If there’s one issue that could tank the imperiled Senate health care plan, it’s abortion.
More specifically, federal Medicaid funding to Planned Parenthood. The health care provider uses federal funding to treat Medicaid patients and subsidize other health services, and by law cannot use those funds to provide abortions. But House Republicans still want to deny Planned Parenthood funding for a year because it performs abortions.
The Senate bill, like its companion in the House, now includes a provision to do just that, but two of the senators whose votes on the health care bill are being courted by Majority Leader Mitch McConnell are opposed. McConnell holds a narrow majority and can only lose two members and still pass the bill under budget reconciliation rules that prevent filibustering by Democrats. Vice President Mike Pence would cast the tiebreaker in the event of a 50-50 tie.
House Republicans, however, have made their stance clear.
“We’ve warned the Senate that there’s nothing they could do that would blow the health care bill to Mars more than taking the pro-life components out of it,” said Rep. Trent Franks, R-Ariz., who signed a Republican Study Committee letter to McConnell outlining the group’s concerns. “I think they know if they do, they might as well not vote. It would blow it to smithereens over here.”
Indeed, committee chairman Rep. Mark Walker, R-N.C., said it took him no time to gather the 30 signatures on the letter, which he said he sent as a “quick reminder” to Senate leaders trying to craft legislation that can satisfy conservative and moderate Republicans in the Senate.
“Pro-life protections are a no-brainer,” Walker said. “For about 80 to 90 guys in the House, that’s an immediate nonstarter.”
House Republicans argue the money could instead be spent on community health centers, though experts say the nation’s community health centers don’t have the staffing or funding to handle the estimated 400,000 people who could lose access to care if Planned Parenthood’s federal Medicaid funding is shuttered.
Senate negotiations on the stalled legislation Thursday centered on keeping one of the Obamacare taxes on the wealthy, which could reduce some cuts to Medicaid, which many moderate senators oppose.
The Senate health bill would cut Medicaid spending by $772 billion, or 26 percent over the next decade, according to the Congressional Budget Office.
But that reduction would widen to 35 percent by 2036 as the Senate bill shifts Medicaid’s inflationary growth rate to a less-generous formula, according to a new CBO analysis released Thursday after Democratic Sens. Ron Wyden of Oregon and Tammy Duckworth of Illinois asked for more detail.
Although conservatives repeatedly promised on the campaign trail to repeal all the taxes, some suggested they could keep the investment tax and look to cut taxes at a later date.
“If there’s a bill that gets (the Senate’s conservatives) on board I would be shocked if there’s not enough support among most conservatives to support it,” said Rep. Mark Meadows, R-N.C., chairman of the House Freedom Caucus. However, “they’d lose a lot of votes if Planned Parenthood gets funded,” he said.
Whether the Planned Parenthood provision will pass muster with the Senate’s complicated rules is not yet clear. That decision will be made by the Senate’s parliamentarian, who will review the legislation before it comes up for a vote.
Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, oppose cutting Planned Parenthood’s funding and plan to introduce an amendment to restore funding. There already are restrictions against using federal funds for abortion, Collins pointed out Sunday on ABC’s This Week.
“Planned Parenthood is an important provider of health care services, including family planning and cancer screenings for millions of Americans, particularly women, and they should be allowed to choose the health provider that they want,” Collins said.
Both senators also are worried about cuts to Medicaid under the legislation and it’s unclear whether they’d vote against the measure if the Planned Parenthood amendment failed.
“It is one of many factors and a very important one that I will consider in casting my vote,” Collins said Sunday.
President Donald Trump, who this week aggressively inserted himself into the health care debate, is hoping for both senators’ support for the legislation. But his personal attack Thursday via Twitter on MSNBC television host Mika Brezinski did him no favors with either one. Collins wrote on Twitter, “This has to stop. We don’t have to get along, but we must show respect and civility.”
Darting into a Senate lunch with Vice President Mike Pence, Murkowski told reporters she had only seen media coverage of the tweets, but “sure don’t like what I’m hearing about them.” An hour later, she echoed Collins in a tweet of her own: “Stop it! The presidential platform should be used for more than bringing people down.”
Planned Parenthood has delivered more than 1 million petitions to members of Congress to oppose the de-funding provision and plans to target members over the Fourth of July recess. It’s also running a TV ad featuring three Planned Parenthood patients from Iowa whose health center is closing Friday under a de-funding law passed by Iowa lawmakers.
“Republican leadership now has a choice –listen to a small group of extremists who will stop at nothing to end women’s access to health care, or listen to the 80 percent of Americans – including 67 percent of Republicans – who stand with Planned Parenthood,” said Erica Sackin, a spokeswoman for the group.
Tony Pugh contributed to this report.