The Senate GOP’s progress on Obamacare repeal has been hard to decipher so far, with lots of public assurances that negotiations are continuing but few tangible results.
The process, which Republicans claim began even before the House passed its repeal bill, has been notable for what it’s been missing. It’s unclear, publicly at least, who is leading the effort, the direction they’re taking and whether there’s even agreement on how far the Senate will stray from the deeply unpopular House proposal, which guts Medicaid while scaling back the Affordable Care Act’s widely-liked consumer protections.
The Senate GOP’s 13-member working group initially unveiled to iron out an approach that could bring 51 votes was quickly met with ugly headlines about the lack of women, while rival groups have popped up among the members left out of the original task force. GOP leaders have since stressed that all Republicans are invited to participate in the talks, which happen twice or thrice weekly in Capitol, behind closed doors.
In the meantime, trial balloon after trial balloon has been floated with anonymous leaks, only to be immediately popped by other Republicans, who sometimes are only hearing of alleged proposals directly from the press.
An automatic enrollment option for states? That was quickly labeled “corporatist single payer” by a Republican staffer.
A short-term measure to stabilize the market while longer-term reform is still being hashed out?
“I don’t think there’s anything in particular that’s happened,” Sen. Bill Cassidy (R-LA) told TPM on Thursday. “I am not sure we have resolved that. There’s an awareness, but I don’t think there’s a point on it.”
If Senate Republicans are close to coming up with a plan to repeal Obamacare that can pass their chamber, they’re certainly not making a show of it.
GOP senators participating in the ongoing health care discussions say they want to avoid airing the negotiations in public. However, the lack of the details may also reflect how far the GOP Senate still has to go in cobbling together a health care bill that 51 of its members will support.
“This is going to take some time. There are a lot of different points of views and a lot of different conflicts here,” Sen. Orrin Hatch (R-UT) said last week.
“We’re still in full discussion stage,” Sen. Mike Rounds (R-SD) told reporters.
There have been “good conversations about health care,” said Sen. Cory Gardner (R-CO), who added, “I am not going to comment on the subject of individual conversations.”
Since House Republicans surprised Washington by reviving their zombie health care bill, the American Health Care Act, and narrowly passing it earlier this month, they’ve passed the politically toxic hot potato to the upper chamber, where GOP senators have stressed it will be slow-going on their end to write their own legislation to dismantle the Affordable Care Act.
“We are going to meet diligently and work together until we come to solution, but that’s going to take some time,” Sen. Ted Cruz (R-TX) told TPM last week.
Contrast that with the enthusiasm Republicans showed last year in describing a lightning strike-like process that would make way for tax reform and other agenda items.
While GOP Senators swear their not adhering to any specific timetable, some deadlines do in fact exist. To stay on track to pass both Obamacare repeal and tax cut legislation this year, the Senate will likely need to wrap up their health care talks this summer. More pressing, however, is insurers’ filing deadlines for their 2018 plans. Insurers would like to see more certainty on what the marketplace will look like, including what will happen to key ACA subsidies Republicans have previously attacked.
According to a Politico profile on Majority Leader Mitch McConnell’s (R-KY) role in the effort, the hope is to have a final vote in June, or by July at the latest.
“He’ll have to make some decisions. I’m sure it will be with the recommendation and input from our members, but there will come a point in which we’ve talked some of this stuff to death,” Sen. John Thune (R-SD),the Senate GOP’s No. 3, told Politico about MccConnell’s approach.
All the divisions in the House that stalled their repeal efforts exists to perhaps a greater degree in the Senate. Twenty GOP Senators represent Medicaid expansion states, and many have expressed discomfort with how quickly the expanded program is wound down in the House bill. Senate conservatives have pushed for an even more aggressive timeline to scale back the program. Sens. Pat Toomey (R-PA) and Rob Portman (R-OH) are leading the talks around a compromise, but those discussions are reportedly getting nowhere.
Then there’s the longer-term overhaul of Medicaid in the House bill, including its transformation of the traditional program from an unlimited match rate into a so-called per capita cap system, in which there’s a limit on the funding states will receive on a per enrollee basis.
“We’re definitely tweaking the House bill on that,” Sen. Shelley Moore Capito (R-WV) said, when asked about the formulas used in the House bill to raise the caps each year.
Sen. John Hoeven (R-ND) is lobbying for states to be able hold on to savings in years their Medicaid programs perform below the caps, so they can bank on the savings in years their programs go over. Moderates are also hopeful that a more robust tax credit scheme — which is being ironed out by Thune — will help cushion the landing on Medicaid cuts.
However, any extra money thrown into Senate bill will have to be offset elsewhere, as the savings in the Senate bill must match those in the House’s.
Perhaps the most closely-watched factor, at least in the near term, is the release of the Congressional Budget Office’s analysis of the final version of the House legislation expected on Wednesday.
The score will determine the savings targets Senate Republicans must hit for their bill to be eligible for reconciliation, the complicated process by which the GOP can avoid a Democratic filibuster in the Senate.
It will also set the tone for the political climate they will be operating in while writing of their bill. The CBO score of the original House GOP bill estimated that 24 million people would lose coverage over the next 10 years — a number that was clearly unacceptable for many Senate GOPers. A round of changes to the House bill before it passed scaled back pre-existing conditions in a way that is unclear how it will affect coverage numbers, while Republicans hope that it at least brings average premiums down — an effect that many GOP lawmakers have said is their primary goal in the repeal effort.
There’s an off-chance that the numbers in the House bill shake out in a way that might require another House vote, if it is found that the legislation did not save enough money total or did not save enough money in the proper committees of jurisdiction. But if those bars are cleared, as expected, there will be pressure for the Senate to get past some of its stalling.
“I can act quickly,” Hatch said, of what happens after the new CBO score is released. “I don’t know how quickly you can bring everyone together.”