Posts Tagged ‘Affordable Care Act’

Bernie Sanders to push for government-funded healthcare and abolition of private insurance

August 14, 2017

The issue has the potential to split the Democratic party

By Alexandra Wilts Washington DC

The Independent

Senator Bernie Sanders is relaunching his push for a government-funded healthcare system, but the move could further divide Democrats on a key issue as the party seeks to regain its footing at the state and national levels.

While defending Obamacare – which Republicans unsuccessfully tried to dismantle in July – the Vermont independent declared that the way forward in the long-term was a “Medicare-for-all” single-payer system, a federally administered programme that would abolish the role of private insurers in basic healthcare coverage.

Single-payer healthcare is a system in which the government, generally through taxes, covers basic healthcare costs for all residents regardless of income, occupation or health status.

“Medicare-for-all …will be saving middle-class families substantial sums of money, and it will be guaranteeing health care to every man, woman, and child in this country,” Mr Sanders, who caucuses with the Democrats, told CNN.

Mr Sanders will soon be introducing a bill in the Senate that would create this system, a major plank of his 2016 presidential campaign, even if he knows it is unlikely to pass in the current political climate.

An Urban Institute study of Mr Sanders’ single-payer proposal during the campaign said implementing the plan would increase federal expenditures by $32 trillion over 10 years. 

“Look, I have no illusions that under a Republican Senate and a very right-wing House and an extremely right-wing president of the United States, that suddenly we’re going to see a Medicare-for-all, single-payer passed,” Mr Sanders recently told NPR. “You’re not going to see it. That’s obvious.”

But he said the point of the bill is to force conversation about the idea.

“Senator Sanders has always believed that health care must be recognized as a right, not a privilege,” office spokesperson Daniel McLean told the Independent. “Like every other major country on Earth, every man, woman and child in our country should be able to access the health care they need regardless of their income.” 

The concept of a single-payer system is becoming increasingly popular in the Democratic party – senators including Cory Booker, Kirsten Gillibrand and Kamala Harris have expressed some support, and, for the first time, a majority of Democrats in the House of Representatives have now signed on to the single-payer bill that Congressman John Conyers has been introducing regularly for more than 10 years.

However, experts fear that supporting a single-payer programme could become a litmus test for Democrats, meaning members either support the bill or progressive political action committees, or PACs, try to prevent them from getting reelected.

“Any Democrat worth their salt that doesn’t unequivocally say Medicare-for-all is the way to go? To me, there’s something wrong with them,” Nina Turner, president of Mr Sanders’ Our Revolution PAC, told Politico. “We’re not going to accept no more hemming and hawing.”

While the progressive, and arguably most energetic, wing of the party has gotten behind the single-payer idea, it still remains a divisive issue for moderate Democrats. The proposal was notably excluded from Democratic leaders’ new economic agenda that was unveiled last month.

The party has been desperate to regain its mojo following its defeat last November, when it failed to win a majority in the Senate and Mr Trump triumphed over Democratic nominee Hillary Clinton.

It will be a challenge for the Democrats to retake a majority in both the House of Representatives and the Senate during the 2018 midterm elections. The party needs a net gain of 24 to have a majority in the 435-member House. And while they only need a net gain of three seats in the 100-member Senate, they are also defending 25 seats – 10 of which are in states that Mr Trump won.

“Single-payer healthcare as an issue is a worthy debate for the Democrats to be having,” said Jim Kessler, the senior vice president for policy for Third Way, a centrist think tank. “But it’s a huge mistake to make it a litmus test for Democrats at this point.”

Instead of pushing for a healthcare system overhaul in the US that Donald Trump will reject, some of suggested, all efforts should be focused on improving Obamacare – otherwise known as the Affordable Care Act – which still remains under attack by the President.

At the end of July, one vote prevented the Senate’s Republican leadership from passing a bill that would have repealed major provisions of former President Barack Obama’s healthcare law.

“We are one lousy election in November 2018 away from losing Obamacare,” Mr Kessler said.

“The stronger that Obamacare is, the great likelihood it will survive the next assault.”

Republican members of Congress, as well as Mr Trump, campaigned for years on repealing and replacing Obamacare, which they say has driven up premiums and forced consumers to buy insurance they do not want or cannot afford.

In June, when asked why Democrats aren’t countering Republicans with a single-payer plan, House Democratic Leader Nancy Pelosi said “it isn’t helpful to tinkle all over the Affordable Care Act right now.”

“The path to public option, single payer is in the Affordable Care Act,” she said. “It is not in distracting us from the focus of stopping what (Republicans) are doing to let people die..with their bill.”

Time for a second referendum on whether Britain should leave the European Union — End the politics of grievance — Former British foreign minister David Miliband

August 13, 2017


LONDON (Reuters) – Former British foreign minister David Miliband called on Saturday for voters to be given a second referendum on whether Britain should leave the European Union.

Writing in the Observer newspaper Miliband, foreign minister under a Labour government between 2007 and 2010, called Brexit an “unparalleled act of economic self-harm” and said there should be another public vote once the final terms of Britain’s exit are known.

Although no longer a serving British politician, Miliband – brother of former Labour leader Ed Miliband – is still seen as an influential centrist voice.

His criticism joins that of a growing number of pro-EU figures from across the political spectrum who say Prime Minister Theresa May’s Brexit strategy is economically damaging and that voters should be given a chance to halt the process.

Reporting by William James, editing by David Evans



Tory Brexit policy is chaotic: the fightback against this stitch-up must begin at once


Democracy did not end in June last year. It is essential MPs have a say on the future or the country may be driven off a cliff
David Miliband

David Miliband says Brexit was an “unparalleled act of economic self-harm”  GETTY IMAGE

For many years Britons and Americans have been proud of the quality of their governance. Yet today our politics and government are setting new standards for dysfunction. Rather than stability and global leadership there is confusion.

The US is suffering from a serious inability to legislate. There is a genuine risk of the country defaulting on its debts. Jeb Bush called Donald Trump the “chaos candidate”, but as the American writer Jonathan Rauch has pointed out the Trump candidacy was the product of political chaos – in campaign finance, for example – not its cause.

Meanwhile, Britain is suffering its own governability crisis. Leaving the EU was mis-sold as a quick fix. Now it looks like a decade-long process of unscrambling the eggs of national and European legislation. Ministers cannot even agree among themselves the destination, the route map or the vehicles to get us there.

This transatlantic malaise has a common root: politics based on what you are against, not what you are for. Look at the campaigns against the Affordable Care Act (Obamacare) and against the EU. There is a common trope: the politics of grievance.

Complaints about individual policies became attacks against a whole institutional architecture. There were outright lies in both campaigns. And there was a complete (and effective) refusal to describe, never mind debate, what would replace the status quo.

Healthcare makes up nearly a fifth of the US economy – about $1tn larger than the whole UK economy. Support for Obamacare is growing, dramatically, because the alternative has finally been spelled out. It turns out that populism is popular until it has to make decisions.

