US Republican rebellion forces Senate vote delay on healthcare

A Republican rebellion forced the delay Tuesday of a Senate vote on the party's health care overhaul, an embarrassing setback for US President Donald Trump who was left scrambling to salvage the controversial plan.

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تاریخ: ۰۷ تير ۱۳۹۶ - ۱۰:۳۱

With the Senate bill delayed until after the July 4 congressional recess, the timeline of the effort -- and the overall viability of a years-long bid to dismantle Barack Obama's Affordable Care Act (ACA) in favour of a Republican replacement -- was thrown into question.

Senate Majority Leader Mitch McConnell acknowledged he did not have the votes after a non-partisan forecast projected the bill would swell the ranks of the uninsured by 22 million by 2026 as compared to current law.

"We will not be on the bill this week, but we're still working toward getting at least 50 people in a comfortable place," he said in announcing the delay.

"We're not quite there, but I think we've got a really good chance of getting there," he added. "It'll just take us a little bit longer."

McConnell is expected to huddle with his caucus to find ways of tweaking the bill that will placate several lawmakers who have expressed concerns with the legislation.

The ideological differences between conservatives and moderates within the party were so stark that it was clear leadership did not even have the 50 votes in the 100-member chamber needed to simply begin debate on the bill.

Republicans hold 52 Senate seats. They need at least 50 votes, as Vice President Mike Pence would break the tie in favour of the measure.

But at least nine Republican senators have now said they oppose the bill as is.

After the announcement, Republican senators headed to the White House for an urgent meeting with Trump, who made it clear that the pressure was on.

'Tinkering'

"We have to have health care, and it can't be Obamacare which is melting down," Trump said, as dozens of lawmakers sat grim-faced around a White House conference table.

But he also signalled that there might not be a path forward.

"This will be great if we get it done. And if we don't get it done it's going to be something that we're not going to like, and that's OK," Trump said.

The president had similarly intervened in March after House Speaker Paul Ryan was forced to pull the first version of that chamber's plan.

A tweaked bill then passed the House, with a handful of Republicans opposing it.

But Trump turned around and branded the House bill "mean," and wanted a Senate bill with more "heart."

The Senate delay is a huge blow to Republican lawmakers who have spent the last seven years plotting an end to the ACA, commonly known as Obamacare.

It also highlights the fractures within the party over how to improve the health care system while not cutting millions of Americans out of insurance coverage.

McConnell insisted after the Trump meeting that "everyone around the table is interested in getting to yes."

But a chasm remained.

"It's difficult for me to see how any tinkering is going to satisfy my fundamental and deep concerns about the impact of the bill," Senator Susan Collins, a Republican moderate, told reporters.

The Senate draft would save some $321 billion in federal spending over the 2017-2016 period, according to the Congressional Budget Office (CBO).

But it would balloon out-of-pocket medical expenses for the working poor and those age 50 to 64.

It would abolish the requirement for most Americans to have health insurance, likely resulting in healthy people dropping off the rolls.

And it provides hundreds of billions of dollars in tax cuts to insurers and the wealthy, while allowing states to drop currently mandated benefits such as maternity care and hospital services, according to CBO.

'Fundamentally flawed'

The bill would also delay cuts to the Medicaid health program for poorer Americans and the disabled, although Medicaid cuts would be severe in the long term.

Republicans want to gradually cap Medicaid expenditure -- which would mean 15 million people by 2026 would lose their benefits through the program, CBO projected.

The bill also maintains for two years the Obamacare tax credits that help lower-income Americans purchase coverage, but eventually transitions that program into one which provides fewer subsidies.

Conservatives say the bill does not go far enough and would retain too heavy a burden on government coffers. Moderates say they can support the number of uninsured Americans ballooning to pre-Obamacare levels.

Democrats accuse the administration of not lifting a finger to help stabilise the Obamacare health insurance exchanges. That insecurity has prompted insurance companies to flee, and costs to rise.

With the Senate bill in peril, Democrats amplified their call for Republicans to quit trying to kill the existing law and join forces in improving it.

"Let's come together, let's reason together, let's fix and improve that which is in the Affordable Care Act, and make it a (law) which serves everybody," number two House Democrat Steny Hoyer said.