Senate leaders scramble for deal on health care bill

WASHINGTON (AP) - Senate GOP leaders scrambled Wednesday for a deal to revive their health care legislation, but encountered new obstacles as recalcitrant senators doubled down on their opposition to the bill sought by President Donald Trump.

Senate Majority Leader Mitch McConnell of Kentucky was conducting non-stop negotiations behind the scenes, but publicly there was little evidence he would be able to get senators to agree to a new version of the legislation by the end of the week, as he hopes to.

Trump, who met with Republican senators on Tuesday, told reporters Wednesday that getting approval of a bill will be "very tough." But he predicted that Republicans will at least "get very close" and may "get it over the line." McConnell canceled planned votes on the bill on Tuesday in face of mounting opposition from within his own ranks.

If Senate Republicans can forge a new version before the July 4 recess, that would allow the Congressional Budget Office to evaluate the changes while senators return to their states. Many are likely to encounter questions or protests about the highly unpopular GOP legislation that kicks millions off the insurance rolls.

"This bill is not a full repeal; this bill is not a full replace; what this bill is is mostly just a Medicaid reform package," GOP Sen. Ben Sasse of Nebraska said in a statement to The Omaha World-Herald.

"Nebraskans are dissatisfied with it and so am I," added Sasse, who had not previously commented on the bill.

Sen. Shelley Moore Capito of West Virginia said negotiators were struggling with how to resolve conflicts between the states that have expanded the Medicaid health program for the poor and disabled, and those that have not. Thirty-one states plus Washington, D.C., accepted the Medicaid expansion offered under former President Barack Obama's Affordable Care Act while 19 states did not, and there are Republican senators representing states in each group.

"What you see now is a great divide between states like mine, who have the expansion, and other states who are non-expansion states," Capito said Wednesday on CNN. "And that's really where we're sort of at loggerheads here."

Medicaid is crucial to addressing West Virginia's frightening opioid epidemic, and that concern caused Capito and Ohio Sen. Rob Portman, who faces similar issues in his state, to announce their opposition to the legislation on Tuesday. They joined several conservatives and a couple moderates who also oppose the bill or have qualms. Once it became clear that there was not enough support for the legislation to advance this week McConnell canceled planned votes.

McConnell can lose only two senators from his 52-member caucus and still pass the bill, with Vice President Mike Pence to cast a tie-breaking vote. Democrats are unanimously opposed.

With the health care bill in limbo the rest of Trump's agenda is also stalled. Indeed, despite full control of Washington, Republicans have yet to achieve any of their marquee legislative goals. The health legislation to get rid of "Obamacare" was supposed to come first, but it has proven far more difficult than anticipated. It stymied the House for much of the spring until a bill was finally passed in May, and now has the Senate tied in knots.

Congressional leaders are eager to dispense with the issue and move on to other matters, including rewriting the nation's loophole-ridden tax code. That's why McConnell was hoping for votes this week on the health bill he crafted largely in secret, but senators needed more time, especially after a Congressional Budget Office report Monday showing 22 million people would lose insurance over the next decade.

The bill has many critics and few outspoken fans on Capitol Hill, and prospects for changing that are uncertain.

"It's a big complicated subject, we've got a lot discussions going on, and we're still optimistic we're going to get there," McConnell said.

But adjustments to placate conservatives, who want the legislation to be more stringent, only push away moderates who think its current limits - on Medicaid for example - are too strong.

In the folksy analysis of John Cornyn of Texas, the Senate GOP vote-counter: "Every time you get one bullfrog in the wheelbarrow, another one jumps out."

The Senate plan would end the tax penalty the law imposes on people who don't buy insurance, in effect erasing Obama's so-called individual mandate, and on larger businesses that don't offer coverage to workers.

It would cut Medicaid, which provides health insurance to over 70 million poor and disabled people, by $772 billion through 2026 by capping its overall spending and phasing out Obama's expansion of the program.

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Associated Press writers Ricardo Alonso-Zaldivar, Ken Thomas, Andrew Taylor, Michael Biesecker and Julie Bykowicz contributed to this report.