In Britain, the implementation of the EU referendum decision has been rash and chaotic. The timing and content has been governed by factions in the Tory party. Our negotiating position is a mystery – even on immigration.

So the fightback against the worst consequences of the referendum has the opportunity and responsibility to get its bearings fast. Recent calls from Stephen Kinnock, Heidi Alexander and William Hague for Britain to embrace the European Economic Area are sensible. Nick Clegg’s point that a reformed Europe centred on the euro implies outer rings which Britain should consider also makes sense.

I never thought I would say this, but the chancellor, Philip Hammond, is also playing a valiant role. The transition he supports is vital. However, a transition postpones a rupture rather than avoiding it. Slow Brexit does not mean soft Brexit. Steve Baker, minister in the department leading the negotiations, has been refreshingly honest in saying the transition period is a “soft landing for a hard Brexit”. We have been warned.

The case against the EU depends on avoiding a discussion of the alternative. It is the equivalent of voting to repeal Obamacare without knowing the replacement. It is a stitch-up. That is one reason it is essential that parliament or the public are given the chance to have a straight vote between EU membership and the negotiated alternative. That is a democratic demand, not just a prudent one.

People say we must respect the referendum. We should. But democracy did not end on 23 June 2016. The referendum will be no excuse if the country is driven off a cliff. MPs are there to exercise judgment. Delegating to Theresa May and David Davis, never mind Boris Johnson and Liam Fox, the settlement of a workable alternative to EU membership is a delusion, not just an abdication.

Brexit is an unparalleled act of economic self-harm. But it was a big mistake to reduce the referendum to this question. The EU represents a vision of society and politics, not just economics. We need to fight on this ground too.

The Europe of Emmanuel Macron and Angela Merkel stands for pluralism, minority rights, the rule of law, international co-operation – and not just a single market. In fact, the real truth about the single market has been lost in translation.

It is not just a market. It is a vision of the good society. Rights (and holidays) for employees, limits on oligopolies, standards for the environment are there to serve the vision. The single market stands against a market society.

This is all the more important in a world where autocratic leadership is on the march. This is not just about China or Russia. The democratic world is itself splitting into authoritarian and pluralist camps. We can see Venezuela has taken a repressive turn. Within the EU, there is a battle to hold Hungary and Poland to their commitments, and Brexit weakens that effort.

And the US is not immune. John Cassidy of the New Yorker has coined the notion of “democratic erosion” – gerrymandered congressional districts, voter suppression and attacks on the media. Half of Republican voters say they would support the decision if President Trump postponed the next election.

The EU is not just a group of neighbouring countries. It is a coalition of democratic states which pledge to advance human rights, the rule of law and democratic rules. That is not a threat to Britain; it is the team we should be in.

So Britain’s choice about its institutional future is not just about pounds and pence. I favour the closest possible relationship with the EU, not only for economic reasons. The EEA does not just make business sense. Europe represents a vital and historic alliance of democracies, founded on the idea that social, economic and political rights go together and that countries best defend them in unison not isolation.

History makes the point. The post-second world war commitments to rights for individuals have their immediate political origins in the Atlantic Charter, agreed between Churchill and Roosevelt in Newfoundland in 1941. It set out the terms of postwar peace – notably human rights, national self-determination and international co-operation. It was called the “birth certificate of the west” by the former German foreign minister Joschka Fischer.

The insight was simple. Globalisation without rules and institutions would not mean more control for ordinary citizens. It would mean less. And less control means more risk to the living standards of those in greatest need. International co-operation was and is a force for social justice and against turbo-capitalism.

President Eisenhower said when you had an insoluble problem, enlarge it. The debate about transitional arrangements and institutional design of our relationship with the EU craves a broader framework. There is nothing more fundamental than the economic, social and political rights that looked like the norm at the end of the cold war. Now they are in retreat. Europe is their bastion. And that is the side we should be on.

David Miliband is president and CEO of the International Rescue Committee, a humanitarian aid, relief and development NGO based in New York. He is writing in a personal capacity

Healthcare: Some Insurers Seek ACA Premium Increases of 30% and Higher — Senate Republicans Rebuff Donald Trump’s Health-Care Push

August 2, 2017

Companies say they are struggling to make decisions as Congress and White House wrangle over health care

Harland Stanley of Louisville, Ky. has an Anthem health-insurance plan, and Anthem has proposed an average rate increase of about 30%.
Harland Stanley of Louisville, Ky. has an Anthem health-insurance plan, and Anthem has proposed an average rate increase of about 30%. PHOTO: JESSICA EBELHAR FOR THE WALL STREET JOURNAL

Aug. 1, 2017 8:19 p.m. ET

Major health insurers in some states are seeking increases as high as 30% or more for premiums on 2018 Affordable Care Act plans, according to new federal data that provide the broadest view so far of the turmoil across exchanges as companies try to anticipate Trump administration policies.

Big insurers in Idaho, West Virginia, South Carolina, Iowa and Wyoming are seeking to raise premiums by averages close to 30% or more, according to preliminary rate requests published Tuesday by the U.S. Department of Health and Human Services. Major marketplace players in New Mexico, Tennessee, North Dakota and Hawaii indicated they were looking for average increases of 20% or more.

In other cases, insurers are looking for more limited premium increases for the suites of products they offer in individual states, reflecting the variety of situations in different markets. Health Care Service Corp., a huge exchange player in five states, filed for average increases including 8.3% in Oklahoma, 23.6% in Texas, and 16% in Illinois.

Together the filings show the uncertainty in the health-insurance marketplaces as insurers around the U.S. try to make decisions about rates and participation for next year amid open questions about changes that could come from the Trump administration and Congress.

Insurers face a mid-August deadline for completing their rates. The companies have until late September to sign federal agreements to offer plans in 2018. In some cases, insurers warn, the figures revealed by federal regulators may not reflect their up-to-date thinking.

The insurers’ decisions will be closely dependent on moves by the Trump administration and Congress. Most important is whether the federal government continues making payments that reduce health-care costs for low-income exchange enrollees, which insurers say are vital and President Donald Trump has threatened to halt.

Insurers are also concerned about whether the Trump administration will enforce the requirement for most people to have insurance coverage, which industry officials say helps hold down rates by prodding young, healthy people to sign up for plans.

In Montana, Health Care Service linked 17 percentage points of its 23% rate increase request to concerns about the cost-sharing payments and enforcement of the mandate that requires everyone to purchase insurance. Kurt Kossen, a senior vice president at Health Care Service, said the company’s rate requests are driven by causes including growing health costs and “uncertainty and the associated risks that exist within this marketplace, including uncertainty around issues like the continued funding of [cost-sharing payments] and mechanisms that encourage broad and continuous coverage.”

Sen. Lamar Alexander (R., Tenn.), who chairs the Senate committee that oversees health policy, said Tuesday that he had told Mr. Trump directly that the government should continue making the payments to insurance companies

The effect of the rate increases will be blunted for many exchange enrollees, because lower-income people receive federal subsidies that cover much of their premiums.

