WASHINGTON — After Senate Majority Leader Mitch McConnell postponed this week’s vote on the GOP’s health care reform bill amid faltering support, the next step depends on which of a handful of competing options GOP leaders pursue.

Option 1: Appease conservatives.
A number of GOP holdouts — including Sens. Rand Paul of Kentucky, Ted Cruz of Texas, and Mike Lee of Utah — blasted the bill for not fulfilling campaign pledges to repeal and replace Obamacare.

While a full repeal is not possible under the budget reconciliation process — which allows Republicans to avoid a Democratic filibuster — McConnell could cut the number of subsidies and mandates the current draft leaves in place.

But that move could backfire if the Congressional Budget Office releases an even harsher score with tens of millions still left uninsured. It also could alienate moderates and even President Trump, who called the House-passed GOP bill “mean” and suggested spending more, not less.

Option 2: Appeal to moderates.

Several moderate Republicans as well as those facing tough re-election prospects flagged the proposed Medicaid rollback, particularly in states gripped by the opioid addition crisis. Medicaid is the largest payer of both mental health and drug treatment services.

The bill “does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural health care providers,” West Virginia U.S. Sen. Shelley Moore Capito said, joining Ohio U.S. Sen. Rob Portman in announcing their opposition. Sens. Susan Collins of Maine and Lisa Murkowski of Alaska oppose stripping Planned Parenthood of funding for a year.

But compromise on these measures could spur conservative backlash.

Option 3: Work with Democrats.

For McConnell, this really is the nuclear option. He framed the prospect of crossing the aisle as a consequence of failure.

“My suspicion is that any negotiation with the Democrats would include none of the reforms that we would like to make, both on the market side and the Medicaid side,” McConnell told reporters yesterday.

Democratic Leader Chuck Schumer said his party is willing to come to the table — but not if the high income tax breaks or Medicaid cuts aren’t nixed.

“We’re the first to say we want to sit down and talk to you about it, but we are not going to be in a position where we say, ‘OK, only 15 million people will be uncovered, we’ll support that bill,’ ” Schumer said. “That’s not the type of compromise we’re talking about.”


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