Republicans have 'zero margin for error' to pass the Senate healthcare bill

After a secretive drafting process, Senate Republican leadership released a draft of its healthcare legislation Thursday, setting off a scramble to secure enough commitments for a vote Majority Leader Mitch McConnell wants to hold next week.

Democrats blasted the bill, while most Republicans took a more measured approach and left their intentions unknown.

Four GOP members — Rand Paul, Ted Cruz, Mike Lee, and Ron Johnson — announced they would not support the bill in its current form just a few hours after its release, but they all remained open to negotiation.

Many moderate members said they were taking time to read the bill and analyse its impact.

The uncertainty and the opposition currently puts the bill short of the 50 votes needed to pass — only two Republicans can defect, since Democrats plan to universally oppose it. That puts the Better Care Reconciliation Act of 2017 (BCRA) in a dicey position from the start.

Greg Valliere, the chief strategist and a long-time political analyst at Horizon Investments, said in a note to clients Friday that the conservative members, besides Paul, are likely to relent since failure to pass the bill “would mean Obamacare wins.”

In addition to Paul, Valliere said, the other likely “no” vote from the GOP is Sen. Dean Heller of Nevada, who is up for reelection in 2018 and facing an uphill battle in a state trending Democratic.

That leaves the deciding votes to moderates like Sens. Susan Collins of Maine and Lisa Murkowski of Alaska.

“Susan Collins’s popularity in Maine would surge if she votes no, and Lisa Murkowski in Alaska in on the fence,” Valliere wrote. “Throw in a handful of other shaky moderates like Rob Portman of Ohio, and McConnell is in trouble, with zero margin for error.”

Much of the outcome could hinge on the BCRA’s cuts to the Medicaid program. Portman, Murkowski, Heller, and other key GOP senators represent states that expanded Medicaid under the Affordable Care Act. They have expressed concerns over the changes to the program that provides low-income Americans with financial support to access health insurance.

As it stands, the BCRA rolls back the Medicaid expansion and includes deep cuts to the rest of the program, which could be a deal-breaker for those lawmakers.

Valliere pointed to public reaction that has been heavily against the GOP’s healthcare overhaul. The House version of the legislation, the American Health Care Act, has the lowest support in polls of any major piece of legislation dating back to 1990.

“Polls support the opponents — and Barack Obama, still popular, will lead the charge. There are other wild cards: the CBO ‘score’ early next week; strong opposition from the AARP, whose members vote; potential parliamentary objections; Planned Parenthood funding; and a lack of enthusiasm among House Republicans, who stuck out their necks only to have Trump call their bill ‘mean’,” Valliere said.

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