The Senate’s new health care bill is already on life support

Republicans can only lose one more vote on the motion to proceed.

Sen. Susan Collins, R-Maine is surrounded by reporters on Capitol Hill in Washington, Thursday, July 13, 2017, after a revised version of the Republican health care bill was announced by Senate Majority Leader Mitch McConnell of Ky. The bill has faced opposition and challenges within the Republican ranks, including by Sen. Collins. CREDIT: AP Photo/J. Scott Applewhite
Sen. Susan Collins, R-Maine is surrounded by reporters on Capitol Hill in Washington, Thursday, July 13, 2017, after a revised version of the Republican health care bill was announced by Senate Majority Leader Mitch McConnell of Ky. The bill has faced opposition and challenges within the Republican ranks, including by Sen. Collins. CREDIT: AP Photo/J. Scott Applewhite

The Senate’s new health care bill may be dead on arrival.

Republican leadership has been trying to find enough support for their health care bill with little luck in recent weeks. Moderates have expressed concerns about Medicaid cuts, while the most conservative members of the Senate have said the proposal doesn’t go far enough.

The GOP is trying to pass the bill via budget reconciliation, meaning a majority of the Senate must vote on a motion to proceed to allow the bill to go to the floor for debate.

McConnell can lose only three votes on the motion to proceed, and two Republicans — Sens. Susan Collins of Maine and Rand Paul of Kentucky — have said they will vote against this motion.

“Still deep cuts to Medicaid in Senate bill,” Collins’ office tweeted. “Will vote no on MTP. Ready to work w/ GOP & Dem colleagues to fix flaws in ACA.”

A spokesperson for Paul told reporters that Paul, too, is a no. In an interview Thursday morning, Paul said he would not vote “to create new entitlements for insurance companies.”

Several other lawmakers, including Sens. Rob Portman of Ohio, Mike Lee of Utah, Shelley Moore Capito of West Virginia, John Hoeven of North Dakota, and Dean Heller of Nevada, remain undecided about whether they will support the motion to proceed, while Sen. Jeff Flake of Arizona told reporters he was “still digesting.”

After huddling with other Senate Republicans Thursday morning for a briefing on the bill, Portman, who many see as one of the most likely potential holdouts, told reporters, “I’m in the same position as I’ve been in. Looking at the language and looking forward to the analysis.”

Sen. Cory Gardner of Colorado would not say whether he was a yes or no on the motion to proceed, saying he wants to see the Congressional Budget Office score first.

But he might never see it.

Sen. John Thune of South Dakota, a member of Senate Republican leadership, said Thursday that Republicans may not use the CBO to score a controversial amendment to the bill proposed by Sen. Ted Cruz of Texas. Instead, they may have Health and Human Services score the amendment, which could result in a much more favorable analysis.

Sen. Lisa Murkowski, a Republican from Alaska, was seen going into a meeting in Senate Majority Leader Mitch McConnell’s office with Portman, and an aide confirmed to the Washington Post that the meeting was about Medicaid. Both Portman and Murkowski have expressed concerns about previous versions of the health care bill going too far to cut Medicaid.

According to the Post, McConnell told moderates who were worried about the Medicaid cuts that they should vote for the bill anyway, as the cuts would not go into effect until long after their next election and that Congress will likely find a way to reverse the cuts by then.

At least one Republican, Cruz, has been persuaded by the changes, telling reporters that he will vote yes “if this is the bill.”

That’s likely because the version of the bill released Thursday includes an amendment proposed by Cruz, one of the most conservative members of Congress, that would allow insurers to sell non-compliant insurance plans as long as they offered at least one Obamacare-compliant plan.

That means insurers could sell plans that did not cover essential health benefits, a requirement under Obamacare that insurers cover 10 basic health care needs like maternity care, mental health care, and emergency room visits. The Cruz amendment also removes the community rating imposed by Obamacare, which requires that people of the same age in a given area are charged the same amount for premiums.

But with so many Republican senators on shaky ground, Cruz might never get a chance to debate the bill, let alone vote for it.

Two Republican senators, Sens. Lindsey Graham of South Carolina and Sen. Bill Cassidy of Louisiana, will vote yes on the motion to proceed, but Graham and Cassidy have also proposed an alternative to the Senate’s current health care bill. Their proposal keeps in place the taxes that Obamacare puts on the wealthy, but gives more control to states. It would also repeal the individual mandate.