The Senate returns to D.C. Monday evening after a week-long recess, and on the surface they appear to be even further from a deal to pass a health care bill than when they canceled a planned vote in late June.
Existing ideological divisions were exacerbated over the break as lawmakers were hit from all sides—hounded by constituents at town halls, hammered with attack ads, and pressured by GOP leaders and President Donald Trump to pass something in the few short weeks before their August recess.
But despite some Republicans declaring the effort “dead,” a flurry of activity—including backroom negotiations and new data from the Congressional Budget Office—could bring the bill back to life. Some GOP leaders are even saying that a vote could happen as early as next week.
Here are the things to watch as the debate unfolds:
Senators go negative, but leave wiggle room
In town halls over the July 4 recess, the few Republicans who spoke publicly about health care slammed the GOP bill released in June, saying it fails to protect people with pre-existing conditions, hurts rural hospitals, and leaves millions of people uninsured.
But in taking a stand against the bill, GOP senators across the political spectrum have left themselves plenty of wiggle room, sticking largely to vague demands that the bill not “pull the rug out from under” people currently on Medicaid and provide more support for people struggling with opioid addiction.
Many lawmakers, including key critics Susan Collins (R-ME) and John Hoeven (R-ND), are also careful to say they oppose the current version of the bill, leaving the door opening to voting for a revised version in the coming weeks.
McConnell is pressuring conservatives to get on board
After weeks of struggling fruitlessly to achieve a GOP consensus on an Obamacare repeal bill, Senate Majority Leader Mitch McConnell (R-KY) began threatening over the July 4 break to work with Democrats to stabilize the individual market if the repeal effort goes down in flames.
This is not meant to scare moderate Republicans, many of whom have been calling for bipartisanship all along, but conservatives like Sens. Ted Cruz (R-TX) and Mike Lee (R-UT). Faced with a choice between a repeal bill they feel isn’t adequately conservative and bipartisan legislation to shore up Obamacare’s exchanges, what is the far right wing likely to choose?
The fate of the Cruz Amendment
Since the bill was pulled, more hardline holdouts have rallied around Cruz’s “Consumer Freedom Amendment”—a policy that would allow insurance companies to sell cheap, bare-bones plans that do not cover essential health benefits like hospital visits, lab work and prescription drugs, as long as there is at least one comprehensive plan per state.
GOP leadership took the significant step of sending the amendment to the CBO for scoring, but as more senators come out in strong opposition to the amendment, it’s unclear whether its adoption would be a net gain or a net loss of votes for McConnell.
Even the conservatives who support the amendment may be scared off if the CBO’s analysis matches that of the Washington Post, which found the policy would cause a spike in federal health care spending as comprehensive coverage becomes unaffordable for the people who need it without generous government subsidies.
What is the least moderates will accept?
To win back a host of moderate GOP defectors, Senate leadership will reportedly propose this week to keep some of Obamacare’s taxes on the wealthy and use that revenue to fund treatment for opioid addiction.
That may be enough to woo lawmakers like Sen. Rob Portman (R-OH) who have singled out opioid addiction funding as their main concern. But others, like Sen. Shelley Moore Capito (R-WV), have explicitly said that extra funding alone will not win them over. Several more have publicly opposed the core provisions of the bill, such as the elimination of the Medicaid expansion, that are extremely unlikely to change as the bill is amended in the weeks ahead.
Senate Republicans can only lose two votes and still hope to pass a bill—and even then will only be able to do so with a tie-breaking vote from Vice President Mike Pence.
Looming recess creates a time crunch
GOP leaders have said they must pass a health care bill before Congress leaves D.C. for their month-long August recess, leaving lawmakers just three weeks to hammer out a deal. Adding to that pressure cooker timeline are messages from President Trump and conservatives in the House and Senate leaning on Congress to stay and work through summer break if they are unable to pass a bill in time.
I cannot imagine that Congress would dare to leave Washington without a beautiful new HealthCare bill fully approved and ready to go!
— Donald J. Trump (@realDonaldTrump) July 10, 2017
It is unclear that this additional pressure will work, however, considering Republicans have already shown themselves willing to blow past several “hard deadlines” this year.