But increases could be tough to stomach for those who aren’t eligible for the help, like Harland Stanley, 53, of Louisville, Ky. Mr. Stanley, who owns his own research business, pays about $400 a month for a plan from Anthem Inc., which is seeking an average increase of 34% in the state, though Mr. Stanley’s own premiums might rise by less or more than that.

“It’s going to hurt,” said Mr. Stanley, who said his monthly premium this year is about $120 more than he paid in 2016. “I worry about, what if it keeps going? When is this going to stop?”

Anthem, which is seeking rate average increases of 30% or more in states including Colorado, Kentucky, Nevada and Virginia, has said it would refile for bigger hikes and may pull back its exchange offerings more if uncertainty continues around issues including the cost-sharing payments.

Centene Corp.’s requests ranged from less than 1% in New Hampshire to 21% in Texas and 12.49% in Georgia. Those rate proposals generally assume the current rules surrounding ACA plans continue, the company said.

Within the marketplaces, “there is relative stability,” said Chief Executive Michael F. Neidorff. “The uncertainty is driven by these policies on the ACA.”

CareSource, a nonprofit insurer that offers exchange plans in four states, has prepared alternate rate filings for different scenarios, and one of its state regulators Monday asked it to refile with proposed rates that assume no cost-sharing payments.

“It’s challenging; you learn to be very fluid,” said Steve Ringel, president of the Ohio market for CareSource. According to actuarial firm Milliman Inc., at least seven states have made similar requests in the past week, while others had earlier asked for two versions of rate filings.

“Resolution of the [cost-sharing payments] is an urgent issue,” said Bill Wehrle, a vice president at Kaiser Permanente, which offers exchange plans in a number of states. “We’re coming up at a point that’s fairly soon, where the pricing decisions we make are set for all of next year.”

The impact of potentially losing the cost-sharing payments was also clear in the rates requested by Blue Cross of Idaho, which average 28%. That would probably be in the lower teens if the payments were guaranteed, said Dave Jeppesen, a senior vice president. “It’s a big swing,” he said. “There’s a lot of risk associated with the uncertainty in Congress right now, and we are pricing appropriately for that risk.”

A recent Kaiser Family Foundation analysis found insurers’ financial results on exchange plans improved in the first quarter of this year, a sign of potentially emerging stability in the business. That is reflected in a number of states where rate-increase requests are limited. The exchange in California said Tuesday that insurers there were seeking an overall average increase of 12.5%—but there would be an additional 12.4% boost layered onto middle-tier “silver” plans if the cost-sharing subsidies aren’t paid.

However, in a number of cases, insurers’ rate requests are well above 20% because of market factors not directly tied to the federal uncertainty. Anthem has warned that it may need to add 18% to 20% to its existing rate requests if the cost-sharing payments aren’t locked in, and it may pull back in more states beyond the five exchanges where it has disclosed plans to leave or sharply reduce its footprint. An Anthem spokeswoman declined to comment on the company’s rate filings.

In Iowa, Medica said its rate increase request was 43.5%, driven by the dynamics of the local market, including the departure of other insurers and the fact that Medica itself has been losing money because enrollees’ health costs ran higher than expected. “You have some element of catching up to what the claims experience is,” says Geoff Bartsh, a Medica vice president.

Medica’s requests in other states have been far lower, he said, a sign of increased steadiness in those markets. But, he said, if the cost-sharing payments go away, Medica estimates it will need to add around 13% to 19% to its rate requests.

Write to Anna Wilde Mathews at

Appeared in the August 2, 2017, print edition as ‘Insurers Seek Hike In ACA Premiums.’


Senate Republicans Rebuff Donald Trump’s Health-Care Push
Lawmakers say they want to focus on a tax overhaul and critical fiscal legislation

President Donald Trump waves to the crowd while attending a small-business event in the East Room of the White House in Washington, D.C., on Tuesday.
President Donald Trump waves to the crowd while attending a small-business event in the East Room of the White House in Washington, D.C., on Tuesday. PHOTO: MARK WILSON/GETTY IMAGES

WASHINGTON—Senate Republicans made clear on Tuesday that they want to chart their own course to focus on a tax overhaul and critical fiscal legislation, bypassing requests from President Donald Trump and White House officials to keep health care their top legislative priority.

In his first press conference since a GOP health bill collapsed in the Senate, Majority Leader Mitch McConnell (R., Ky.) on Tuesday left health legislation off the list of items to be voted on before the chamber leaves for recess later this month, despite Mr. Trump’s calls for the Senate to dive back in.

Mr. McConnell, who has said he prefers to keep disagreements with the president private, also disclosed that he had told Mr. Trump that most senators don’t support changing the chamber’s rules to allow bills to pass on a simple majority vote, as the president urged on Twitter several times in the past week.

“There are not the votes in the Senate, as I’ve said repeatedly to the president and all of you, to change the rules of the Senate,” Mr. McConnell said.

Mr. McConnell was one of several senators in recent days who have resisted White House entreaties on health care, often expressed in language that is frank for leaders of the same party.

Sen. John Cornyn (R., Texas) took a shot at White House Budget Director Mick Mulvaney, who said Sunday that Congress should continue to work on health care rather than move on to other issues.

“I don’t think he’s got much experience in the Senate, as I recall,” Mr. Cornyn told reporters on Monday night about Mr. Mulvaney, who served three terms in the House. “He’s got a big job. He ought to do that job and let us do our job.”

A spokesman for the Office of Management and Budget said Mr. Mulvaney was merely conveying Mr. Trump’s view. “Health care is a priority for most Americans,” the spokesman said. “It should be for Congress as well.”

In an effort to keep the health-care effort front and center, Mr. Trump has threatened to take away government contributions toward the cost of lawmakers’ health care and to stop government payments to insurers that reduce copayments and deductibles for some of the poorest customers under the 2010 health law. Mr. Trump also has ousted White House staffers most closely linked to the Republican National Committee and the House leadership—former Chief of Staff Reince Priebus and spokesman Sean Spicer —as part of a staff shake-up.

Potentially rebuffing Mr. Trump’s plans, Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R., Tenn.) said Tuesday that his committee would begin drafting legislation this week to stabilize the Affordable Care Act’s fragile insurance markets, where people who don’t get health coverage through work purchase insurance. He said the committee aims to pass short-term legislation in mid-September.

For its part, the White House on Tuesday rejected a suggestion made at the White House press briefing that Mr. Trump’s agenda was suffering because he was losing credibility on Capitol Hill.

“What’s hurting the legislative agenda is Congress’s inability to get things passed,” White House spokeswoman Sarah Huckabee Sanders said.

Next on the Senate Republicans’ agenda is a tax overhaul. “We began to discuss today at lunch tax reform,” Sen. Bob Corker (R., Tenn.) said Tuesday. “That’s our next agenda item, and it’s something that regardless of who’s president we would want to be pursuing at this time.”

