Tierney Sneed

Tierney Sneed is a reporter for Talking Points Memo. She previously worked for U.S. News and World Report. She grew up in Florida and attended Georgetown University.

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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:

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Sen. Rand Paul (R-KY) sent a letter to Majority Leader Mitch McConnell (R-KY) Wednesday outlining the changes he’d like to see to the Senate health care bill to earn his vote. His requests are a whole-scale remodeling of the main framework of the bill, making his vote among the toughest for GOP leaders to win.

His letter takes issue with the Obamacare-like tax credits for individual insurance the Republican bill offers, the “stabilization” funding it carves out for insurers and the continuous coverage requirement it imposes in the place of Obamacare individual mandate. He also requests a further loosening of federal insurance regulations, with a particular focus on the opportunity for consumers to form their own small group plans.

Read the letter below:

Alice Ollstein contributed reporting.

Senate Republicans coming out of a GOP conference lunch—where it was announced that plans to vote on their Obamacare repeal legislation this week had pushed back until after the July 4 recess due to lack of support—weren’t exactly excited that the process was being dragged out at least a week or two longer, but were hopeful that the current impasse could be overcome with a little extra time for negotiations.

“It could be good and it could be bad,” Sen. Pat Toomey (R-PA) said, when asked what the delay meant for the fate of the bill.

At the lunch, where Republican senators were joined by top White House officials including Vice President Mike Pence, Majority Leader Mitch McConnell (R-KY) indicated that the conference would spend a few more days negotiating a potential deal, with the aim of voting soon after they return from their recess.

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Conservatives skeptical of the Senate GOP’s recently unveiled Obamacare repeal bill, which could be voted on this week, have claimed that it does not really repeal the Affordable Care Act.

Sen. Rand Paul (R-KY) has called in “Obamacare-lite.” Sen. Mike Lee (R-UT) argued its “far short of “repeal” and “keeps the Democrats’ broken system intact.” The fact that conservatives believe the Senate bill, the Better Care Reconciliation Act, doesn’t go farther to dismantle the ACA is driving a far-right revolt that may threaten the passage of the bill.

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Language tucked deep in the Medicaid provisions of the Senate GOP Obamacare repeal legislation appears to allow states to funnel leftover Medicaid money for use on roads, bridges, stadiums and other projects not directly related to Medicaid’s traditional definition.

A GOP aide is already walking back the language, telling the Washington Post on Monday that it was “an inadvertent error” and that the language would be fixed before a final bill is filed for a vote.

Yet health care experts say that language points to the larger problems posed if states take congressional Republicans up on their offer to convert Medicaid’s structure into a lump sum system under the Senate GOP bill.

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The CBO score released Monday on the Senate health care bill rained down what must have been the worst nightmare—or close to it—for the GOP senators squeamish about the bill: blockbuster coverage losses just about as bad as the House version’s, Medicaid provisions that kick off even more people from the program than the House bill and average premium reductions that come at the cost of making insurance inaccessible for many low income people.

Already, it appears Senate Republicans don’t have enough votes to advance the legislation, and it will be a scramble to get that number up to 50 for Senate Republicans to pass the bill, the Better Care Reconciliation Act, this week, as planned.

Lawmakers will only have a day, maybe two, to analyze the report before GOP leaders are expected to move forward with a procedural vote to advance the legislation Tuesday or Wednesday, with the goal of a final vote by the end of the week. Before the score was released, a handful of conservatives and two moderate Republicans had signaled opposition to the draft legislation, though the conservatives said they were mostly open to negotiations. About a half dozen more moderate Republicans, and particularly those from Medicaid expansion states, are in the hot seat to make up their mind about supporting the bill, and the CBO score only turns up the temperature.

Here are 5 points on how Monday’s score affects GOP leaders’ ability to find 50 votes in favor of the legislation:

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Twenty two million fewer people would have insurance under the Senate GOP’s health care bill by 2026 when compared to current law, the Congressional Budget Office said Monday. The CBO’s analysis of the Senate’s Better Care Reconciliation Act, which would partially dismantle the Affordable Care Act, comes just days before the Senate is expected to vote on the bill.

