Senate Majority Leader Mitch McConnell can only afford to lose two Republican votes and already two senators, Rand Paul of Kentucky and Susan Collins of Maine, are firmly against it, but for different reasons.
“Let’s do a clean repeal,” said Sen. Paul. “That’s what we promised the voters.”
Collins tweeted, “Still deep cuts to Medicaid in Senate bill. Will vote no on MTP. Ready to work with GOP and Dem colleagues to fix flaws in ACA.”
The 172-page bill is designed to fulfill the GOP campaign promise to repeal and replace the Affordable Care Act.
And there is no one with more at stake in this stage of the debate than Senate Majority Leader Mitch McConnell, who was personally called out by President Trump on Wednesday.
“He’s got to pull it off. Mitch has to pull it off. He’s working very hard. He’s got to pull it off,” the President tweeted.
McConnell, the leader of the Healthcare Working Group in the Senate, promised the revised plan would help bring the party together. He said, “After extensive consultations across the conference, numerous meetings with constituents and intensive conversations with members, our conference has updated last month’s better care discussion drafts with additional provisions to make it stronger.”
But the plan is not the major overhaul that some senators were looking for.
It keeps in place many of the sharp Medicaid cuts originally proposed.
It includes a version of the so-called “Cruz Amendment” that allows insurers that sell Obamacare plans to also offer policies outside the confines of Affordable Care Act regulations.
It adds more money to state stabilization funds to help lower premiums, particularly for the sick.
The bill also avoids repealing Obamacare taxes for wealthy Americans, a reversal from the previous GOP plan.
And it boosts funding to combat the opioid crisis.
While the mood coming out of an all GOP senators closed door meeting was positive, there are still concerns that the bill doesn’t go far enough.
“I think it’s worse,” said Sen. Paul. “The old version repealed most of Obamacare taxes. This repeals about half the Obamacare taxes.”
The bill is now in the hands of the Congressional Budget Office, which will forecast how much this bill will cost and how it will impact insurance coverage.
The first vote is a critical step to allow debate on the bill. It could come as soon as Tuesday.
And even undecided senators, like Thom Tillis of North Carolina, are asking their colleagues to allow that vote to go through.
He said, “I’m willing to take a position that we should debate it. We should on the bill. We should consider the amendments.”
But right now Senate leaders have a lot of work to do to get the fifty votes they need.