GOP Voters Push for Health Care Changes09/22 05:51

   It's divisive and difficult, but the Republican drive to erase the Obama 
health care overhaul has gotten a huge boost from one of Washington's perennial 
incentives: Political necessity.

   WASHINGTON (AP) -- It's divisive and difficult, but the Republican drive to 
erase the Obama health care overhaul has gotten a huge boost from one of 
Washington's perennial incentives: Political necessity.

   In the two months since Senate Republicans lost their initial attempt to 
scuttle President Barack Obama's statute, there's fresh evidence GOP voters are 
adamant that the party achieve its long-promised goal of dismantling that law. 
This includes conservative firebrand Roy Moore forcing a GOP primary runoff 
against Sen. Luther Strange, R-Ala., who's backed by President Donald Trump, 
and lots of money, plus credible primary challenges facing Republican Sens. 
Jeff Flake of Arizona and Nevada's Dean Heller.

   "Republicans campaigned on this so often that we have a responsibility to 
carry out what you said in the campaign. And that's as pretty much as much of a 
reason as the substance of the bill" to support it, Sen. Charles Grassley, 
R-Iowa, told Iowa reporters in a conference call Wednesday.

   "That base is so insistent. You made this promise, stick to it, and you'll 
be penalized if you don't," said Bill Hoagland, a former top Senate GOP aide 
and health policy expert.

   GOP Sens. Bill Cassidy of Louisiana and South Carolina's Lindsey Graham have 
spent weeks concocting and selling the party's new approach to scrapping 
Obama's law. They say their proposal, shifting money and decision-making from 
Washington to the states, nearly has the votes it would need in a showdown 
expected next week, a deadline that's focused the party on making a final run 
at the issue.

   Graham and Cassidy would end Obama's requirement that most people buy health 
coverage and larger employers offer it to workers. It would let insurers charge 
higher premiums to seriously ill customers and cut Medicaid, the health 
insurance program for the poor, over time. Money from the law's Medicaid 
expansion and cost-reductions it provides lower-earning people would be folded 
into block grants dispersed to states ---totaling $1.2 trillion over seven 
years --- with few federal strings attached.

   The new package has clear appeal to most Republicans. It would wed the 
party's oft-repeated goals of uprooting Obama's law and shipping more power and 
plenty of money back home.

   "We have ONE LAST CHANCE to repeal and replace the most intrusive, 
overbearing health care law in the history of our country," Cassidy emailed 
supporters Wednesday.

   Republicans commanding the Senate by a 52-48 margin must stage the vote 
before Sept. 30, when special protections expire that have shielded the measure 
from needing 60 votes to pass. Three GOP defections would sink the measure 
because of solid Democratic opposition.

   So far, conservative Sen. Rand Paul, R-Ky., has said he'll oppose the bill 
because it doesn't abolish enough of Obama's 2010 law. Sen. Susan Collins, 
R-Maine, has cited concerns including the measure's Medicaid cuts and seems a 
likely no, while noncommittal senators include Lisa Murkowski of Alaska and 
Arizona's John McCain.

   That's not good enough for many conservatives. In a fundraising email, tea 
party leader Jenny Beth Martin said some party moderates "have betrayed their 
promises and utterly failed to fully repeal Obamacare. This is not acceptable."

   More agonizingly for Republicans, Trump is back on the Twitter warpath. He 
tweeted Wednesday that he hopes Republicans will "fulfill their promise to 
Repeal & Replace Obamacare" and took special aim at Paul, a rival for last 
year's GOP presidential nomination.

   "Rand Paul is a friend of mine but he is such a negative force when it comes 
to fixing healthcare," Trump wrote.

   Trump used the platform to repeatedly savage Senate Majority Leader Mitch 
McConnell, R-Ky., after the effort's July collapse. With nearly 39 million 
followers, plenty of Republicans would rather not be his next target.

   "They're scared to death of a promise they may not keep to the Republican 
primary base," said Sen. Chris Murphy, D-Conn.

   Some Republicans have juxtaposed the new bill with last week's unveiling by 
Sen. Bernie Sanders, I-Vt., of a measure embodying a liberal dream of 
government-run health insurance, a dramatic reshaping of the country's health 
care system. Graham says the contrast --- "socialism versus federalism" --- has 
helped him fire up conservatives.

   "It was a marriage of a desire for the base not to quit fighting and a new 
proposal that makes us want to fight more," Graham said in an interview. "The 
timing, I couldn't have scripted this."

   Taking it one step further, Sen. John Kennedy, R-La., said he plans to 
propose an amendment that would bar states from using their block grants to set 
up state-run insurance systems. Analysts from both parties say such a threat is 
implausible because the GOP bill wouldn't give states enough money to do that.

   "I've heard the argument that it's impossible. So what's the harm in putting 
it in," Kennedy said to reporters.

   Others discount the impact of using Sanders' bill to drum up support for the 
Republican legislation. Wavering senators are likelier to base their decision 
on their views of how the bill will affect home-state constituents and its 
reception from local GOP officials and voters.


(KA)