President Donald Trump urged Senate Republicans on Sunday to "not let the American people down," as the contentious debate over overhauling the U.S. health care systems shifts to Congress' upper chamber, where a vote is potentially weeks, if not months, away.
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 cited concerns about potential higher costs for older people and those with pre-existing conditions, along with cuts to Medicaid.
Sen. Susan Collins of Maine, a moderate Republican whose vote will be critical to getting a bill to 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, Trump's budget director, also said the version that gets to the president likely will 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.
Collins also complained that the House rushed a vote before the Congressional Budget Office could complete its cost-benefit analysis.
Eager to check off a top campaign promise, Trump sought Sunday to pressure Senate Republicans on the issue.
"Republican senators will not let the American people down!" Trump tweeted from his private golf course in central New Jersey, where he has stayed since late Thursday. "ObamaCare premiums and deductibles are way up — it was a lie and it is dead!"
Trump has said the current system is failing as insurers pull out of markets, forcing costs and deductibles to rise.
The White House on Sunday 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, 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 consumer-friendly insurance coverage requirements, like prohibiting higher premiums for customers with pre-existing medical conditions and watering down the subsidies that help consumers afford health insurance.
Obama defended his signature achievement in Boston Sunday night while accepting the John F. Kennedy Profile in Courage Award.
"I hope that current members of Congress recall that it actually doesn't take a lot of courage to aid those who are already powerful, already comfortable, already influential," he said. "But it does require some courage to champion the vulnerable, and the sick and the infirm."
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 federal-state health care program for the poor and disabled.
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 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 program and make sure that people who rely on Medicaid get the care and coverage they need.
"There are no cuts to the Medicaid program," 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, Kasich predicted.
Senate Majority Leader Mitch McConnell, R-Ky., plans to move forward under special procedures that allow legislation to pass with a simple majority vote, instead of the 60 usually required for major bills in the Senate. That means McConnell can afford to lose just two senators; Vice President Mike Pence would vote to break a 50-50 tie in his constitutional role as vice president of the Senate.
House Speaker Paul Ryan, R-Wis., appeared resigned to the legislative reality that the bill he unveiled with great fanfare, after years of Republican pledges to replace what's become known as "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," Ryan acknowledged. "The Senate will complete the job."
A political group with ties to House Republican leadership, American Action Network, said Sunday it was buying $500,000 in television time to promote the Republican health care bill. The ad will focus on key elements of the American Health Care Act and thank Ryan and fellow Republicans for "keeping their promise" on the health care issue, the group said.
On the other side, a health advocacy group is launching a six-figure advertising campaign this week targeting 24 Republican House members who voted to repeal Barack Obama's health care law. Save My Care says the campaign will include a mix of TV and digital advertising, costing more than a half million dollars.
Among those being targeted: Tom MacArthur of New Jersey, the moderate Republican who helped revive the bill by authoring an amendment on pre-existing conditions.
Some House lawmakers have been challenged by the public over the House vote.
Conservative Rep. Raul Labrador, R-Idaho, drew boos Friday at a public meeting for his response to a constituent who said the House bill tells people on Medicaid to "accept dying.
Labrador responded: "That line is so indefensible. Nobody dies because they don't have access to health care." The comment traveled quickly on social media.
Collins and Ryan appeared on ABC's "This Week," Price was on NBC's "Meet the Press" and on CNN's "State of the Union" with Kasich, while Mulvaney was interviewed on CBS' "Face the Nation." Priebus was on "Fox News Sunday."