The five biggest hurdles Senate Republicans are facing to pass their revised health care bill

Erin Kelly | USA TODAY

WASHINGTON — Senate Republicans hope their latest proposed bill to replace Obamacare will attract enough votes from the moderate and conservative wings of their party to pass next week.
But there are at least five hurdles that could derail efforts to reach consensus. They include:

Majority Leader Mitch McConnell heads to the Senate floor following a meeting where he shared a new ...more
Chip Somodevilla, Getty Images

1. The Bill Still Makes Major Cuts To Medicaid
   More than 14 million Americans gained eligibility for Medicaid through Obamacare, and they could lose that coverage under the Senate bill, which phases out federal funds by 2024 for expanded Medicaid coverage.
   That's a problem for some moderate Republicans, who worry that their most vulnerable constituents will be harmed. Sen. Susan Collins, R-Maine, cited those cuts in a tweet Thursday saying that she will vote against a procedural motion to bring the bill to the floor, known as a "motion to proceed."
   Patients who rely on Medicaid to get treatment for opioid abuse also could lose that coverage, undermining efforts by moderate GOP Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia to boost federal support to fight the epidemic in their states. However, the bill does provide $45 billion in additional funding for opioid treatment, in an effort to lure Portman, Capito and others.

Sen. Susan Collins is surrounded by reporters on Capitol Hill on July 13, 2017.
J. Scott Applewhite, AP

1. It Does Not Fully Repeal Obamacare
   Conservatives want a complete repeal of the Affordable Care Act, especially its taxes. This bill would not do that.
   While it eliminates taxes on health insurance, prescription drugs, medical devices and high-cost employer-sponsored plans, the legislation leaves in place Obamacare taxes on wealthy Americans to help subsidize coverage for lower-income people.
   Sen. Rand Paul, R-Ky., a conservative with a libertarian bent, said he cannot support a bill that leaves so much of Obamacare in place. His spokesman said the senator plans to vote against the motion to bring the GOP legislation to the Senate floor next week.
   "I pledged to the voters to repeal Obamacare, I think it's a disaster," Paul said Thursday on Fox News. "But this bill doesn't repeal it. It keeps about half of the Obamacare taxes, it keeps most of the Obamacare regulations, it keeps most of the Obamacare subsidies, and it creates a giant new insurance bailout superfund of about $200 billion. This isn't repeal by any means, shape or form."

Sen. Rand Paul speaks with reporters on his way to a vote on Capitol Hill on July 12, 2017.
J. Scott Applewhite, AP

1. It Still Raises Costs For Older Americans
   Groups representing older Americans — who traditionally vote in higher numbers — are blasting the bill for continuing to impose an "age tax" on Americans 55 to 64, who are still too young to benefit from Medicare.
   "AARP reiterates our opposition to the Age Tax which would allow insurance companies to charge older Americans five times more than everyone else for the same coverage," the organization said in a statement Thursday. The organization has 38 million members 50 and older.
   Democrats signaled that they would hit Republicans hard during next year's congressional elections if they vote for this provision.
   "Premiums for so many people aged 55 to 64 will go way up," said Minority Leader Chuck Schumer, D-N.Y., in a speech on the Senate floor Thursday. "Americans in their sixties could be paying tens of thousands of dollars more than they do today."

Senate Minority Leader Chuck Schumer departs a press conference at the U.S. Capitol on July 13, ...more
Win McNamee, Getty Images

1. It Still Defunds Planned Parenthood
   The bill would block Planned Parenthood from receiving Medicaid funding for a year. Federal law already prohibits the organization from using federal funds to perform abortions, but the bill would also prevent the group from using Medicaid money to offer birth control services, treat sexually transmitted diseases, and provide other medical care.
   Most Republicans support defunding Planned Parenthood, but two key moderates — Collins and Sen. Lisa Murkowski, R-Alaska — are strong supporters of the group and have consistently opposed efforts to defund it.
   "I, for one, do not believe that Planned Parenthood has any place in our deliberations on the Affordable Care Act," Murkowski said in an address to Alaska state lawmakers earlier this year. "Taxpayer dollars should not be used to pay for abortions, but I will not vote to deny Alaskans access to the health services that Planned Parenthood provides."

Sen. Lisa Murkowski is surrounded by members of the media on Capitol Hill on July 13, 2017.
Alex Wong, Getty Images

1. Two GOP Senators Are Offering A Potentially Attractive Alternative
   Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., offered an alternative Thursday that they said could attract more support than the bill introduced by GOP leaders.
   Their plan would send the current federal funding for Obamacare, estimated at about $110 billion last year, to the states in the form of block grants that governors could use however they want. Graham said states could keep Obamacare in place or replace it with a new system.
   "Instead of having a one-size-fits-all solution from Washington, we should return dollars back to the states to address each individual state’s health care needs," Graham said.
   Sen. Ron Johnson, R-Wis., who opposed an earlier version of the GOP health care bill and is undecided on the latest version, said the Graham-Cassidy alternative "actually has some appeal to me."