One more Republican defection would doom Senate health care bill



WASHINGTON (Reuters) - President Donald Trump turned up the heat on Friday on fellow Republicans in the U.S. Senate to pass a bill dismantling the Obamacare law, but with their retooled health care plan drawing fire within the party even one more defection would doom it.

Majority Leader Mitch McConnell has planned for a vote next week on revised legislation, unveiled on Thursday, and he has his work cut out for him in the coming days to get the 50 "yes" votes needed for passage. Republicans control the Senate by a 52-48 margin and cannot afford to lose more than two from within their ranks because of united Democratic opposition, but two Republican senators already have declared opposition.

SEE ALSO: Vice President Pence lobbies governors to support Senate health care bill

"After all of these years of suffering thru Obamacare, Republican Senators must come through as they have promised," Trump, who made gutting Obamacare one of his central campaign promises last year, wrote on Twitter from Paris, where he attended Bastille Day celebrations.

The top U.S. doctors' group, the American Medical Association, on Friday called the new bill inadequate and said more bipartisan collaboration is needed in the months ahead to improve the delivery and financing of health care. Hospital and medical advocacy groups also have criticized the bill.

"The revised bill does not address the key concerns of physicians and patients regarding proposed Medicaid cuts and inadequate subsidies that will result in millions of Americans losing health insurance coverage," AMA President Dr. David Barbe said, referring to the government insurance program for the poor and disabled.

A major test for McConnell's legislation expected early next week is an analysis by the nonpartisan Congressional Budget Office, which last month forecast that the prior version of the bill would have resulted in 22 million Americans losing insurance over the next decade.

A day after that CBO analysis was issued, McConnell postponed a planned vote on the legislation because of a revolt within his own party, including moderates and hard-line conservatives.

While the bill's prospects may look precarious, the same could have been said of health care legislation that ultimately was passed by the House of Representatives. Republican House Speaker Paul Ryan called off a vote in March in the face of a rebellion involving the disparate factions of the party but managed to coax enough lawmakers to back it and engineered narrow approval on May 4.

PENCE SEEKS SUPPORT

Vice President Mike Pence sought to shore up support among the nation's governors at a meeting in Rhode Island, but a key Republican governor, Ohio's John Kasich, came out strongly against the revised bill, saying its Medicaid cuts were too deep and it does too little to stabilize the insurance market.

Kasich's opposition could put pressure on Rob Portman, a Republican senator from Ohio, who has not yet taken a position on the bill.