Senate and House Republicans plan to advance the issue in September after their recess and have been working with administration officials on a coordinated plan. But Senate Republicans also dismissed White House suggestions they take input from Democrats.

“I don’t think this is going to be 1986, when you had a bipartisan effort to scrub the code,” Mr. McConnell said.

Mr. Trump retains some support in Congress, despite the differences over legislative priorities in the Senate.

“He doubted Congress could repeal and replace Obamacare with no Democrat help,” said Rep. Chris Collins (R., N.Y.), one of Mr. Trump’s earliest supporters. “He was right, so Donald Trump’s not wearing this at all.”

Texas Sen. Ted Cruz, Mr. Trump’s rival for the 2016 GOP presidential nomination, agrees with his call to end the cost-sharing payments to insurers. “The answer is not simply to pass a bailout for insurance companies,” Mr. Cruz said. “That would be a mistake. It’s what the Democrats want.”

Congress also must pass legislation to fund the government beyond Sept. 30, when the current spending law expires, and it needs to raise the borrowing limit by the end of September.

The Treasury has been resorting to cash-management techniques in order to keep paying its bills, but its cash balance is expected to drop to near $25 billion in September, a precariously low level.

Some conservative Republicans have in the past demanded budget concessions in return for voting to raise the debt ceiling. Treasury Secretary Steven Mnuchin met early Tuesday with Mr. McConnell and Sen. Chuck Schumer (D., N.Y.), the top Senate Democrat, to urge Congress to raise the debt ceiling with no strings attached, according to aides. Mr. McConnell told reporters he was committed to raising the borrowing limit  “to make sure America continues to never, ever default.”

Democrats are holding back on entering negotiations on the debt ceiling until Republicans take a position on whether they will to attach conditions on an increase.

“They’ve got to make some decisions themselves about how they’re going to handle it,” Sen. Ron Wyden, an Oregon Democrat, said. “The leader, of course, is the executive branch.”

Write to Siobhan Hughes at, Natalie Andrews at and Janet Hook at

Appeared in the August 2, 2017, print edition as ‘Senate GOP Rebuffs Trump Health Push.’

GOP Senate Leader Mitch McConnell Abandons Health-Care Bill

July 18, 2017

Majority leader says “it is now apparent” Republican effort to repeal and replace Obamacare won’t be successful

Senate Majority Leader Mitch McConnell withdrew the GOP’s health-bill overhaul late Monday night.
Senate Majority Leader Mitch McConnell withdrew the GOP’s health-bill overhaul late Monday night. PHOTO: REUTERS

WASHINGTON—Senate GOP leaders gave up their effort to dismantle and simultaneously replace much of the Affordable Care Act, after the defections of two more Republican senators left the party short of the votes needed to pass President Donald Trump’s top legislative priority of his first seven months in office.

In a stinging defection for party leadership, GOP Sens. Mike Lee of Utah and Jerry Moran of Kansas on Monday night became the third and fourth Republicans to oppose the latest version of the GOP bill, which would roll back and replace much of the Affordable Care Act.

Senate Republicans had already lost two GOP votes, from Sens. Rand Paul of Kentucky and Susan Collins of Maine, and the new opposition from Messrs. Lee and Moran meant Senate leaders didn’t have enough support to advance the bill in a procedural vote.

Senate Majority Leader Mitch McConnell (R, Ky.) acknowledged the defeat. “Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful,” he said in a statement.

Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!

In a strategy facing long odds, the majority leader said the Senate would instead vote in coming days on a bill the chamber passed in late 2015 to unravel most of the ACA, which former President Barack Obama vetoed in January 2016.

Conservatives in both chambers and Mr. Trump have pressed to repeat the vote on the 2015 bill, which Mr. McConnell said would come as an amendment to the health-care bill passed by the House in May and would allow for a two-year transition.

“Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!” Mr. Trump tweeted shortly before Mr. McConnell’s statement.

Mr. Trump had embraced the idea earlier in July when it was proposed by Republican Sen. Ben Sasse, who noted that 49 sitting GOP senators had voted for a sweeping repeal bill earlier.

But many Republican senators have balked at this strategy, saying they wouldn’t feel comfortable rolling back the ACA without being able to tell their constituents what would supplant it.

Mr. McConnell’s latest tactic applies new pressure to conservatives who have so far blocked a bill they have said falls short of ACA repeal by offering them the chance to vote on exactly that. And while it is unlikely to become law, it also offers a way to move on from a bruising fight.

With 52 Republicans in the Senate, Mr. McConnell needed to secure at least 50 GOP votes, with Vice President Mike Pence casting a tiebreaking vote. No Democrats were expected to support the bill. The opposition from Messrs. Lee and Moran ended a frenzied period of negotiations aimed at shoring up faltering GOP support.

“In addition to not repealing all of the Obamacare taxes, it doesn’t go far enough in lowering premiums for middle-class families; nor does it create enough free space from the most costly Obamacare regulations,” Mr. Lee, one of the Senate’s most conservative Republicans, said in a statement Monday night.

Mr. Moran said he objected to the process used to craft the Senate GOP health-care bill, which he said “fails to repeal the Affordable Care Act or address health care’s rising costs.”

Messrs. Lee and Moran are likely to face backlash from Mr. Trump and his supporters, who were eager to see Republicans keep their seven-year promise to repeal the 2010 health law.

Their move comes as a surprise to many in Washington, since Mr. Moran rarely breaks with GOP leaders and Mr. Lee has often voted in step with Republican Sen. Ted Cruz (R., Texas), who introduced a key measure that GOP leaders incorporated into the bill last week.

On Monday night, the White House issued a statement that repeated a stance the president’s officials have taken in recent days—that GOP senators have no choice but to act.

“Insurance markets continue to collapse, premiums continue to rise, and Obamacare remains a failure. Inaction is not an option,” a spokesman said. “We look forward to Congress continuing to work toward a bill the president can sign to end the Obamacare nightmare and restore quality care at affordable prices.”

Republicans’ struggle to pass a health-care bill has exposed divisions within the party that could imperil other key items on their legislative agenda, including their yearslong push to overhaul the tax code.

Many had expected the next defection to come from the more centrist GOP senators, who have wavered over the latest version of the health-care bill, including Sens. Dean Heller of Nevada, who is up for re-election next year, and Republicans concerned about the bill’s cuts to federal Medicaid funding, such as Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia.

Democrats said it was time for Republicans to begin to work with them on strengthening the health-care system.

“This second failure of Trumpcare is proof positive that the core of this bill is unworkable,” Senate Minority Leader Chuck Schumer (D., N.Y.) said Monday night. “Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long term stability to the markets and improves our health-care system.”

The downfall of the bill is a tough blow for Mr. Trump, who has made it clear that undoing the 2010 law is a priority and has leaned heavily on fellow Republicans to make it happen. Mr. Trump said recently he would be very angry if the repeal legislation didn’t make it to his desk, and he was meeting Monday night with a handful of Republican senators to discuss the legislation.

