President Donald Trump has urged Senate Republicans to “not let the American people down,” as the contentious debate over overhauling the U.S. health care systems shifts to Congress' upper chamber.
Some senators have already voiced displeasure with the health care bill that cleared the House last week, with Republicans providing all the 'yes' votes in the 217-213 count. They have cited concerns about potential higher costs for older people and those with pre-existing conditions, along with cuts to Medicaid - the federal-state health care programme for the poor and disabled.
Senator Susan Collins of Maine, a moderate Republican whose vote will be critical to getting a bill to Mr Trump's desk and who voiced similar concerns, said the Senate would not take up the House bill.
“The Senate is starting from scratch. We're going to draft our bill, and I'm convinced we will take the time to do it right,” she said.
Mick Mulvaney, Mr Trump's budget director, also said the version that gets to the president will likely differ from the House measure. Such a scenario would then force the House and Senate to work together to forge a compromise bill that both houses can support.
Eager to check off a top campaign promise, Mr Trump sought to pressure Senate Republicans on the issue on Sunday.
“Republican senators will not let the American people down!” Mr Trump tweeted from his private golf course in central New Jersey. “ObamaCare premiums and deductibles are way up — it was a lie and it is dead!”
Mr Trump has repeatedly said the current system is failing as insurers pull out of markets, forcing costs and deductibles to rise.
The controversial orders Donald Trump has already issued
The controversial orders Donald Trump has already issued
1/9 Trump and the media
White House Press Secretary Sean Spicer takes questions during the daily press briefing
2/9 Trump and the Trans-Pacific Partnership
Union leaders applaud US President Donald Trump for signing an executive order withdrawing the US from the Trans-Pacific Partnership negotiations during a meeting in the Roosevelt Room of the White House in Washington DC. Mr Trump issued a presidential memorandum in January announcing that the US would withdraw from the trade deal
3/9 Trump and the Mexico wall
A US Border Patrol vehicle sits waiting for illegal immigrants at a fence opening near the US-Mexico border near McAllen, Texas. The number of incoming immigrants has surged ahead of the upcoming Presidential inauguration of Donald Trump, who has pledged to build a wall along the US-Mexico border. A signature campaign promise, Mr Trump outlined his intention to build a border wall on the US-Mexico border days after taking office
4/9 Trump and abortion
US President Donald Trump signs an executive order as Chief of Staff Reince Priebus looks on in the Oval Office of the White House. Mr Trump reinstated a ban on American financial aide being granted to non-governmental organizations that provide abortion counseling, provide abortion referrals, or advocate for abortion access outside of the United States
5/9 Trump and the Dakota Access pipeline
Opponents of the Keystone XL and Dakota Access pipelines hold a rally as they protest US President Donald Trump's executive orders advancing their construction, at Columbus Circle in New York. US President Donald Trump signed executive orders reviving the construction of two controversial oil pipelines, but said the projects would be subject to renegotiation
6/9 Trump and 'Obamacare'
Nancy Pelosi who is the minority leader of the House of Representatives speaks beside House Democrats at an event to protect the Affordable Care Act in Los Angeles, California. US President Donald Trump's effort to make good on his campaign promise to repeal and replace the healthcare law failed when Republicans failed to get enough votes. Mr Trump has promised to revisit the matter
7/9 Donald Trump and 'sanctuary cities'
US President Donald Trump signed an executive order in January threatening to pull funding for so-called "sanctuary cities" if they do not comply with federal immigration law
8/9 Trump and the travel ban
US President Donald Trump has attempted twice to restrict travel into the United States from several predominantly Muslim countries. The first attempt, in February, was met with swift opposition from protesters who flocked to airports around the country. That travel ban was later blocked by the Ninth Circuit Court of Appeals. The second ban was blocked by a federal judge a day before it was scheduled to be implemented in mid-March
SANDY HUFFAKER/AFP/Getty Images
9/9 Trump and climate change
US President Donald Trump sought to dismantle several of his predecessor's actions on climate change in March. His order instructed the Environmental Protection Agency to reevaluate the Clean Power Plan, which would cap power plant emissions
Ms Collins, who has been working on her own healthcare plan, said she was reaching out to moderate Democrats to try to find common ground. She wants to see a broader effort to replace Obama's 2010 healthcare law.
“I would like to see us put together a bipartisan group to solve this problem, of Democrats who acknowledge there are problems with the current law, that it is not working well in several states, and Republicans who also want to make sure that we're not reducing coverage and we're giving flexibility,” Ms Collins said on ABC's This Week.
The offer comes as Democrats criticised the lack of women on a working group in the Senate that will craft a plan to pass the healthcare legislation - with Senators questionning why the 13-member working group put together by Senate Republican leader Mitch McConnell does not include any of the chamber's five Republican women.
“Women's health is a big part of this and women are a majority of the population, and their health interests deserve to be contemplated in any reform,” Democratic Senator Dianne Feinstein of California said on NBC's Meet the Press.
Democratic Senator Patty Murray of Washington wrote on Twitter: “It matters to have women at the table and it matters when they aren't.”
Don Stewart, a senior aide to Mr McConnell, told Reuters that critics were getting “hung up on process” while ignoring the problems of Obamacare such as higher costs and limited choices.
Meanwhile, the White House has scoffed at Democratic claims that voters will punish the GOP in the 2018 elections for upending former President Barack Obama's law. “I think that the Republican Party will be rewarded,” said Reince Priebus, Mr Trump's chief of staff. House Democratic leader Nancy Pelosi of California has threatened that GOP lawmakers will “glow in the dark” over their vote.
The House bill would end the health care law's fines on people who don't buy policies and erase its taxes on health industry businesses and higher earners. It would dilute measures that prohibit higher premiums for customers with pre-existing medical conditions and watering down the subsidies that help consumers afford health insurance.
Major medical and other groups, including the American Medical Association, opposed the House bill. Democrats are also refusing to participate in any effort to dismantle Obama's law, while some Republican senators — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska — object to cutting Medicaid.
The ACA expanded Medicaid with extra payments to 31 states to cover more people. The House bill halts the expansion, in addition to cutting federal spending on the program, which Mr Trump's health chief argued is flawed and dictates too much from Washington.
Health and Human Services Secretary Tom Price argued that states will get more freedom to experiment with the programme and make sure that people who rely on Medicaid get the care and coverage they need.
“There are no cuts to the Medicaid program,” Mr Price insisted Sunday, adding that resources are being doled out to allow states greater flexibility.
Gov. John Kasich of Ohio questioned what would happen to the mentally ill, drug addicts and people with chronic illnesses under the changes proposed for Medicaid.
“They are going to be living in the emergency rooms again,” potentially driving up health care costs, Mr Kasich predicted.
House Speaker Paul Ryan appeared resigned to the legislative reality that the bill he unveiled with great fanfare, after years of Republican pledges to replace Obamacare will be altered as part of a “multistage process.”
“We think we need to do even more support for people who are older and also more support for people with pre-existing conditions,” Mr Ryan acknowledged. “The Senate will complete the job.”
Tensions are clearly running high.
Conservative Representative Raul Labrador, of Idaho, drew boos on Friday at a public meeting for his response to a constituent who said the House bill tells people on Medicaid to “accept dying.
Mr Labrador responded: “That line is so indefensible. Nobody dies because they don't have access to health care.”
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