(Bloomberg) -- Senate Majority Leader Mitch McConnell’s decision to delay a vote on health-care legislation came as a relief to some Republican holdouts, but it sets off what will be a furious few weeks of talks to deliver on the GOP’s seven-year promise to repeal the Affordable Care Act.
Senate Republicans went to the White House Tuesday afternoon to meet with President Donald Trump, who also promised his political supporters he would do away with Obamacare. "We’re going to solve the problem," the president told senators.
But Trump also conceded the possibility that the health bill wouldn’t pass.
“If we don’t get it done, it’s just going to be something that we’re not going to like,” he said at the meeting. “And that’s OK, and I understand that very well.”
McConnell’s plan to pass a bill this week fell apart amid opposition from both the conservative and moderate wings of his party.
"The president got an opportunity to hear from the members who have concerns about market reforms and the future of Medicaid," the majority leader told reporters after the senators’ meeting with Trump. "Everyone around the table is interested in getting to yes."
McConnell needs support from at least 50 of the 52 Republicans to move forward with the measure, but at least five Republicans said they would vote to block Senate debate on the current version of the bill. Congress leaves Washington next week for a July 4 recess, and talks will continue during the break. Lawmakers will be back for three weeks before their August recess.
Alaska’s Lisa Murkowski said Republicans weren’t ready to make a decision this week. Delaying the vote was "an important step," she said.
She and other moderates were concerned about the bill’s sharp cuts to Medicaid for low-income Americans, while conservatives said the measure didn’t go far enough to uproot Obamacare. To pass a bill, McConnell must find a way to please one side without losing more support from the other.
The House mustered barely enough votes to pass its own proposal on May 4 after also having to cancel earlier vote plans for lack of support. McConnell released his proposal on June 22 after weeks of secret drafting.
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.
Five GOP senators had said they would refuse to bring McConnell’s bill to the Senate floor: Dean Heller of Nevada, Rand Paul of Kentucky, Ron Johnson of Wisconsin, Susan Collins of Maine and Mike Lee of Utah in saying they would refuse to bring the bill to the Senate floor.
Later, Jerry Moran of Kansas, Shelley Moore Capito of West Virginia and Rob Portman of Ohio also said they opposed the measure.
Hours earlier Tuesday, second-ranking Republican John Cornyn insisted to reporters that "we’re gonna vote, we’re gonna pass it" this week.
But the serious negotiating has yet to begin. McConnell and Senate GOP leaders hadn’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.
Keeping Up the Fight
Democrats said they’re planning to keep up the fight against the Republican legislation.
“McConnell is going to relentlessly work all recess to cobble together 50 votes,” Senator Chris Murphy of Connecticut wrote on Twitter. “We Will Work Harder.”
"We want to fix it," Senate Minority Leader Chuck Schumer of New York said in an interview. "But they’ve got to get rid of tax cuts to the rich, get rid of cutting Medicaid and we can talk."
McConnell plans to seek changes to the bill and a new CBO analysis, a Republican aide said.
Johnson said the goal is to get an agreement by Friday so the CBO can analyze it over the weeklong recess. He said Trump was "not at all" frustrated during the meeting.
Part of Republicans’ argument for urgency in replacing Obamacare is their repeated assertion that the health-care system is collapsing. While insurers including Aetna Inc., UnitedHealth Group Inc. and Humana Inc. have pulled out of the individual market in some states, part of that decision stems from uncertainty about the future of the Affordable Care Act as Republicans seek to dismantle that law.
McConnell said that either Republicans will agree on a health-care plan, "or the market will continue to collapse and we’ll have to sit down with Senator Schumer" to work out a bipartisan agreement.
"My suspicion is that any discussion with the Democrats would include none of the reforms that we’d like to make both on the market side and the Medicaid side," McConnell said.
Health and Financial Security
The health-care measure could dramatically affect many Americans’ health and financial security while also posing challenges to state governments facing proposed cuts in Medicaid coverage for low-income residents.
The Senate bill would reduce taxes on the wealthy, as well as on insurers, drug companies, device makers and tanning salons by $700 billion over a decade, paying for it with sharp cuts to Medicaid and with reductions to the subsidies that help middle-class people buy insurance on their own.
Medicaid spending would be cut by $772 billion over a decade, which would result in 15 million fewer people enrolled in the program in 2026 than under current law. Another 7 million wouldn’t have coverage in the individual insurance market.
The CBO estimated that the law would lower premiums in the long term, but raise out-of-pocket costs. 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.