Earlier Monday, the president promised Republicans would replace the law with “something that is going to be outstanding” and “far, far better than failing Obamacare.”

“We’re going to get that done,” he said, “and I think we’re going to surprise a lot of people.”

Health and Human Services Secretary Tom Price has already encouraged states to apply for waivers giving them more flexibility in enforcing the law and structuring their Medicaid programs. The waivers allow states to require many people to work to obtain their Medicaid benefits, among other changes.

Insurers will immediately be looking for assurances that the cost-sharing subsidies will be paid, said Larry Levitt, a senior vice president at the Kaiser Family Foundation. The drop-dead date for insurers will be mid to late September, when they have to sign contracts for 2018.

The individual insurance market has been stabilizing in most of the country and could continue just fine, Mr. Levitt said, but insurers will be reading the tea leaves for whether the Trump administration will make the subsidy payments they are expecting and enforce the individual mandate.

There are still some fragile markets, especially in rural areas, and they will likely require some shoring up to make sure insurers are participating and premiums are affordable, he said.

Write to Kristina Peterson at and Stephanie Armour at

Appeared in the July 18, 2017, print edition as ‘GOP Abandons Senate Health Bill.’


Revised Senate GOP Legislation Would Allow Insurers to Sell Cheaper Plans With Fewer Benefits

July 13, 2017

At least 10 senators opposed an earlier version of the bill

Updated July 13, 2017 1:16 p.m. ET

WASHINGTON—Senate Republican leadership on Thursday released revised legislation that would topple major parts of the Affordable Care Act, impose steep cuts on Medicaid, and allow insurers to sell cheaper plans that don’t meet the current law’s regulations.

The revisions to the health bill unveiled last month aim to bridge a yawning divide between conservative Republican senators who have resumed calls for a full repeal of the ACA…


Image may contain: one or more people


WASHINGTON — Senate Republicans unveiled their newest health care bill Thursday as they continue to search for the majority needed to repeal and replace Obamacare.

The revision includes a version of Texas Sen. Ted Cruz’s amendment, which would allow insurers offering Obamacare plans to also offer cheaper, bare-bones policies. This is meant to appeal to conservatives, but could also drive away moderates who are concerned the amendment would cause premiums to spike for those with pre-existing conditions.

It also contains significant new funding for opioid treatment and money for states meant to lower premiums for high-cost enrollees. But it would keep two Obamacare-era taxes on the wealthy and maintains significant cuts to Medicaid, meaning 15 million fewer people could insured by the program by 2026.

Majority Leader Mitch McConnell is still in search of the 50 votes he needs to pass the bill — he can only afford to lose two senators — but the hope for leadership is that a few changes may be able to finally get Republicans on a path to repeal and replace Obamacare after seven years of campaign promises.

There is still a long way to go. Already, Sen. Rand Paul, a conservative from Kentucky, has said he will oppose a key procedural vote next week. And, Sen. Susan Collins, a moderate from Maine, has also expressed doubts that she could support the bill unless it was completely overhauled.

Senators walking into a meeting of fellow Republicans mostly said they were unfamiliar with the revised bill.

Alaska Sen. Lisa Murkowski, one of the GOP holdouts, was unhappy that reporters had seen a summary distributed to lobbyists before she had seen the bill.

Asked if she was upset by how the process unfolded, she said “yes.”

“I think that as a courtesy to those of us who are actually making the decisions that we would actually have an opportunity to see it first,” Murkowski added.

President Donald Trump has lobbied to call for Republicans to move quickly. The President said Wednesday he would be “very angry” if Republicans can’t pass the bill.

“I don’t even want to talk about it because I think it would be very bad,” Trump said in an interview with the Christian Broadcasting Network. “I will be very angry about it and a lot of people will be very upset.”

What’s new?

The revised legislation has $45 billion in opioid treatment funding — a top request from senators like Rob Portman of Ohio and Shelley Moore Capito of West Virginia — as well as another $70 billion in state stabilization money aimed at lowering premiums for high-cost enrollees.

But another concern for moderate senators — that the Senate bill makes too steep a cut to Medicaid funding — was not addressed in the new version. The original bill calls for slashing $772 billion from Medicaid by 2026, compared to current law, leaving 15 million fewer people insured by the program.

In a retreat from a key GOP promise, the bill would also keep two Obamacare-era taxes on the wealthy. That came as members said they worried about the optics of cutting taxes for the rich while also slashing funding for subsidies that go to help low-income people to buy insurance. That money will help boost the stabilization fund, sources said.

Graham plan

Also Thursday, GOP Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana proposed an alternative approach to replacing Obamacare that would keep much of the federal taxes in place and sending that money to the states to control.

They say that one of the primary reasons Republicans are having such a hard time agreeing is because they are working from the Obamacare template — particularly federal control of health insurance.

Cruz amendment

Cruz’s so-called Consumer Freedom amendment is considered contentious among Republican senators with some moderates having raised concerns that it could hurt those with pre-existing conditions. The amendment would allow insurers to sell cheaper plans with fewer benefits that would likely attract younger and healthier Americans.

But that would cause premiums to spike for those who are sick and need more comprehensive policies.

The amendment has been key to getting Cruz to vote for the GOP plan to overhaul Obamacare. Cruz said Wednesday that his vote to advance the bill next week would depend on whether he was convinced premiums would lower with the GOP health care bill.

Sen. Mike Lee — a Utah Republican and close Cruz ally — tweeted Thursday morning to say that he has not seen the newest version of the Cruz amendment included in leadership’s health care bill and was unsure if he could support it.

There’s also no guarantee the Cruz amendment — in whatever form — will even get a Senate vote. It could be stripped from bill at any time as GOP leaders negotiate and work their way through Senate rules.

Insurers, who have largely stayed on the sideline in the health care debate, voiced strong opposition to the amendment, saying it would destabilize the individual market. Two major lobbying groups said this week that it would create two sets of rules and make coverage unaffordable to those who are sick.


GOP Health-Care Push Gets Trickier

July 9, 2017

Divisions within the party complicate McConnell’s path

The U.S. Capitol, shown in late June, will be the focus of health-care maneuvering as lawmakers return from their recess.

The U.S. Capitol, shown in late June, will be the focus of health-care maneuvering as lawmakers return from their recess. PHOTO: SAUL LOEB/AGENCE FRANCE-PRESSE/GETTY IMAGES

A weeklong recess has only made Senate Republicans’ path toward health legislation harder, with lawmakers returning to Washington facing at least one more defection and negotiations sputtering between conservatives and centrists.

In addition, a concession by Senate Majority Leader Mitch McConnell (R., Ky.) over the recess that lawmakers would have to act to stabilize health-insurance markets if GOP senators can’t agree on legislation drew sniping from within his own party.

The recess, which GOP leaders hoped would spur Republican senators to coalesce around a bill to overturn much of the Affordable Care Act, instead saw lawmakers getting an earful from constituents and casting further doubts on the Republican plan. Sen. John Hoeven of North Dakota told a local newspaper that he doesn’t support the current legislation, joining nine other members who had already come out against it.

