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The GOP healthcare bill faces an uncertain future in the Senate this week after its long-anticipated introduction.
Even though Senate Majority Leader Mitch McConnell wants to vote on the Better Care Reconciliation Act (BCRA) by the end of the week, many Republican senators have not embraced the bill with open arms.
Some more conservative senators want the bill to go further in its repeal of the Affordable Care Act, or Obamacare, and four members released a statement on Thursday saying they would vote against the bill along those lines.
Some moderates, on the other hand, think the bill goes too far and want to keep some of the more popular parts of the ACA intact.
Here are the nine GOP senators likely to shape the fight over the BCRA – and what they might want in terms of changes.
Rand Paul of Kentucky
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What he’s said: Paul was among the four senators that came out publicly against the BCRA on Thursday, arguing that it did not deliver on its promise to repeal Obamacare. “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.”
What he wants: Paul wants to roll back much of the regulations set up by the ACA and eliminate much of the funding to provide insurance subsidies. He said during the legislation’s drafting of the bill that he doesn’t want to create “a new entitlement” by solidifying the tax credits into law under the plan. Basically he wants less of everything: funding, regulation, and taxes.
Susan Collins of Maine
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What she’s said: After the release of the bill, Collins’ office released a statement suggesting that the senator’s decision was still up in the air. “Senator Collins will carefully review the text of the Senate health care bill this week and into the weekend,” said the statement. “She has a number of concerns and will be particularly interested in examining the forthcoming CBO analysis on the impact on insurance coverage, the effect on insurance premiums, and the changes in the Medicaid program.”
What she wants: While Collins’ state has not expanded Medicaid, the slower growth caps for the program could be enough to push her away from the bill. Additionally, Collins opposes defunding Planned Parenthood, which the Senate bill would do for one year. Collins’ term is up in 2020.
Ted Cruz of Texas
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What he’s said: Cruz was also one of the four conservatives to come out against the Senate bill. “I want to get to yes, but this first draft doesn’t get the job done,” Cruz said in his own statement. “Over the next week and beyond, I will continue working to bring Republicans together to honor our promise, repeal Obamacare, and adopt common-sense, consensus reforms that can actually be passed into law.”
What he wants: Cruz had a litany of demands in his statement, including some provisions that would not be admissible in the bill under the budget reconciliation process Republicans are using to try to pass it. What can be included is a full repeal of so-called essential health benefits, which Cruz called for, along with a desire to do more to lower premiums. Cruz is up for reelection in 2018.
Dean Heller of Nevada
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What he’s said: Heller faces a tight reelection bid in 2018 in a state that recently passed a bill, which was eventually vetoed by the governor, to expand Medicaid access to everyone in Nevada. He said Friday that he opposes the legislation in its current form.
What he wants: Heller took issue with the proposed phaseout of the Medicaid expansion and the funding growth-rate formula.
Lisa Murkowski of Alaska
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What she’s said: “I will be working closely with the state over the next several days to analyze the text and crunch the numbers,” Murkowski said Thursday. “It’s no secret that health care needs to be reformed, but it needs to be done right. So know that I remain committed to ensuring that all Alaskans have access to affordable, quality health care and will vet this bill through that lens.”
What she wants: Murkowski also supports continuing the expansion of Medicaid and keeping funding for Planned Parenthood. Additionally, Alaska’s premiums are much higher than the rest of the country, so Murkowski may push for more generous tax credits. Murkowski was reelected in 2016.
Mike Lee of Utah
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What he’s said: Lee was also one of the four conservatives against the bill on Thursday. “There are provisions in this draft that represent an improvement to our current health care system but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs,” the statement said.
What he wants: Lee wants to see a quicker phaseout of the Medicaid expansion and repeal of various insurance market regulations. Lee was reelected in 2016.
Rob Portman of Ohio
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What he’s said: “There are some promising changes to reduce premiums in the individual insurance market, but I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic,” Portman said in a statement. “I look forward to examining this new proposal carefully and reviewing the analysis by the Congressional Budget Office when it is available.”
What he wants: Ohio was one of the states to expand Medicaid under Obamacare, so a slower phaseout will likely be on his list of asks. Additionally, the bill supplies only $2 billion to combat the opioid crisis, less than the House’s legislation. More funds to fight the crisis, one of Portman’s core issues in a state hit especially hard by it, could be on his list of proposed alterations. Portman won reelection in 2016.
Shelley Moore Capito of West Virginia
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What she’s said: “Over the course of the next several days, I will review the draft legislation released this morning, using several factors to evaluate whether it provides access to affordable health care for West Virginians, including those on the Medicaid expansion and those struggling with drug addiction,” Capito said.
What she wants: West Virginia has a large Medicaid population and expanded the program under the ACA. Capito expressed desire for a seven-year phase out of the expansion. The discussion draft proposes to phase it out over four years. Capito also wants more money to fight the opioid crisis. Capito is up for reelection in 2020.
Ron Johnson of Wisconsin
What he’s said: Johnson was also among the four members who said they would vote against the bill, but told reporters his biggest request for changes was “more information.”
What he wants: A more complete repeal of Obamacare, much like Cruz, Lee, and Paul.
A few more…
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While those nine are the most likely to raise objections, there are few other Republicans who could come into play depending on how the negotiations proceed.
Some lawmakers in states that expanded Medicaid, like Sens. Jeff Flake of Arizona and Tom Cotton of Arkansas, have so far been noncommittal. Other Republicans like Sen. Pat Toomey of Pennsylvania could raise objections to tax credits.