It felt like Groundhog Day in the U.S. Senate Thursday, as Majority Leader Mitch McConnell released yet another version of his vaunted health care overhaul in yet another closed-door meeting with, yet again, only members of his own party who, once more, greeted the plan with reactions ranging from high praise to outright scorn.
The new changes provide states with an additional $70 billion to help keep premiums down, while allowing insurance companies to offer cheap plans that don't comply with the stringent requirements of the Affordable Care Act. But it still would likely strip Medicaid from roughly 15 million people within the decade.
Lobbyists were given the bill, yet again, before the meeting, but Republican senators are still digesting the sweeping legislation that McConnell is asking them to vote on next week.
Asked if this bill is an improvement from the last version, Republican Sen. John McCain tells Rolling Stone, "Damned if [I know]. As I said, I'm not optimistic," adding that he predicts the bill will fail when it comes up for a vote. "I don't see consensus."
But other Republican senators say the legislation is improving, and they like the direction it's headed in.
"There shouldn't be consensus yet. If that was the case, we'd vote today," Republican Sen. Mike Rounds says. "But look, our goal is: Are we getting there? I think we are, and I'm impressed by the way the whole team is kind of pulling together right now. ... We want to make this as good as we can possibly make it, and that's our goal."
McConnell is being forced to open up the legislation to an unlimited number of amendments – known as a vote-a-rama inside the Beltway – because he's using a budget rule, known as reconciliation, to pass the bill with only 51 Republican votes, instead of trying to negotiate changes with Democrats. Republicans like the sound of that.
"I think the bill is moving in a very positive direction ... and I look forward to next week, improving it more," Republican Sen. Bob Corker tells Rolling Stone, noting that the lack of consensus doesn't surprise him. "Before people have had an opportunity to offer amendments, I don't think that's unnatural. I think that people are very invested in this, spent a lot of time trying to understand it.
"In the 10-and-a-half years I've been here, there hasn't been a substantive debate on health care where you can actually change the content of it with 51 votes. Think about that. The other time there's been a 60-vote super-majority, so if people want to get involved in affecting health care for Americans, next week is the time to do it," says Corker.
Just before the new version of the legislation was unveiled, two Republican senators, Lindsey Graham and Bill Cassidy, took to CNN to announce their own proposal, which would keep most of Obamacare's taxes in place and send the money to states as a block grant so they can set up their own insurance systems and local rules. But the senators deny they're trying to undermine McConnell's effort – they say they merely want it offered as an amendment during next week's debate.
"I'm not trying to undercut them; they're not undercutting me," Graham tells reporters, adding he likes the new direction McConnell is going. "We're trying maybe to merge these two concepts, but it was definitely better. It was received well, whether we got 50 votes or not I don't know. But I know this, that if you're a United States senator and you've got a governor saying this bill hurts your state, and you're a Republican, they're a Republican, you're pretty much in trouble."
But Graham predicts their proposal will have broad appeal, even on the other side of the aisle, because it puts state leaders in the driver's seat.
"I can see where some moderate Democrats would like the combination of keeping the revenue flowing but allowing the money to go back home rather than being spent in Washington," Graham says.
"Sen. Graham and I are working on something which we think makes it more likely to pass," Sen. Cassidy tells reporters. "So rather than predict failure, I'll just say that we're going to continue to work to fulfill President Trump's promises and see if we can do it."
Unlike the last version of the health care bill, this new legislation preserves two Obamacare taxes on wealthy Americans. One is a 3.8 percent tax on investment income, and the other a 0.9 percent payroll tax – both only apply to individuals who make more than $200,000 or couples who make more than $250,000.
Many Republicans don't like those, but they say they can support the health bill now and try to eliminate those taxes later when they hope to overhaul the entire tax code.
"I just think the tax provisions could ultimately be dealt with in tax reform," Republican Sen. Marco Rubio tells reporters. "I don't support those taxes, I'd like to see them come out, but I think they can come out as part of tax reform it doesn't have to be as part of the Obamacare debate."
But there are already some hardliners who are defecting, and it's unclear if McConnell – a master tactician, at least when he was playing defense against President Obama – can muster even the votes to bring the bill up on the floor for debate, because he can only afford to lose two Republicans, and he's already lost his fellow Kentuckian, Rand Paul, and the moderate Susan Collins of Maine.
"One of the reasons that I'm going to vote 'no' on the motion to precede is I don't believe that you make major changes in an entitlement program, upon which millions of Americans depend, without having a single hearing in the Senate to evaluate the impact," Collins tells a gaggle of reporters steps away from the Capitol rotunda. "There's no doubt in my mind that there are hundreds of billions of dollars of cuts in the Medicaid program. That would ship costs onto state governments, it would hurt the most vulnerable citizens, it would have an adverse impact, particularly on our referral health care providers, hospitals and our nursing homes, and it is not something I can support."
The addition of Sen. Ted Cruz's amendment, which would allow insurers to offer bare-bones plans, complicates things because it not only scares away moderate Republicans but also makes the bill a non-starter for Democrats. Critics are also blasting the GOP for rushing the bill through without a score from the nonpartisan Congressional Budget Office, and instead relying on a partisan analysis from Health and Human Services Secretary Tom Price.
"So in other words, it's not only writing the bill behind closed doors with drug company lobbyists and insurance company lobbyists, it's also gaming the score so they can look better," Democratic Sen. Sherrod Brown tells reporters. "Nobody that knows anything about insurance supports the whole idea of the Cruz amendment, because they know what's going to happen. They know that healthy people are going one place, and sick people are going elsewhere – and disabled people – and prices go up."