Negotiations over changes to the bill to bring more Republicans on board have reached an apparent standoff. Conservatives, like Mike Lee of Utah, are insisting on a provision that would let insurers sell cheaper, less-comprehensive plans. But centrists have signaled they would oppose such a measure, fearing it would erode protections for people with pre-existing health conditions.

The intraparty divide presents a tough obstacle for Mr. McConnell. Republicans initially aimed to get health legislation to President Donald Trump’s desk by early April, according to a presentation by GOP leaders. Then a vote was planned for just before the recess, but Mr. McConnell, of Kentucky, was forced to postpone it.

Now a vote, if one occurs, would likely come in mid-to-late July, with Congress’s August recess serving as the next deadline. If that fails, the legislative calendar would only get more difficult.

While the ACA funds expansions in health coverage with taxes on health industries and high-income households, the GOP bill does the reverse. It would repeal taxes and lower projected government spending toward Americans’ health coverage while phasing out the ACA’s Medicaid expansion and cutting Medicaid more broadly. It would reduce the ACA’s tax credits for low-income consumers and would let states get waivers from some insurance regulations. It also would scale back ACA requirements imposed on employer-based health plans.

The most conservative senators say the bill doesn’t go far enough toward repealing the ACA, while more centrist lawmakers such as Sen. Susan Collins of Maine worry that it guts too much of the current law and takes coverage from too many people.

The legislation would leave 22 million more people uninsured in a decade compared with the ACA, according to the nonpartisan Congressional Budget Office.

As Republicans struggled to unite behind a bill, Mr. Trump said in late June that if they can’t, they should pass a bill repealing the ACA, sometimes called Obamacare, and then work on a replacement. Mr. McConnell has shown little enthusiasm for that idea, and some Capitol Hill aides say Mr. Trump’s suggestion has complicated the ability to get legislation passed.

The majority leader, who presides over a narrow 52-48 majority, can only afford to lose two GOP votes and still pass the bill, with Vice President Mike Pence breaking a potential 50-50 tie.

Mr. McConnell hoped to assemble a revised bill over the recess, but publicly at least, Senate Republicans seem at least as polarized as before. Mr. Hoeven said he is concerned the bill doesn’t do enough to help low-income people in his state and those with pre-existing conditions.

Still, he said he hopes health-care legislation, possibly composed of multiple bills instead of one, would pass.

“I think there’s a number of ways to do it, but we’re going to have to make sure that between Medicaid and the refundable tax credit that we have a good option for low-income individuals,” he said in an interview last week.

Conservatives responded sharply to Mr. McConnell’s suggestion that Republicans, presumably working with Democrats, would have to pass a measure to stabilize the insurance markets if they couldn’t agree on their own health bill. Such efforts could include continuing billions of dollars in payments to insurers to offset their costs for providing subsidies that lower out-of-pocket costs for low-income consumers. Mr. Trump has threatened to stop those payments.

“If the Republican Party wants to work with Democrats to bail out Obamacare, the results will be catastrophic for the party,” said Michael Needham, CEO of Heritage Action. “For seven years it has pledged it is the party of repeal, and now is the time to work toward that goal.”

A recent proposal from Sen. Ted Cruz (R., Texas) has also provoked divisions. It would let insurers that sell plans complying with ACA regulations to also sell health policies that don’t.

Health analysts say that would likely cut premiums for younger, healthier people, who would buy more limited policies, while causing premiums to rise for people with pre-existing conditions who would buy the more comprehensive plans that comply with the ACA.

Conservative groups are insisting the Cruz proposal be a part of the Senate legislation. Mr. Cruz’s plan has been sent to CBO, which is expected to provide an analysis of its financial and coverage impact as early as this week, according to a person familiar with the talks.

Mr. Cruz has said that providing additional choices would lower premiums for many, and that sicker people would still have options. “Under this amendment, the protections for pre-existing conditions remain there,” Mr. Cruz told a Dallas television station.

But Democrats said the plan would create a bifurcated system with insurance becoming increasingly expensive for older, less-healthy individuals. “This is nothing more than a two-track system for making Trumpcare even meaner,” said Sen. Patty Murray (D., Wash.).

Write to Stephanie Armour at

Trump says Obamacare should be repealed even if it’s not replaced with anything

July 2, 2017

Senators from different wings of the Republican party disagree with key parts of the Obamacare repeal and replacement bill

By Alexandra Wilts Washington DC

The Independent

trumpcare-protest.jpgActivists march around the US Capitol to protest the Senate Republicans’ health care bill Getty Images

Donald Trump is calling for Senate Republicans to repeal Obamacare – even if they have no bill to replace it with.

A proposal to repeal and replace Obamacare, officially known as the Affordable Care Act, has struggled in the Senate, with senators from different wings of the Republican party disagreeing on key aspects of the plan.

Moderate senators worry that millions of people would lose their insurance following cuts to Medicaid – a healthcare programme for the poor – while conservatives assert that the bill does not do enough to erase Democratic former President Barack Obama’s signature domestic legislation.

The senators’ efforts were complicated on Thursday when the nonpartisan Congressional Budget Office reported that the Senate proposal would cut spending on government Medicaid by 35 per cent come 2036.

“If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” Mr Trump wrote on Twitter.

Republican Senator Ben Sasse, who said this week that he was not satisfied with the Senate healthcare measure, appeared to welcome Mr Trump’s suggestion.

If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!

“Sounds great, Pres. @realDonaldTrump,” Mr Sasse wrote in a response on Twitter. “We are agreed. We need to break the logjam.”

However, the prospect of not having an alternative to Obamacare in place has raised concerns that insurance markets would collapse and people not insured under the ACA would be left with few or no options for coverage, hitting the poor particularly hard.

Senator Rand Paul, a leading voice on the conservative wing, wants to ditch more parts of Obamacare and supports splitting the Senate healthcare bill into two – one for repeal and one for spending.

“You can repeal the taxes, you can repeal some of the regulations – I prefer all of them – and you can also do some Medicaid reform. That could be in a repeal bill, and it will be a much narrower and much cleaner repeal,” he told MSNBC.

Sounds great, Pres. @realDonaldTrump

We are agreed. We need to break the logjam. 

Photo published for Sasse Sends Plan B to Trump: If No Agreement Next Week, Repeal First and Spend August on Replace

Sasse Sends Plan B to Trump: If No Agreement Next Week, Repeal First and Spend August on Replace

Sasse Sends Plan B to Trump: If No Agreement Next Week, Repeal First and Spend August on Replace

Asked about that option, White House adviser Kellyanne Conway said, “That’s a very strong possible alternative strategy.”

She told Fox News that the White House was confident healthcare reform can get done this summer, followed by tax reform.

Mr Trump’s proposal for the Senate to just repeal Obamacare comes after he told reporters earlier this week that “healthcare is working along very well…we’re gonna have a big surprise. We have a great healthcare package.”

