preexisting conditions.
This process is different than the one included in the House bill, which some members worried would allow states to end requirements that insurers cover people with preexisting conditions.
The legislation also includes money to help states reduce premiums on the individual market, starting with $15 billion in 2018 and going down to $10 billion in 2020 and 2021. Another fund would give $8 billion to states in 2019 and $14 billion in 2020 and 2021 to stabilize markets, $5 billion of which would have to go towards reducing premiums. The money in the funds would then go down after 2021, a senior GOP Senate staff member told reporters Thursday.
Republicans are moving the bill using a process known as reconciliation, which only requires 50 votes to pass but that places some restrictions on what can be included in the legislation. As a result, Republicans were unable to repeal requirements on essential health benefits for private insurers, though they would be phased out of the Medicaid program in 2019, a senior GOP Senate staffer said Thursday.
Unlike the House bill, the Senate draft does not include a requirement that people maintain continuous health coverage, though a senior GOP Senate staff member told reporters they are working with the Senate parliamentarian and the Congressional Budget Office to see if such a provision could be included in the bill.
The process used to draft the proposed legislation has been criticized by many as secretive and left many lawmakers — even those within the GOP — in the dark about what the bill contained until Thursday morning.
Senate Republicans met in a room just off the Senate chamber to discuss the bill, which went online for the public to read for the first time shortly before 11 am. Even after leaving the meeting, many senators were still not clear on what exactly is in the 142-page draft and said they would still need to read it along with the general public.
“I think everybody’s going to want to sit down and look at it,” Sen. Bob Corker, R-Tenn., told reporters after leaving the meeting. “It’s serious. We know it affects people back home in a real way.”
But even with the lingering questions, the proposal generally received a more positive reaction in the Senate than the bill the House passed last month. Sen. Lindsey Graham said the Senate bill appears to him to be better than American Health Care Act and predicted pushback from more conservative members of the House.
Specifically, Graham said he is more confident in how the Senate bill deals with ensuring people with preexisting conditions would still be able to afford health care.
“The preexisting illness problem — I feel comfortable that nobody’s going to be denied coverage because they get sick,” Graham told reporters Thursday.
But without having much time to read the text of the bill, some Republicans were unwilling to unequivocally throw their support behind the proposal. The GOP can only afford to lose two of its members when the bill goes for a vote, assuming all Democrats remain united in opposing the legislation.
Republican leadership has said they hope to bring the bill to the floor at the end of next week, with the expectation that the Congressional Budget Office will have released its analysis of the legislation by then.
Graham, who had previously expressed skepticism of Republicans’ ability to pass the health care package, was more hopeful on Thursday, though he acknowledged he and his staff still need time to pour over the bill.
“I think the ability to get 50 votes is greater today than I thought yesterday,” Graham said.
Other senators saw the text that was released on Thursday as a jumping off point rather than a final proposal.
“It does, but it’s a starting point,” Sen. Jim Inhofe, R-Okla., told reporters when asked if the bill had his support. “Lots of improvements to be made.”
Sen. Bill Cassidy, a key vote for Republicans on the bill, said he still has not fully been able to assess the bill, but sounded tentatively supportive if he finds some of his concerns satisfied.
“I still have to see what the generosity of the credits are so that as this is scaled back we don’t lose the ability for lower-income folks to be able to afford insurance and that’s why I need to review the text,” Cassidy told reporters Thursday.
Democrats predictably leaped on the bill after it was released, criticizing its content and calling it the result of a secretive process. Sen. Dick Durbin, D-Ill., said on the Senate floor that the bill is “not much of a change” from the version the House passed last month.
“I’ll tell you, at the end of the day, from the reports that we have, this is still a mean dog,” Durbin said.
Senate Minority Leader Chuck Schumer stepped up the Democratic criticism of the bill during a news conference Thursday afternoon.
“The bill takes dollars out of health care from millions of Americans and puts them right back in the pocket of the wealthy,” the senator said.
Schumer called the bill “nasty” and said health care costs will rise for middle class and working families and millions more will lose their healthcare altogether, adding that costs of long-term care for middle class families with loved ones in nursing homes will also rise.
Schumer called the bill as bad as the House bill, and in some ways worse.
Though Republicans say the bill won’t deny coverage to people with preexisting conditions, Schumer insisted the bill will abandon them and will give states more latitude to deny coverage for essential health benefits like maternity and mental health care.
“The president has said that the Senate bill needed heart. The way this bill cuts health care is heartless,” Schumer said. “The president said the House bill was mean, the Senate bill is even meaner.”
Sen. Ron Wyden, D-Ore., assailed Senate Republicans for refusing to reach out to Democrats to work on the bill in a bipartisan fashion.
“Not once, not once have my colleagues been asked by a single Republican to work on this bill or just discuss fixes – but bipartisan fixes – to the Affordable Care Act,” Wyden said.
Wyden called Republican claims that Democrats have refused to work them on health care a “gross fiction.”
In Wyden’s estimation, his Republican colleagues are trying to con the American people.
“Senate Republicans are going to keep telling Americans they’re fixing their health care right up until the second when it gets taken away,” Wyden said.