Over the past week, Marco Rubio played hard-to-get on the Obamacare repeal bill.
“Senate healthcare proposal needs changes before I vote yes,” Rubio tweeted on Sunday, without identifying what changes were necessary to secure his vote. A number of national media outlets included Rubio as a potential “no” vote early this week.
Then, less than 24 hours before Senate leadership released the second draft of the Obamacare repeal bill, Rubio got more specific, again on Twitter.
“I've been working with Senate colleagues for weeks on lots of changes” on the bill, Rubio tweeted. “Some of my proposals must be included in tomorrow’s bill.”
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Rubio’s list of demands included more Medicaid payments to Florida hospitals that serve a large number of low-income people, an option to choose catastrophic coverage plans with low monthly payments but high deductibles, and flexible Medicaid caps for public-health emergencies like Zika.
After the bill was released on Thursday and he huddled with his Republican colleagues, Rubio said his demands were met, and Florida’s junior senator was ready to announce his support.
“The sooner we get to the floor and start the debate on the floor in front of the American people, the better off it’s going to be for everyone,” Rubio said.
But the bill may not make it to the floor.
Two Republican senators said Thursday they are not in favor of moving forward with the bill: Maine Sen. Susan Collins, a moderate, and conservative Kentucky Sen. Rand Paul. A slew of other senators, most of them moderates, said they were unsure of their position.
If three Republicans vote against proceeding on the bill and all 48 Democrats and independents vote against it, as expected, the current effort will fail.
Florida Democratic Sen. Bill Nelson reiterated his opposition after the GOP’s proposal was released.
“This latest Republican health care bill is just as bad as the previous versions,” Nelson said in a statement. “It makes huge cuts to Medicaid, allows insurance companies to hike rates for older Americans and will take coverage away from millions of people. We need to be working together to improve our nation’s health care system, not make it worse. If approved, this bill will hurt a lot of Floridians and for that reason alone, I will oppose it.”
Rubio said that despite his support for the motion to proceed with the bill, he will introduce an amendment that ensures Florida, which chose not to expand Medicaid, isn't locked into a baseline “that puts us at a disadvantageous position.”
“It depends what the final bill looks like. If Florida's not treated fairly it'll be a problem,” Rubio said. “But ultimately, I campaigned to repeal and replace Obamacare and that’s what I want, but I want to do it in a way that’s positive for the country and fair for Florida.”
Rubio is pleased that his proposal to waive Medicaid caps for public health emergencies like Zika is included in the bill, although it doesn’t change the mechanisms that led to Florida lawmakers begging for federal funds to fight the disease last summer.
“This has nothing to do with that. This has to do more with if you have any sort of pandemic or significant event in your state... and suddenly costs increase substantially because you have a significant number of people on Medicaid impacted by it, then the per capita growth limitations should be waived for that period of time as long as that situation is in place,” Rubio said.
The newly released bill includes a bevy of compromises intended to woo moderates and conservatives alike, including scrapping the elimination of several taxes on the wealthy that help fund the Affordable Care Act’s coverage expansion.
Instead it keeps the 3.8 percent tax on investment income, a 0.9-percent Medicare tax on high-income individuals and a tax on health insurance executive compensation.
The revenue is expected to help provide more money for states to lower premium costs, although conservatives aren’t happy about the taxes staying in the current bill.
Rubio says Congress’ other big-ticket item, an overhaul of the nation’s tax system, could undo the remaining Obamacare taxes left in the Senate’s health-care bill.
“I just think the tax provisions could ultimately be dealt with in tax reform,” Rubio said. “I don’t support those taxes, I’d like to see them come out, but I do think they come out as part of tax reform.”
Rubio acknowledged the difficulty of securing 50 Republican votes, but declined to characterize the mood of fellow Republicans disenchanted with the proposal during the GOP meeting on Thursday.
“The mood? I’m not a good mood analyzer,” Rubio said. “We have at least 51 insurance markets in the country, we don't have one, so everybody’s approaching it from the perspective of their own state.”
The Obamacare repeal bill can still be changed if the motion to proceed passes. Senators can offer amendments before a final vote.
Rubio said President Donald Trump’s involvement will be critical in making sure the bill gets enough votes.
“The bully pulpit of the presidency is critical,” Rubio said. “When he returns from France it’s my understanding that he intends to engage significantly on that topic.”