The President also told Republican senators during a meeting at the White House that “this will be great if we get it done.”

But appearing to recognise the opposition the healthcare bill faces, he added: “And if we don’t get it done, it’s just going to be something that we’re not going to like. And that’s okay, and I understand that very well.”

With a majority of 52 senators, Senate Majority Leader Mitch McConnell can only afford two defections on the bill and still be able to pass it. No Democrats are expected to vote in favour of the legislation.

Mr McConnell is trying to send a revised version of their healthcare bill to the Congressional Budget Office so that the nonpartisan group can measure the legislation’s impact on coverage levels and federal spending by the time senators return to Washington DC in mid-July.


GOP senator calls for ObamaCare repeal first, replacement LATER

June 30, 2017

The Hill

 Image may contain: 1 person, smiling, closeup

Sen. Ben Sasse (R-Neb.) told Fox News on Friday that if Republicans can’t pass a bill to replace ObamaCare soon, they should repeal the entire law and work on a replacement later.

Speaking on “Fox and Friends,” Sasse said that if progress isn’t made by July 10, he’ll call on the president to separate the process.

“To date, we’ve been trying to do those two things at once, and not been making enough progress” Sasse said. “I still hope that process can work, but most people are leaving D.C. today to go home for the Fourth of July weekend.”

“If we don’t get this resolved by the Monday of next week, July 10, if there isn’t a combined repeal-and-replace plan, I’m writing a letter to the president this morning urging him to call on us to separate them,” he told Fox News.

Sasse said that the GOP has the votes it needs in the Senate to repeal ObamaCare, and it should focus on that first.

“Every Republican except one has already voted for repeal in the past,” Sasse said. “Let’s do that first, if we can’t do them together.””Let’s do as much repeal as we can,” Sasse continued, “And then let’s ask the president to cancel our August 8 work period, and then stay here and work on replace separate.”

Nine GOP senators have already said they won’t vote for the Senate’s bill to replace ObamaCare in its current form. The Senate GOP holds a 52-48 majority, meaning they can afford just two Republican defections and still pass the bill.

Includes video:


Senators Urge Trump to Back Wholesale Obamacare Repeal if GOP Bill Stalls

June 30, 2017

‘We must keep our word,’ says Ben Sasse of Nebraska

U.S. Sen. Ben Sasse listens to testimony before the Senate Committee on the Judiciary on June 21.

U.S. Sen. Ben Sasse listens to testimony before the Senate Committee on the Judiciary on June 21. PHOTO: ZUMA PRESS

June 30, 2017 8:24 a.m. ET

WASHINGTON—Two key senators in the Republican effort to pass a health-care bill on Friday morning called for the White House to intervene with a more aggressive strategy if Senate Majority Leader Mitch McConnell hasn’t locked in 50 votes by the time lawmakers return from the July 4 recess—and President Donald Trump seemed to embrace the idea.

Sen. Ben Sasse of Nebraska said that congressional leaders’ prospects of overturning parts of the 2010 Affordable Care Act and enact their own provisions in its place were dimming. He said the party’s best hope for passing a health-care bill now could be to wipe out the law in its entirety, then work on a deal to fill the void.

“On the current path it looks like Republicans will either fail to pass any meaningful bill at all, or will instead pass a bill that looks to prop up many of the crumbling Obama care structures,” he said in a letter he announced he was sending to the White House.

“We must keep our word. Therefore, if on July 10 we don’t have agreement on a combined repeal and replace plan, we should immediately vote again on H.R. 3762, the December 2015 Obamacare repeal legislation that the Congress passed but President Obama vetoed.”

Within minutes of Mr. Sasse’s announcement, which he also discussed on “Fox & Friends,” Mr. Trump suggested his support in a tweet.

If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!

“If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” he wrote.

Rand Paul of Kentucky, another senator whose support could make or break the legislation’s prospect, also endorsed the idea.

“I have spoken to @realDonaldTrump & Senate leadership about this and agree. Let’s keep our word to repeal then work on replacing right away,” he said on Twitter.

I have spoken to @realDonaldTrump & Senate leadership about this and agree. Let’s keep our word to repeal then work on replacing right away.

Conservative grass-roots groups have long pointed to the “dry run” vote that 49 current GOP senators took in 2015 under President Barack Obama to repeal the law they call “Obamacare,” saying that it put them on record as supporting a more sweeping measure than some are willing to accept.

Mr. Sasse said that another two GOP senators who have since joined Congress should also be expected to support the measure. The 52nd, Susan Collins of Maine, was in office but did not support it in 2015, but such a bill could pass with only 50 votes assuming it had the support of Vice President Pence. Mr. Sasse also said the Senate should stay in town for the month of August, working six days a week to pass replacement legislation by Labor Day.

Mr. Sasse has bucked the administration on things including the firing of FBI Director James Comey and Mr.Trump’s tweets. But he had kept his position on health-care legislation relatively quiet, even as almost a dozen other centrist and conservative Republican senators made various misgivings known. On Friday, he replied warmly to Mr. Trump’s suggestion on Twitter.

Glad you agree, Mr Pres. If no agreement next wk, 2 steps:
1. Repeal 1st; then
2. Spend August full-time on replace: 

“Glad you agree, Mr. Pres.” If no agreement next wk, 2 steps: 1. Repeal 1st; then 2. Spend August full-time on replace,” he wrote.

Senate Republicans can afford to lose no more than two votes to pass health-care legislation, counting on Vice President Mike Pence to break a tie and assuming no support from Democrats.

The White House had been eyeing Mr. Sasse and a handful of other undeclared conservative legislators; earlier this week, Sens. Sasse, James Lankford of Oklahoma and Tom Cotton of Arkansas dined with Mr. Pence, joined by the more openly critical Mike Lee of Utah.

Mr. Sasse’s move makes clear the extent of the challenge now facing Mr. McConnell, who in the past week has already seen an unusual rebuke to his authority when senators threatened to block a motion to proceed with a vote on the health-care bill.

But it also exposes the long-running pressure that GOP leaders from Mr. McConnell to Mr. Trump are under to mediate disputes between competing wings of the party.

Conservative groups have said since Mr. Trump’s election that they want to hold newly empowered Republicans to their campaign-trail promises to repeal Obamacare and replace it with a substantially different health-care policy.

Centrist Republicans have sought to retain popular provisions of the law, fearing disruption and a backlash if people lose coverage or states face funding crunches.

And both sides say they want to ensure that Republicans, now in control of both Congress and the White House, can notch legislative wins.

