A bill focused on buttressing the nation's insurance marketplaces will be needed if the full-fledged Republican effort to repeal much of President Barack Obama's health care law fails, Senate Majority Leader Mitch McConnell said Thursday. It was one of his most explicit acknowledgments that his party's top-priority drive to erase much of Obama's landmark 2010 statutes might fall short.
The remarks by McConnell, R-Ky., also implicitly meant that to show progress on health care, Republicans controlling the White House and Congress might have to negotiate with Democrats. While the current, wide-ranging GOP health care bill — which McConnell is still hoping to push through the Senate — has procedural protections against a Democratic Senate filibuster, a subsequent, narrower measure would not and would take 60 votes to pass.
The existing bill would fail if just three of the 52 Republicans vote no, since all Democrats oppose it. McConnell was forced to cancel a planned vote on the measure last week after far more Republicans than that objected, and he's been spending the Independence Day recess studying possible changes that might win over GOP dissidents.
"If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur," McConnell said at a Rotary Club lunch in this deep-red rural area in southern Kentucky. He made the comment after being asked if he envisioned needing bipartisan cooperation to replace Obama's law.
"No action is not an alternative," McConnell said. "We've got the insurance markets imploding all over the country, including in this state."
Even as Republicans have struggled to write legislation they can pass, some have acknowledged that if they encountered problems, a smaller bill with quicker help for insurers and consumers might be needed. They've said it could include provisions continuing federal payments to insurers that help them contain costs for lower-earning customers, and some inducements to keep healthy people buying policies — a step that helps curb premiums.
Trump, McConnell, House Speaker Paul Ryan, R-Wis., and other Republicans have all said Obama's law is failing, citing markets around the country where insurers have pulled out or sharply boosted premiums.
Democrats acknowledge Obama's law needs changes that would help curb the growth of health care costs. But they say the GOP is exaggerating the problem and note that several insurers have attributed their decisions to stop selling policies in unprofitable areas, in part, to indications from the Trump administration that it may halt federal payments to insurers that help them control costs for many customers.
In its report last week on the Senate bill, the nonpartisan Congressional Budget Office said that under Obama's law, it expected health care markets "to be stable in most areas."
It said the same about the Senate legislation. But it also said under the GOP bill, 22 million added Americans would be uninsured because it would eliminate Obama's tax penalty on people who don't buy coverage and it would cut Medicaid, the health insurance program for the poor, disabled and many nursing home patients.
McConnell spoke hours after Sen. Ted Cruz, R-Texas, said the bill's prospects were "precarious." Speaking on San Antonio's KTSA Radio, Cruz said the GOP's Senate majority "is so narrow, I don't know if we can get it done or not."
Further qualms were voiced by Sen. Jerry Moran, R-Kan.
"There are people who tell me they are better off" under Obama's law, "and I believe them," Moran said at a town hall meeting Thursday in Palco, Kansas. Moran, who'd said he could not support the current version of the bill, said health care is "almost impossible to solve" with the slim GOP majority in the Senate.
Another Republican, Sen. Pat Toomey of Pennsylvania, suggested it may take some time before McConnell can win enough support for the GOP legislation.
"We're still several weeks away from a vote, I think," Toomey said Wednesday during an hour-long appearance before a live studio audience at WHTM-TV in Harrisburg, Pennsylvania.