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John Kasich through his career
MT. PLEASANT, SC - FEBRUARY 10: Republican presidential candidate John Kasich talks to an overflow crowd outside of Finn's Brick Oven Pizza February 10, 2016 in Mt. Pleasant, South Carolina. The South Carolina Republican primary will be held Saturday, February 20. (Photo by Sean Rayford/Getty Images)
11/3/95 - Rep. John R. Kasich (R-OH), seated 2nd from left, and Sen. Pete V. Domenici (R-NM) in the dark suit standing, go over their response to President Clinton's radio address just prior to recording the radio broadcast in the Senate studio. Kasich was casually dressed as the House was out of session for the weekend. (Photo by Robert A. Reeder/The Washington Post/Getty Images)
D:\BOB\budget3.tif - slug: NA/BUDGET date: May 2, 1997 photog: Robert A. Reeder TWP The Rotunda of the Capitol description: GOP happy with their signed budget John R. Kasich (R-OH) is having a particularly good time during the GOP announcement of a new budget in the Rotunda of the Capitol. In front of him is Speaker Newt Gingrich. (Photo by Robert A. Reeder/The Washington Post/Getty Images)
P 350430 022 2May99 Manchester, Nh John Kasich (R-Oh), At The First-In-The-Nation Primary Kick-Off Weekend. (Photo By Jonathan Elderfield/Getty Images)
UNITED STATES - FEBRUARY 02: HOUSE ARMED SERVICES--John R. Kasich, R-Ohio, and Duncan Hunter, R-Calif., talk during House Armed Services Committee hearing on the president's fiscal year 2000 defence budget authorization budget request. (Photo by Douglas Graham/Congressional Quarterly/Getty Images)
Former Ohio congressman John Kasich attends the Republican National Convention at the Xcel Energy Center in St. Paul, Minnesota, Wednesday, September 3, 2008. (Photo by Harry E. Walker/MCT/MCT via Getty Images)
WASHINGTON, DC- Dec. 01: Governor-elect John Kasich, R-Ohio, and House Minority Leader John A. Boehner, R-Ohio, during a news conference after their meeting with other Republican members and governors-elect. Boehner is the presumed House Speaker for the 112th Congress. (Photo by Scott J. Ferrell/Congressional Quarterly/Getty Images)
John Kasich, governor of Ohio, speaks during a groundbreaking ceremony for the Cleveland Medical Mart and Convention Center in Cleveland, Ohio, U.S., on Friday, Jan. 14, 2011. The Cleveland Medical Mart and Convention Center will include a 100,000 square foot medical mart and an adjoining convention center with 230,000 square feet of exhibit hall space. The facility is expected to open in September 2013. Photographer: David Maxwell/Bloomberg via Getty Images
COLUMBUS, OH - MARCH 30: Ohio Governor John Kasich works long hours with staff on his new budget proposal at his office, in the Ohio State House office, Columbus, Ohio, Wednesday, March 30, 2011. Newly elected republican Ohio Governor John Kasich is working toward to balancing an Ohio budget in deficit through a budget proposal with extensive budget cuts, spending reform, and changes in labor laws, including restrictions on collective bargaining. (Photo by Melina Mara/ The Washington Post via Getty Images)
US Republican presidential candidate and former Massachusetts Governor Mitt Romney (2nd L) waves alongside Ohio Republican Senator Rob Portman (L) and Ohio Governor John Kasich (R) during a campaign stop at Tom's Ice Cream Bowl in Zanesville, Ohio, on August 14, 2012. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/GettyImages)
UNITED STATES - AUGUST 28: Ohio Gov. John Kasich speaks at the 2012 Republican National Convention at the Tampa Bay Times Forum. (Photo By Chris Maddaloni/CQ Roll Call)
COLUMBUS, OHIO - JULY 21: Ohio Governor John Kasich gives his speech announcing his 2016 Presidential candidacy at the Ohio Student Union, at The Ohio State University on July 21, 2015 in Columbus, Ohio. Kasich became the 16th candidate to officially enter the race for the Republican presidential nomination. (Photo by Ty Wright/Getty Images)
CONCORD, NH - FEBRUARY 09: Republican presidential candidate Ohio Governor John Kasich waves to the crowd after speaking at a campaign gathering with supporters upon placing second place in the New Hampshire republican primary on February 9, 2016 in Concord, New Hampshire. Kasich lost the Republican primary to Donald Trump, though he upset fellow Republican governors Chris Christie and former Governor Jeb Bush. (Photo by Andrew Burton/Getty Images)
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If the current Senate legislation collapses, some lawmakers have raised the possibility of seeking bipartisan legislation to fix parts of Obamacare but leaving intact the structure of the Affordable Care Act, Democratic former President Barack Obama's signature legislative achievement, commonly known as Obamacare.

"There are changes that need to be made to the law," Dick Durbin, the No. 2 Senate Democrat, told MSNBC, citing "a bipartisan appetite to tackle this issue."

Moderate Susan Collins and conservative Rand Paul already oppose the revised Senate bill. Other Republican senators have either expressed concern or remained noncommittal, including Portman, Mike Lee, Shelley Moore Capito, John McCain, Dean Heller, John Hoeven, Lisa Murkowski, Jeff Flake, Ben Sasse, Cory Gardner, Todd Young and Thom Tillis. Republican Senators Lindsey Graham and Bill Cassidy floated an alternative plan.

The new version was crafted to satisfy the Republican Party's various elements, including moderates worried about Americans who would be left without medical coverage and hard-line conservatives who demand less government regulation of health insurance.

A provision championed by Republican Senator Ted Cruz and aimed at attracting conservatives would let insurers sell cheap, bare-bones insurance policies that would not have to cover broad benefits mandated under Obamacare.

But two major health insurance groups, America's Health Insurance Plans and the Blue Cross Blue Shield Association, called on McConnell to drop the Cruz proposal, saying it would undermine protections for pre-existing medical conditions, raise insurance premiums and destabilize the individual insurance market.

The bill retained certain Obamacare taxes on the wealthy that the earlier version would have eliminated, a step moderates could embrace. But it kept the core of the earlier bill, including ending the expansion of Medicaid that was instrumental in enabling Obamacare to expand coverage to 20 million people, and restructuring that social safety-net program.

John Thune, a member of the Senate Republican leadership, said in order to complete work on the bill by the end of next week, Senate leaders would have to try to formally begin debate on Tuesday or Wednesday, a move that requires a majority vote.

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