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    GOP unveils slim bill on health

    Senate leaders quell revolt on pared plan

    David R. Lutman for The Boston Globe
    Senate Majority Leader Mitch McConnell.

    Update: In an early-morning 51-49 vote, senators voted down the proposed repeal to Obamacare. For more on the vote, read our update here.

    WASHINGTON — Senate Republican leaders on Thursday trimmed their vision of legislation to repeal the Affordable Care Act, unveiling a new, scaled-down bill that would repeal a few parts of the health law in a last-ditch effort to win passage in an early morning vote Friday.

    After three days of debate, and with little hope of passing more ambitious health legislation, Republican leaders hoped that their bill could win the support of at least 50 of the 52 Senate Republicans.

    Passing the bill, though far from what they had hoped to put into law, would at least keep the repeal effort alive, setting the stage for negotiations with the House on what could be a much broader measure to repeal and replace the health law. Several Republican senators castigated the new measure, but that revolt appeared to be quelled after Speaker Paul Ryan assured them that he did not intend to take up their narrow bill and pass it in the House.

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    The new, eight-page Senate bill, called the Health Care Freedom Act, would eliminate penalties for people who go without insurance, but it would not put in place other incentives for people to obtain coverage — a situation that insurers say would leave them with a pool of sicker, costlier customers.

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    The “skinny repeal” would delay a tax on medical devices. It would also cut off federal funds for Planned Parenthood for one year and increase federal grants to community health centers. And it would increase the limit on contributions to tax-favored health savings accounts.

    In addition, the bill would make it much easier for states to waive federal requirements that health insurance plans provide consumers with a minimum set of benefits like maternity care and prescription drugs. It would also eliminate funds provided by the Affordable Care Act for a wide range of prevention and public health programs.

    Before rolling out the new legislation, Senate leaders had to deal with a rebellion from Republican senators who demanded assurances that the legislation would never become law.

    That raised the spectacle of senators pressed by their leaders to vote on legislation that some of them despise, with a promise that a “yes” would not really be approval, just a vote to start House-Senate negotiations on something better.

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    Senators Lindsey Graham of South Carolina, John McCain of Arizona and Ron Johnson of Wisconsin demanded ironclad assurances from House leaders that the bill would not be enacted.

    “I’m not going to vote for a bill that is terrible policy and horrible politics just because we have to get something done,” Graham said at a news conference, calling the stripped-down bill a “disaster” and a “fraud” as a replacement for the health law.

    On Thursday night, Ryan tried to reassure senators as he goaded them to act. “If moving forward requires a conference committee, that is something the House is willing to do,” he said in a statement. “The reality, however, is that repealing and replacing Obamacare still ultimately requires the Senate to produce 51 votes for an actual plan.”

    But Ryan did leave open the possibility that if a compromise measure fails in the Senate, the House could still pass the stripped-down Senate health bill. Late Thursday night, Graham said that he now felt comfortable and would vote for the measure.

    Senator John Cornyn of Texas, the No. 2 Senate Republican, said the scaled-down bill was “a vehicle to get to conference” with the House, which in May passed a more ambitious bill that would repeal much of the 2010 health care law and make deep cuts in projected Medicaid spending.

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    That was an unusual pitch, considering that in normal House-Senate conferences each chamber advocates its version of a bill.

    “The skinny plan manages to anger everyone — conservatives who know it’s a surrender and know it doesn’t come close to the full repeal they promised, and moderates who know it will be terrible for their constituents,” said the Senate Democratic leader, Chuck Schumer of New York. He added, “You don’t vote to advance terrible legislation and hope it magically gets better in conference.”

    Republicans found themselves in the strange position of hoping their bill would never be approved by the House.

    “It may very well be a good vehicle to get us into conference, but you got to make sure that it’s not so good that the House simply passes it rather than going to conference,” said Senator Michael Rounds of South Dakota. Rounds, who built a successful insurance business in his home state, said he was concerned that “the markets may collapse” if the Senate bill ever took effect.

    Two influential North Carolina conservatives in the House made it clear that they did not want to simply pass the Senate bill. Representative Mark Walker, chairman of the conservative Republican Study Committee, said he favored a conference, calling the bill “ugly to the bone.”

    And Representative Mark Meadows, the chairman of the hard-line Freedom Caucus, said that for many conservatives, it would be a “nonstarter” to send President Donald Trump a bill that has “gotten so skinny that it doesn’t resemble a repeal.”

    But senators had at least some reason to be nervous. The House majority leader, Kevin McCarthy of California, notified House members that “pending Senate action on health care,” the House schedule could change, and that “all members should remain flexible in their travel plans over the next few days.” That did not sound like a man preparing for protracted House-Senate negotiations.

    Ryan told reporters, “I’m going to reserve judgment until I see what the Senate actually produces.” The Senate is considering numerous amendments, and “it is anybody’s guess what they come out with,” he said.

    Representative Chris Collins of New York said the stripped-down bill would be “better than nothing” if it became apparent that the Senate did not have the votes for a more ambitious bill. “It becomes a binary choice,” he said. “If it’s this or nothing, who wants to go home and say I did nothing?”

    Relatively modest as it is, the Senate bill could have a large effect, especially with the repeal of the individual and employer mandates. “The one thing that unifies our conference is the repeal of the individual mandate and the employer mandate, because those are two of the biggest overreaches of Obamacare and are essential to Obamacare’s functioning,” Cornyn said.