Despite changes, tough road ahead for Senate healthcare bill as GOP pushes toward a vote

Sen. Rob Portman, R-Ohio, is one of the key swing votes regarding the Better Care Reconciliation Act. (Gage Skidmore / CC BY-SA 2.0)

Though Senate GOP leaders have now tweaked their healthcare bill in a bid to win more votes, they’re still struggling to gain enough support to ensure the measure will pass.

Senators Rand Paul, R-Ky., and Susan Collins, R-Maine, are both "no" votes on the revised Better Care Reconciliation Act, which Republicans released Thursday ahead of a planned vote next week.

That leaves Senate Majority Leader Mitch McConnell with no margin of error, as he can only lose two votes.

As for other senators on the fence, Julius Hobson, a healthcare lobbyist and attorney at the law firm Polsinelli, doesn’t think the picture looks good.

A combination of insufficient changes to the original bill’s Medicaid cuts and an inadequate level of funding for the opioid addiction fight makes him doubtful that Sen. Rob Portman, R-Ohio, and Sen. Shelley Moore Capito, R-W.Va., will support the measure, he said. Another undecided Republican, Dean Heller of Nevada, could also be a "no" vote if his state’s governor doesn’t support the revised bill, Hobson noted.

Indeed, wooing moderates is likely to be McConnell’s biggest problem, as the changes to the bill mostly moved it to the right. For instance, the newly revised draft includes an amendment floated by Ted Cruz, R-Texas, which allows insurers to sell plans that don’t comply with the Affordable Care Act’s coverage rules.

RELATED: 3 changes to the BCRA that healthcare leaders should know

“McConnell made the same tactical decision that [House Speaker Paul] Ryan made—he decided to negotiate with folks to the right rather than moderates,” Hobson said. But that doesn’t mean the Senate’s bill will pass like the House’s eventually did, he noted, since “Ryan had more leeway than McConnell.”

Much will depend upon what the Congressional Budget Office has to say about the revised bill; McConnell said Thursday that he expects a new score next week. That will pave the way for the Senate to vote on a motion for the bill to proceed, followed by what McConnell said will be a “robust debate and a robust amendment process.”

But if the CBO says the new BCRA will leave a similar number of individuals uninsured as it estimated for the first version, that will not bode well for the measure’s future.

And, “even if it lowers the number of people who will lose insurance, that may not be enough,” Hobson added.