WASHINGTON — Senate Republicans launched their plan for shriveling Barack Obama’s health care law Thursday, edging a step closer to their dream of repeal with a bill that would slice and reshape Medicaid for the poor, relax rules on insurers and end tax increases on higher earners that have helped finance expanded coverage for millions.
Four conservative GOP senators quickly announced initial opposition to the measure and others were evasive, raising the specter of a jarring rejection by the Republican-controlled body. But Senate Majority Leader Mitch McConnell, R-Ky., indicated he was open to discussion and seemed determined to muscle the measure through his chamber next week.
Release of the 142-page proposal ended the long wait for one of the most closely guarded bills in years. McConnell stitched it together behind closed doors, potentially moving President Donald Trump and the GOP toward achieving perhaps their fondest goal — repealing former President Obama’s 2010 statute, his proudest domestic legacy.
On Twitter, Trump said he was “very supportive” of the bill. On Facebook, Obama said at the heart of the bill was “fundamental meanness.”
The bill would end Obama’s tax penalties on people who don’t buy insurance — effectively ending the so-called individual mandate — and on larger companies that don’t offer coverage to their workers. It would offer less generous subsidies for people than Obama’s law but provide billions to states and insurance companies to buttress markets that in some areas have been abandoned by insurers.
McConnell must navigate a narrow route in which defections by just three of the 52 Republican senators would doom the legislation. He and others said the measure would make health insurance more affordable and eliminate Obama coverage requirements that some people find onerous.
“We have to act,” McConnell said. “Because Obamacare is a direct attack on the middle class, and American families deserve better than its failing status quo.”
Democrats said the measure would result in skimpier policies and higher out-of-pocket costs for many and erode gains made under Obama that saw roughly 20 million additional Americans gain coverage.
“We live in the wealthiest country on earth. Surely we can do better than what the Republican health care bill promises,” said Senate Minority Leader Chuck Schumer, D-N.Y.
Four conservative senators expressed opposition but openness to talks: Ted Cruz of Texas, Kentucky’s Rand Paul, Mike Lee of Utah and Ron Johnson from Wisconsin. They said the measure falls short, missing “the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.”
On the other hand, Sens. Dean Heller of Nevada, facing a competitive 2018 re-election battle, Ohio’s Rob Portman and Shelley Moore Capito of West Virginia expressed concerns about the bill’s cuts to Medicaid and drug addiction efforts. And Susan Collins of Maine reiterated her opposition to language blocking federal money for Planned Parenthood, which many Republicans oppose because it provides abortions.
Late Thursday, Trump tweeted, “I am very supportive of the Senate #HealthcareBill. Look forward to making it really special! Remember, ObamaCare is dead.”
Obama was more than skeptical.
“If there’s a chance you might get sick, get old or start a family, this bill will do you harm,” he wrote. He said “small tweaks” during the upcoming debate “cannot change the fundamental meanness at the core of this legislation.”
The House approved its version of the bill last month. Though Trump lauded its passage in a Rose Garden ceremony, he called the House measure “mean” last week.
The nonpartisan Congressional Budget Office said under the House bill, 23 million fewer people would have coverage by 2026. The budget office analysis of the Senate measure is expected early next week.