The analysis find that the Senate Republicans did not much better than their House counterparts—whose Obamacare repeal bill the CBO found would result in 23 million losing insurance—in staving off devastating coverage losses under their plans. The CBO said of the Senate bill on Monday that the first round of coverage losses, some 15 million in 2018, would come from the elimination of the individual mandate.

As time goes on, the Senate bill’s deep cuts to Medicaid would take hold, and the CBO predicted that by 2026 enrollment in the program among those under 65 would fall by 16 percent. By 2026, the CBO predicts 15 million fewer people enrolled in Medicaid under the Senate bill compared to current law.

The CBO found that the Senate bill imposes a $772 billion cut on Medicaid and, by making Obamacare’s tax credits less generous, saves the government another $408 billion. Those funding cuts in turn go to pay for the repeal of many ACA taxes (costing the government $541 billion), the loss of the mandates (costing $210 billion) and the funding for states and insurers ($107 billion). The silver lining in Monday’s report for Senate GOP leaders is that their bill altogether reduces the deficit by $321 billion, giving them about $200 billion to play with in order to win the votes of skeptical moderates.

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With just a few days before an anticipated vote, Senate Republicans released a revised version of their Obamacare repeal legislation Monday that adds a continuous coverage requirement to the draft bill they unveiled last week.

The original draft, known as the Better Care Reconciliation Act, repealed the Affordable Care Act’s individual mandate, but did not include a similar mechanism in its place incentivizing healthy people to get insurance. Health care experts and insurers warned that such a system would risk a death spiral, as only sick people sought coverage.

The revised legislation released Monday requires insurers to impose a six-month waiting period on those seeking to join plans if they have had a break in coverage lasting two months or more in the previous year. Vox and other outlets over the weekend reported that Senate Republicans were considering the change to their bill.

Under the Affordable Care Act, people who lose coverage and don’t promptly use a special enrollment period have to wait until the next open enrollment period to regain coverage. The Senate provision adds a six-month waiting period on top of that — the later of either six months after his or her application for insurance or the first day of the next plan year.

The House bill, the American Health Care Act, included its own version of a continuous coverage requirement that imposed a 30 percent surcharge on consumers who had not maintained continuous coverage when they sought to enroll in a plan. The Congressional Budget Office was skeptical of the effectiveness of such a penalty. It remains to be seen how it will assess the Senate’s version, but Obamacare supporters are already criticizing it for locking out consumers from coverage if they have a gap in coverage.

The Senate provision includes an exemption for newborns and those under 18 years of age who are newly adopted.

The Republican state official tapped by President Trump to lead his sketchy voter fraud commission was sanctioned by a federal judge Friday for his “deceptive conduct and lack of candor” in a voting rights case brought against him.

Kansas Secretary of Kris Kobach will have to pay the court a $1,000 fine as punishment for “patently misleading representations” during the litigation over the proof-of-citizenship voter registration requirement Kobach is seeking to implement in his state.

As part of its lawsuit challenging the requirement, the ACLU asked the court to sanction Kobach for how he handled the group’s request to view documents believed to be proposals to amend the National Voter Registration Act, including a proposal he was photographed holding while meeting with Trump back in December. The ACLU’s legal challenge against his proof-of-citizenship requirement claims it to be in violation of the NVRA, making the documents potentially relevant to the case.

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At first glance, it appeared the Senate Obamacare repeal legislation took a less aggressive approach than House Republicans to the waivers offered to states to opt-out of Affordable Care Act insurer mandates. In fact, some conservatives were griping about it.

But, while substantively the Senate GOP proposed waivers look narrower than the House bill’s version, procedurally they are incredibly more lax. That means states will have all kinds of space to wreak havoc on Obamacare’s consumer protections, even as Senate Republicans claim they’re protecting people with pre-existing conditions.

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