(Bloomberg) -- Senate Majority Leader Mitch McConnell is facing strong pressure to delay this week’s planned debate over his party’s health-care bill, with at least five GOP senators threatening to vote with Democrats to block the current version.
Republican leaders wanted to formally introduce the plan as early as Tuesday, but defections started even before the nonpartisan Congressional Budget Office said late Monday that the bill would leave an additional 22 million Americans without health insurance in a decade.
Second-ranking Republican John Cornyn insisted to reporters Tuesday that a procedural vote is likely to be held Wednesday and that "we’re gonna vote, we’re gonna pass it" this week.
Senator Dean Heller of Nevada said Friday he’s concerned about aspects of the bill, including its deep cuts to Medicaid and to subsidies for individual insurance coverage. After the CBO report’s release, he was joined by Rand Paul of Kentucky, Ron Johnson of Wisconsin, Susan Collins of Maine and Mike Lee of Utah.
Moving a bill this week, Johnson said, “would be a mistake. If Leader McConnell says failure is not an option, don’t set yourself up for failure."
But McConnell and Senate GOP leaders haven’t discussed possible changes with members concerned about some of the bill’s provisions, two senators said.
"I have not heard back from the leadership with any suggestions for changes," Collins said.
Senator Bill Cassidy of Louisiana also said he is waiting to hear from leaders about revisions before deciding how he’ll vote.
The White House is stepping up its efforts to lobby for the legislation. Paul said he is meeting with President Donald Trump Tuesday afternoon to discuss the health-care bill.
“The bill is currently not real repeal and needs major improvement,” Paul said on Twitter.
Dinner with Pence
Vice President Mike Pence will attend Tuesday’s private Senate GOP meeting, and he’s invited at least four Republicans to join him for dinner at his Northwest Washington residence. That includes Lee, James Lankford of Oklahoma, Tom Cotton of Arkansas and Ben Sasse of Nebraska.
“There are a lot of good discussions underway,” Pence told reporters at the Capitol. “We’ll continue to work very diligently.”
McConnell can only lose two Republicans and prevail in his drive to begin debate and pass it under expedited procedures that require just 50 votes and a tie-breaker from Pence.
The political prospects for the overall bill remain unclear. Senate Republicans will meet behind closed doors Tuesday to talk strategy. Democrats are holding at least three press conferences to highlight their objections to the measure and to discuss the CBO findings.
Republican leaders insisted they still hope to hold a final vote this week, and McConnell got one piece of good news in the CBO estimate: an extra $200 billion in deficit savings compared to the House-passed bill.
Budget Wiggle Room
Some or all of that funding could be used to boost programs or subsidies to help win over moderates like Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Lisa Murkowski of Alaska and Collins, who have been seeking more help for opioid addiction, rural areas, subsidies for older people or slimmer Medicaid cuts.
If a deal is to be had, it would require more money for moderates, as well as more regulatory relief upfront for conservatives, who want a more drastic Obamacare rollback and to loosen Obamacare’s consumer protections, including one shielding people with pre-existing conditions from higher premiums.
Some holdouts are signaling their willingness to compromise.
Senator Ted Cruz of Texas said Tuesday his focus is still to add "reforms in the bill to reduce premiums. That is the central issue. It will be our test for success or failure, what happens to premiums."
Senate Minority Leader Chuck Schumer said the CBO report makes it clear "this bill is every bit as mean as the House bill.” He added, “I don’t count Senator McConnell out, but this is such a bad bill that even his legislative wizardry is having a rough time here.”
Medicaid and Deficit Cuts
The CBO estimated the Senate health bill would raise costs for many people currently enrolled in private insurance and slash Medicaid by billions of dollars. It would reduce the deficit by $321 billion over a decade, according to the nonpartisan agency, significantly higher than the $119 billion in estimated savings from the version passed by the House in May.
The CBO estimated that the law would lower premiums in the long term, but raise out-of-pocket costs. Premiums would rise over the next several years and then fall, relative to current law. In 2026, average premiums would be about 20 percent lower than they would be under Obamacare. That’s in part because coverage would be skimpier, and people would face higher deductibles and other cost-sharing.
For example, a 64-year-old making $56,800 in 2026 would have a $6,800 annual premium after an $8,500 subsidy for a silver-level plan covering 70 percent of their expected health costs under existing law. That person would face a $20,500 premium for the same coverage under the Senate bill and get no subsidy.