A day after a harsh judgment by the Congressional Budget Office on the House plan to repeal the Affordable Care Act, nervous Senate Republicans on Tuesday suggested changes to the bill.
They told Trump administration officials — including the health secretary, Tom Price — that they wanted to see lower insurance costs for poorer, older Americans and an increase in funding for states with high populations of hard-to-insure people. They said those changes would greatly improve the chances of Senate approval even though they might further alienate conservatives.
Because Democrats are expected to vote as a bloc against the House bill, Republicans cannot afford many defections when the bill is expected to come to a vote next week.
By underscoring the bill’s effect on the ranks of the uninsured, Congress’s official scorekeeper, the C.B.O., made wavering Senate Republicans all the more skittish of the House’s legislation.
The House bill includes large transition grants to the states that can be used to help cover people with pre-existing medical conditions, subsidize insurance purchases beyond the bill’s tax credits, or other interventions; some Senate Republicans would seek to make those bigger as well. Senator John Thune of South Dakota, wants to revise the tax credits so that they would be focused more on lower-income people.
Any of the changes that senators are seeking would almost certainly alienate conservative House Republicans who already believe the bill is too generous.
And if changes are not made, conservatives are balking.
But the very elements of the bill that conservatives, whose votes will be needed for final House passage, want changed are the very things that many Republican senators, who have a far broader base of constituents, are fighting to maintain or enhance.
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