The dynamics for Senate Majority Leader Mitch McConnell (R-KY) to corral 50 out of his 52 Republican senators into supporting his health care bill don’t get much easier, now that he’s delayed a vote on it for at least a week for another round of tweaks. The only difference in the competing demands McConnell is facing from his conference between the days before he announced he was delaying the vote and the days after is that they’re going more public with their negotiating requests.
If Senate Republicans pass their bill, the Better Care Reconciliation Act, something will have to give. And for something to give, someone is likely going to cave.
Here’s a look at who is asking for what – so that you can monitor who caves and on which of their own demands:
Dean Heller (R-NV): Keep the Medicaid expansion or give more money to traditional Medicaid
Heller, a Medicaid expansion Republican facing a tough reelection next year, has admitted it will be “very difficult” to get his vote. His big ask comes down to either keeping the expansion or boosting—rather than cutting—traditional Medicaid to make up for the shortfall of phasing out the expansion.
Shelley Moore Capito (R-WV): Soften the cuts to Medicaid and boost the tax credits
Prior to the bill’s unveiling, Capito was lobbying for a seven-year phase out of the Medicaid expansion, which includes her state, and $45 billion in opioid funding. The draft bill gave her a three-year phase out and $2 billion, respectively. She has since made clear that more money for opioid funding alone will not be enough to win her back, and has also said she’d like the tax credits to be more generous to older consumers.
Rob Portman (R-OH): More money to opioid programs
Portman was aligned with Capito before the draft release last week. His subsequent statement of opposition was a little less tough than Capito’s, suggesting a boost in funding for opioid programs, and perhaps Medicaid, may be all that he needs.
Susan Collins (R-ME): Soften Medicaid cuts, protect rural hospitals, and preserve Planned Parenthood funding
Collins was always going be a hard vote for leadership to win over, and sure enough, her statement of opposition that came out before the vote was delayed ran through a litany of issues. From the get go, she was skeptical of the push to defund Planned Parenthood. She is also concerned about the Medicaid cuts and the effect the bill will have on rural hospitals. “It’s difficult for me to see how any tinkering is going to satisfy my fundamental and deep concerns about the impact of the bill,” she said.
Lisa Murkowski (R-AK): Preserve Planned Parenthood funding and protect rural areas
Murkowski, like Collins, is no fan of defunding Planned Parenthood and her state is hit particularly hard by the GOP bill. It’s an open question whether there’s an Alaska carveout big enough to be written to assuage her concerns. She hasn’t been too specific with the press on exactly what her ideal bill would look like, and has complained instead that she doesn’t know enough about how the current bill will affect her rural state.
Mike Lee (R-UT): Let states opt out of Obamacare altogether
Lee laid out his argument against the draft bill in a Medium post that called it a “caricature of a Republican health care bill” with “with less spending on the poor to pay for corporate bailouts and tax cuts.” What he is seeking, broadly, is for states to be able to opt out of the traces of Obamacare the Republican bill is leaving intact. His spokesperson has pointed specifically to community rating—which prohibits insurers from charging more based on one’s health status—as an area that should be waivable for states.
Rand Paul (R-KY): Nix the tax credits, insurer “bailouts,” and the pseudo-mandate
Paul has railed against the legislation for being “Obamacare-lite,” and what he is a requesting is a whole-scale gut job of the current bill’s framework. He opposes the tax credits for individual insurance, the “market subsidization” fund for insurers, and the continuous coverage requirement that replaces Obamacare’s individual mandate. He also wants individuals to have more freedom to create small group insurance pools.
Ted Cruz (R-TX): Let insurers sell skimpier plans
Cruz, in his attempt to abandon his bomb-thrower reputation ahead of his 2018 reelection, has stuck mostly to bland talking points in his conversations with the press. But a leaflet handed out after the draft was unveiled more clearly laid out his demands: let insurers sell skimpier plans on the exchanges and a larger overhaul of the Medicaid program.
Ron Johnson (R-WI): Scale back guaranteed issue
Johnson argues that guaranteed issue—Obamacare’s ban on insurer discrimination based on pre-existing conditions—is the main driver or premium increases. Thus, his ideal bill will give insurers more wiggle room to discriminate against high-cost individuals, with funding for some sort of risk program that catches people who fall through the cracks. “The problem is, what’s driven up premiums in Obamacare, they are all these politically popular things that people don’t even want to touch, but the good news, for example, preexisting conditions—you can take care of that, you can take care of people with pre-existing conditions, with an invisible high risk pool,” he said.
Bill Cassidy (R-LA): Preserve protections for pre-existing conditions
If you ask Cassidy, this is not about what he wants, but what President Trump promised on the campaign trail: “The president very explicitly said, over and over again during the campaign, that he wishes to preserve guaranteed issue,” he said Wednesday. Though it looked like he had warmed up to the original draft, his so-called Jimmy Kimmel test that nobody is denied coverage due to inability to pay—may stand in the way of conservatives’ push to further scale back Obamacare’s insurer mandates.
