Donald Trump to help Senate with health care bill vote

President Trump may be called upon once again to deliver support for a Republican health care bill as the Senate angles for a vote next week.

For weeks, Mr. Trump has given Majority Leader Mitch McConnell of Kentucky breathing room to write a bill, cheering on the effort from the sidelines. But with a floor showdown looming, the president plans to ratchet up his involvement with the sorts of phone calls and tweets that helped get a bill through the House last month.

“I think it helps when he speaks to the specifics of what we’re trying to accomplish here,” said Sen. Thom Tillis, North Carolina Republican.

Senate Republicans have been writing their bill in secret, but Mr. McConnell plans to release a discussion draft Thursday. Republican lawmakers are hoping for a bill that lowers customers’ premiums and chases fewer people out of the health care markets than the House bill.

But Republicans will need near unanimity to pass the bill, and resistance is strong among a sizable chunk of Senate Republicans, who dislike the process or the substance of the legislation.

“I personally think that holding a vote on this next week would definitely be rushed,” Sen. Ron Johnson, Wisconsin Republican, said on CNN. “I can’t imagine, quite honestly, that I’d have the information to evaluate and justify a yes vote just within a week.”

He received a tacit rebuke from Wisconsin Gov. Scott Walker, who said Republicans will have no excuses if they balk at their primary chance for repeal.

Republicans insist that Obamacare is collapsing and say they are on what amounts to a rescue mission. They say the choice is between their solution and a disaster.

The Affordable Care Act’s woes deepened Wednesday as insurer Anthem said it was largely exiting Wisconsin and Indiana.

“This law has failed our state,” said House Speaker Paul D. Ryan, Wisconsin Republican.

He harnessed Mr. Trump and other top administration officials this year to bridge gaps among House Republicans and deliver passage of a plan that would lower costs for younger, healthier Americans — though it would free insurers to raise costs for those approaching Medicare eligibility, and would leave tens of millions fewer people insured within a decade, according to the Congressional Budget Office.

Mr. Trump has been increasing his efforts on the Senate side in recent days. Last week, he hosted more than a dozen Senate Republicans at the White House to build unity ahead of the bill’s unveiling.

The White House launched a webpage to encourage Obamacare repeal, and the administration has deployed Health and Human Services Secretary Tom Price to highlight the rising rates and declining choices in Obamacare’s exchanges.

“It is clear that Obamacare needs to be fixed, and that is what we are focusing on. Our team here is working with Senate leadership to support them as they work though proposing a bill that will work for all Americans,” said White House deputy press secretary Lindsay Walters.

At a rally in Iowa on Wednesday, Mr. Trump said passing a repeal bill is achievable, even if it’s an uphill struggle.

“We have a very slim, 52-48 [majority.] That means we basically can’t lose anybody,” Mr. Trump said. “I think and I hope — I can’t guarantee anything — but I hope we’re going to surprise you with a really good plan.”

He also took credit for urging senators to reinvest federal savings into from the House bill into the Senate plan, saying he wants a bill with “heart.”

Earlier Wednesday, senior White House officials attended an HHS listening session with health care consumers, including retirees, business owners, doctors and insurance agents.

Kellyanne Conway, counselor to the president, told the gathering that repealing and replacing Obamacare was not just a campaign promise, but “an imperative” for the president.

Yet the headwinds are growing.

A Politico-Morning Consult poll released Wednesday said opposition to the Republican health care plan has doubled from 15 percent to 30 percent among Republican voters since late April, shortly before the House passed its version.

Democrats are calling on Republicans to help sink the bill next week. Just a few defections from the 52-seat Republican majority could doom the repeal effort.

“If three of them will step up and say this is wrong then we can roll up our sleeves and do the right thing for America,” said Sen. Richard J. Durbin, Illinois Democrat.

Among the items conservative Republican lawmakers will be looking for in the draft bill is a provision to gut as many of Obamacare’s strictures as possible. Moderate Republicans, meanwhile, are looking for a gradual phaseout of Obamacare’s vast expansion of Medicaid, hoping to shield states from a major funding cliff.

Some thorny social issues are also rearing their heads.

Mr. Tillis said drafters are researching ways to ban consumers from using refundable tax credits offered in the plan to pay for abortions. The House version contained a prohibition, but the Senate parliamentarian is likely to rule that it flouts the budget rules that govern the debate.

Barring the use of taxpayer assistance for abortion is key for conservatives, who say the overall plan already is falling short of expectations.

Democrats, meanwhile, are ratcheting up their resistance, hoping to apply enough eleventh-hour pressure to sink the Republican effort.

Sen. Bernard Sanders, Vermont independent, told progressive demonstrators on Capitol Hill on Wednesday “to rally the American people, to tell the Republican leadership, ’Yes, let us improve Obamacare, but we’re not going to destroy it.’”

Democrats say Medicaid cuts in the Republican plan will be devastating and that Obamacare’s struggling exchanges can be salvaged with more federal spending to beef up subsidies and backstop insurers’ losses.

Despite the widespread exodus of insurers from the program, an online startup called Oscar announced Wednesday that it would expand next year into five states: Ohio, Texas, New Jersey, Tennessee and California. It will also continue to sell products in New York.

Their decision to expand follows a move by Centene Corp. to expand into Kansas, Missouri and Nevada next year and reach further into Florida, Georgia, Indiana, Ohio, Texas, and Washington.