Write to Louise Radnofsky at


Short on Backers, GOP Delays Vote on Health Bill Until After July 4 Recess

June 28, 2017

Senate Majority Leader McConnell tells lawmakers vote wouldn’t happen until July 4 recess

Senate Republicans Delay Vote on Health Bill
Image may contain: 3 people, suit
Sen. Mitch McConnell (R., Ky.) announced on Tuesday that Senate Republicans have delayed a vote on their health-care bill until after the July 4 recess. McConnell added that President Trump has been “very involved” in helping push the bill, which currently doesn’t have enough support to pass. Photo: AP

Senate Republican leaders abruptly postponed a vote Tuesday on a sweeping health-care bill until after Congress’ July 4 recess, setting off a high-stakes lobbying sprint that could determine the fate of the GOP’s legislation to topple most of the Affordable Care Act.

Senate Majority Leader Mitch McConnell (R., Ky.), who worked for weeks in closed-door sessions to craft a bill, told lawmakers that a vote wouldn’t happen until Congress returns from recess the week of July 10.

The delay came after efforts stalled to tweak the legislation and garner support from the nine Republican senators who now oppose the bill. The Republican opposition was significant enough that even a routine procedural motion allowing the vote to proceed faced potential defeat.

In a test of his leadership, Mr. McConnell now will need to bridge a divide between conservative Republicans, who say the bill retains too many of the ACA’s regulations to significantly lower premiums, and GOP centrists, who worry the legislation goes too far in cutting funding to Medicaid.

From now until Congress’ return from the recess, there is likely to be a run of deal-making, arm-twisting and lobbying, with voters voicing their opinions in town-hall meetings, Republican leaders offering changes and organizations trying to sway senators on all sides.

The delay is a setback for President Donald Trump and Mr. McConnell, who had promised a vote this week. On Monday, Sen. John Cornyn of Texas, the second-ranking Senate Republican, tweeted that “I am closing the door” on a delay because “we need to do it this week.” On Tuesday, asked if the door was back open, Mr. Cornyn tweeted, “Just a crack.”

Still, Senate leaders took comfort from the experience of House Republicans, whose own health bill was initially declared dead. They were then able to regroup, bring it to the floor and pass it in May.

Senate Republicans say they must pass the legislation before Congress’ August recess. If that doesn’t occur, the path ahead would become more difficult and other parts of the GOP agenda would be at risk. Success, on the other hand, could boost momentum for other Republican priorities such as a tax overhaul.

Republican senators said the delay had become unavoidable, especially after the nonpartisan Congressional Budget Office found the bill would result in 22 million more people uninsured than the ACA over the next decade.

“It’s the only way forward. People have issues that need to be addressed,” said Sen. Bob Corker (R., Tenn.) Tuesday, who has said he has some concerns about the bill but hasn’t come out against it. “I read the CBO report this morning at about 4 a.m., and as you go through it, it raises questions and they’re legitimate.”

GOP leaders will try to hammer out a compromise in coming days. “The hope is that we can at least have an agreement on what we can get enough votes on this week and turn to it when we get back,” said Sen. Marco Rubio (R., Fla.). “It’s possible. I can’t tell you if it’s likely until we know more about what options are to address people’s concerns.”

Others were less optimistic. Sen. Shelley Moore Capito (R., W.Va.), who objected to the level of Medicaid cuts in the bill, said senators are “coming at it from all angles.” She said she isn’t sure “how or if” Republicans can come together behind a final version.

Democrats said Republicans’ struggles reflected the bill’s underlying problems, particularly the fact that it would reduce health coverage while giving a tax cut to the wealthy.

“While I’m glad that Senate Republicans have delayed the vote on their health plan, this isn’t cause for celebration,” said Sen. Al Franken (D., Minn.). “This bill, which has been misguided from the start, needs be thrown out.”

Mr. McConnell’s challenge is that the bill’s GOP opponents come from both wings of his party, and appeasing one faction could harden the other side’s resistance.

Conservative Sens. Mike Lee of Utah, Rand Paul of Kentucky, Ted Cruz of Texas and Ron Johnson of Wisconsin are pushing for more deregulation and lower premiums. Sen. Jerry Moran of Kansas also joined the bill’s opponents on Tuesday, saying the sprint to a vote should be slowed down.

Centrist senators opposing the bill are especially concerned about cuts to the Medicaid program, including Sens. Susan Collins of Maine, Dean Heller of Nevada, Rob Portman of Ohio and Ms. Capito.

Mr. McConnell can only afford to lose two of the 52 Republicans in the chamber, with Vice President Mike Pence able to break a 50-50 tie. No Democrats are expected to support the health-care bill.

Securing the votes would be a major coup for Mr. Trump, who largely stayed on the sidelines of the Senate discussions until recently. After the vote was postponed Tuesday, the president summoned all Republican senators to the White House.

Key centrists—including Ms. Collins, Sen. Lisa Murkowski of Alaska and Sen. Cory Gardner of Colorado—were seated near the president. Mr. Trump opened the meeting with exhortations to get the bill passed, saying “we’re getting very close.”

He added, “We have really no choice but to solve the situation,” arguing the ACA, sometimes called Obamacare, is collapsing, an assertion disputed by Democrats.

Mr. McConnell, speaking outside the White House, said “we made good progress” inside. He said the president had heard from conservative Republicans about their calls for insurance-market changes, and from others about the future of Medicaid.

“The one thing I would say is that I think everybody around the table is interested in getting to yes,” he said, “because we know the status quo is simply unacceptable and unsustainable, and no action is simply not an option.”

Separately, Mr. Pence had half a dozen meetings Tuesday afternoon, including with Messrs. McConnell and Portman, and hosted another four senators for dinner at the vice president’s residence in the evening.

Both chambers have to pass the same legislation, and there are several paths to do that. The fastest way would be for the House to vote on the version that passes the Senate. Rep. Mark Meadows (R., N.C.), chairman of the House Freedom Caucus, a group of three dozen conservative House Republicans, said Tuesday that amendments would need to be added to get enough Republicans there to support it.

“If it’s predominantly the bill that’s currently in the Senate without significant amendments, there would not be enough votes in the House or the Senate to pass it,” Mr. Meadows said.

The Senate bill would strike down much of the ACA, including a requirement that most Americans have insurance or pay a penalty. It would provide smaller tax credits than the ACA’s to help people buy insurance, and it would impose steep spending cuts to Medicaid as well as phasing out enhanced federal funding to the 31 states that expanded the program under the current health law.

Republican leaders hope the delay gives them time to reverse the defections and build support, but they acknowledge it could give opponents time to mobilize against the bill. “The politics of this doesn’t get any easier the longer you wait,” said Sen. John Thune (R., S.D.). But he added, “If we can make some changes that improve the policy in a way that makes it more likely that we can get 50 of our senators to vote for this, then this was a good judgment on behalf of the leader.”

At the same time, some Republican governors continue to express concern.

Ohio Gov. John Kasich, a frequent critic of the GOP health efforts, said the Senate bill was “unacceptable.” Echoing Democratic complaints, Mr. Kasich said the bill didn’t provide adequate funding for resources such as Medicaid and tax credits that help low-income people obtain insurance, in exchange for tax breaks to the “already very wealthy.”

Write to Stephanie Armour at and Kristina Peterson at

Includes videos: