House Republicans successfully passed the American Health Care Act on Thursday, but the bill is still a long way from becoming a law. Now all eyes turn to the Senate, where the GOP can't afford to lose more than two votes.
Many Republicans are already voicing concerns. "Don't know what it's in it," Sen. Lindsey Graham (R-S.C.) said Thursday, joking: "Waiting to see if it's a boy or a girl."
There are several major minefields that will have to be navigated, not least of which is Medicaid. "The American Health Care Act, as currently constructed, phases out the expansion of Medicaid and changes the funding for the whole program by introducing a spending cap based on the number of people enrolled," Vox writes. "Combined, those changes are expected to cut Medicaid spending by more than $800 billion over the next 10 years and lead to 14 million fewer people being covered by the program."
A spokesman for Sen. Rob Portman (R-Ohio) is already working "to ensure that those in the Medicaid expansion population who are receiving health care, and especially treatment for opioids, continue to have good treatment options after any reform proposal would take effect," Axios reports. Republican Sen. Susan Collins of Maine has additionally expressed concern about "how people with pre-existing conditions would be treated under the bill."
Axios describes Sen. Rand Paul (R-Ky.) as a "wild card" vote, while a skeptical Louisiana Sen. Bill Cassidy (R) said, "I expect the Senate to do something different. I don't expect we'll vote on the House bill as it is. I expect we will put forward our alternative."
Sen. Joe Manchin, a centrist West Virginia Democrat, warned his colleagues that a bipartisan compromise is the only possible solution. "I said, 'Mr. President, 172,000 West Virginians got insurance for the first time,'" Manchin told Politico. "They've got something they never had before. They don't know how they got it, they don't know who gave it to them, they don't know the Democrats, nothing about, 'It's ObamaCare.' They don't know any of that. All they know is they've got it."
"And you know what?" Manchin added. "They voted for you, Mr. President. They're going to know who took it away from them."