Trump again touts party's health plan

GOP block-grant bill still shy votes

President Donald Trump on Wednesday endorsed the latest effort by Senate Republicans to advance a health care bill, calling it legislation that would fulfill the party's promise to repeal and replace the Patient Protection and Affordable Care Act.

But later in the day, Trump said the Republicans' effort remains two or three votes short, forecasting days of lobbying ahead of a deadline looming next week.

The legislation by Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina would repeal major pillars of former President Barack Obama's health law, replacing them with block grants to states to let the states design their own health care programs.

Senate Majority Leader Mitch McConnell, R-Ky., is trying to round up 50 votes to pass the legislation before Sept. 30, when special rules preventing a Democratic filibuster will expire. If they got to 50 votes, Vice President Mike Pence would provide the tie-breaker vote.

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The majority leader's "intention" is to have the legislation on the Senate floor next week, McConnell's office announced in a statement Wednesday.

Sen. Dick Durbin of Illinois, the Senate's second-ranking Democrat, told reporters that McConnell's statement is "an indication he believes he has the votes" and there is alarm among Democrats.

Trump told reporters covering the U.N. General Assembly meeting in New York: "We think this has a very good chance; Obamacare is only getting worse. At some point, the Senate is going to be forced to make a deal."

"We're at 47 or 48 already, senators, and a lot of others are looking at it very positively," he said.

In two tweets Wednesday morning, the president urged Senate Republicans to support the measure.

"I hope Republican Senators will vote for Graham-Cassidy and fulfill their promise to Repeal & Replace ObamaCare. Money direct to States!" Trump tweeted.

In his second message, he took a swipe at Sen. Rand Paul, R-Ky., who has criticized the measure as insufficient.

"Rand Paul is a friend of mine but he is such a negative force when it comes to fixing healthcare," Trump wrote. "Graham-Cassidy Bill is GREAT! Ends Ocare!"

Shortly after the president's tweets, Paul responded with his own tweets, renewing his criticism of the bill.

"#GrahamCassidy is amnesty for Obamacare. It keeps it, it does not repeal it," Paul wrote. "I will keep working with the President for real repeal."

In a Senate split 52-48 between the Republican and Democratic caucuses, McConnell has little room for error. In addition to Paul, moderate Republican Sen. Susan Collins of Maine is also seen as a likely "no" vote.

With Democrats unanimously opposed, McConnell cannot afford to lose even one more Republican senator. The focus is on Sens. John McCain of Arizona and Lisa Murkowski of Alaska, both of whom opposed earlier versions of repeal legislation.

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Graham on Wednesday appealed for support from fellow senators for his GOP health care bill despite "all its imperfections."

"We're going to vote," Graham told broadcaster Sean Hannity. "Everybody will be held accountable."

Graham made his comments in an overheard cellphone call in front of a passenger at Reagan National Airport before he boarded a flight. They were earlier misinterpreted by The Associated Press as being delivered to a fellow senator. Graham's office did not dispute that interpretation when asked about the comments and did not say who was on the call with the senator. It turned out to be Hannity.

Graham said Republicans have for years been tripped up by their inability to offer a credible alternative to the Affordable Care Act. He said he thinks that alternative now exists with his bill and that it can prevail against tough odds with the help of Trump.

But one leading Republican, Sen. Charles Grassley of Iowa, expressed pessimism about the Republicans' efforts to round up the votes.

In an interview Wednesday with reporters from him home state, Grassley said: "I think we're one or two votes short, and I don't see those other votes coming. And I hope I'm wrong."

"Republicans campaigned on this so often that we have a responsibility to carry out what you said in the campaign. And that's pretty much as much of a reason as the substance of the bill" to support it, Grassley said.

PRE-EXISTING CONDITIONS

One of the key points of contention in the bill is whether it protects people with pre-existing health problems.

Under the legislation, states would have wide latitude in creating their own health systems and requirements and would be able to seek waivers from certain mandates, including those related to coverage for people with pre-existing conditions.

The bill does say that coverage must remain "adequate and affordable" for those with pre-existing conditions. But because those terms are not defined, critics fear that insurers could raise prices beyond many people's ability to pay.

Cassidy on Wednesday defended the bill against criticism from late-night TV host Jimmy Kimmel, who jumped into the debate after his son was born with a congenital heart defect in April.

"I am sorry he does not understand," Cassidy said of Kimmel on CNN, arguing that his bill would protect people with pre-existing conditions, a claim that leading health advocacy groups dispute. "I think the price will actually be lower."

On his ABC television show Tuesday night, Kimmel said "this guy Bill Cassidy just lied right to my face," referring to Cassidy's promises to Kimmel and others that his health bill would pass the "Jimmy Kimmel test."

In a past interview on Kimmel's show, Cassidy coined the phrase to mean that people with pre-existing conditions would have protections and would not face lifetime caps on coverage from insurers.

"We can't let 'em do this to our children and our senior citizens and our veterans, or to any of us," Kimmel said Tuesday.

Graham said Wednesday that Kimmel was falling for "liberal talking points."

"We're going to give flexibility to cover sick people, but sick people will be covered," Graham said. "We'll have 50 different ways to deal with people who've been sick, not just one bureaucratic way."

Before the Affordable Care Act became law, it was difficult for sick people to get coverage in the individual insurance market. Insurers could charge them higher premiums or deny them coverage entirely for a variety of conditions such as asthma and cancer. Republicans have promised for months that their replacement plan won't harm those people.

America's Health Insurance Plans, the industry's main lobbying group, said in a letter Wednesday that it won't back the bill because its effects on the market would include "pulling back on protections for pre-existing conditions." The American Medical Association and senior citizens' group AARP announced their opposition to the measure Tuesday.

Trump touched on the issue in a tweet Wednesday night, asserting: "I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does! A great Bill. Repeal & Replace."

OBAMA WEIGHS IN

Obama on Wednesday spoke out against the effort, saying that any attempt to repeal the Affordable Care Act would end up "inflicting real human suffering" on Americans who had gained health coverage and consumer protections under the 2010 law.

"It wasn't perfect, but it was better," the former president said at an event hosted by the Bill & Melinda Gates Foundation. "And so when I see people trying to undo that hard-won progress, for the 50th or 60th time -- with bills that would raise costs or reduce coverage, or roll back protections for older Americans, people with pre-existing conditions, the cancer survivor, the expectant mom, or the child with autism, or asthma, for whom coverage once again will be unattainable -- it is aggravating."

"And it's certainly frustrating to have to mobilize every couple of months to keep our leaders from inflicting real human suffering on our constituents," Obama said. "But typically, that is how progress is won and how progress is maintained on every single issue."

"We have to stand up for each other and recognize that progress is never inevitable, that it often can be fragile, it's in need of constant renewal," he said, "and our individual progress and our collective progress depends on our willingness to roll up our sleeves and work, and not be afraid to work."

In response, Graham noted in a statement that "It's unrealistic to expect President Obama would acknowledge his signature issue is failing."

"It's no surprise President Obama opposes sending money and power back to the states and closer to where the patients live," Graham added. "Obamacare was designed with the exact opposite goal in mind -- which is to consolidate health care power and decision-making in Washington."

Information for this article was contributed by Abby Phillip and Juliet Eilperin of The Washington Post; by Erica Werner, Alan Fram, Matthew Daly, Scott McFetridge, Calvin Woodward of The Associated Press; and by Steven T. Dennis, Zachary Tracer, Krista Gmelich, Sahil Kapur, Justin Sink, Laura Litvan and Margaret Talev of Bloomberg News.

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