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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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Senate Republicans, as they headed into a lunch where they’d learn from GOP leadership how they would be proceeding in their Obamacare repeal efforts, were already spinning the emerging “skinny repeal” plan that may be the final bill they vote on as a success, after failing to settle on a replacement bill.

Progress is progress,” Sen. Tim Scott (R-SC) told reporters before the lunch. He said would still prefer more substantial legislation to dismantle the Affordable Care Act, but that “eliminating the individual mandate would be a good thing.”

Seeking to claw their way out of a quagmire where neither the Obamacare replacement legislation the Senate has been working on nor a backup repeal-and-delay modeled on 2015 legislation would get enough votes to pass, Senate sources were floating the possibility that Republicans instead would vote on a so-called “skinny repeal,” a narrow set of repeal proposals on which Republicans mostly agree. Medicaid would go untouched under such a measure, so would the Affordable Care Act’s insurers regs, which conservatives were seeking to gut in order to lower premiums.

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If Senate Republicans pass their Frankenstein monster of an Obamacare replacement plan this week, it’s because Majority Leader Mitch McConnell (R-KY) bent the dozen or so Republicans previously against it to his will, and not the other way around.

Few of the fundamentals of the repeal bill, the Better Care Reconciliation Act, have changed since McConnell delayed his initial plans for a vote last month. The major revisions Republicans did make, such as the preservation of some of the Affordable Care Act’s taxes, appeared to be optics-based, or even further alienated the senators wavering on the bill.

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As the Senate GOP efforts to repeal the Affordable Care Act reaches its supposed apex this week, a remarkable amount remains unknown – even to Republican senators. But what is close to a given is that whatever happens, the effort will likely fail.

Majority Leader Mitch McConnell (R-KY) last week indicated that he was sticking to his plans to hold a vote Tuesday to open the debate on a health care bill. But neither of the two repeal proposals he has floated — a repeal-and-delay bill and the Obamacare replacement legislation the GOP has been negotiating — has enough support to pass.

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Democrats on the Senate Budget Committee posted a document Friday that they say reflects the various provisions in the GOP Obamacare replacement bill that the Senate parliamentarian has ruled to be not eligible for reconciliation, the process by which Republicans can avoid a Democratic filibuster.

The Senate parliamentarian’s office did not immediately respond to attempts to confirm the parliamentarian’s rulings on the bill, which were expected Friday.

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Senate Republicans eager to rescue their flailing Obamacare repeal effort — or at least, eager not to be blamed if it fails — are clinging to a vague idea reportedly being pitched by top Trump administration officials that they say will mitigate the replacement bill’s massive cuts to Medicaid.

The idea is being called a “wraparound” by GOP senators, and they say the goal would be to funnel the low-income people who would lose Medicaid coverage into private plans, using a combination of tax credits for private insurance, the legislation’s stabilization fund and existing Medicaid revenue streams.

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Republicans must be feeling beach season, because they all have their flip-flops on.

The prospect that the Senate might vote on a version of 2015 legislation that repealed many parts of Obamacare with a two-year delay to replace it down the road has key Republicans in the health care debate doing a 180 — or even a full 360, in some cases. All but one current GOP senator voted for the repeal-and-delay bill, which was vetoed by then-President Obama, in 2015. Some are saying they won’t vote for it again, while others in favor of going in this direction a few months ago insisted that Republican pass a replacement the Affordable Care Act instead of just repealing it.

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The Congressional Budget Office said Thursday that a new draft of the Senate Obamacare replacement legislation would result in 22 million fewer people with health coverage by 2026, compared to current law.

By 2026, 15 million fewer people would be enrolled in Medicaid, 5 million fewer people would have nongroup coverage and two million fewer people would have coverage through their employer when compared to current law, the CBO said.

The score did not reflect any analysis of a proposal being offered by Sen. Ted Cruz (R-TX) that would let insurers sell unregulated plans because that amendment was not in the bill text submitted to the CBO its Thursday score. The coverage losses were akin to the ones predicted under the office’s first score of the Senate health care legislation, the Better Care Reconciliation Act.

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The score that the Congressional Budget Office is expected to release Thursday of the latest version of the Senate Obamacare replacement legislation will not include analysis of the biggest change to the bill senators may or may not be voting on next week: An amendment by Sen. Ted Cruz (R-TX) that the insurance industry already warned would cause “millions of more individuals” to “become uninsured.”

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Forty-eight hours ago, GOP senators, led by Majority Leader Mitch McConnell (R-KY), appeared ready to leave their embattled health care legislation for dead and instead attempt a likely-doomed vote on clean Obamacare repeal legislation that would put on the record those Republicans who killed their long-held dream of dismantling the Affordable Care Act.

One White House lunch and a late-night huddle later, senators appear willing to at least keep their Obamacare replacement legislation, the Better Care Reconciliation Act, on life support. GOPers emerging from Wednesday night’s meeting, held in Sen. John Barrasso’s (R-WY) office, offered few details of what could bridge the differences in their conference that had sunk the legislation earlier this week.

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Thirty-two million more people people will be uninsured by 2026, compared to current law, if the GOP repeal-and-delay legislation the Senate may vote on next week becomes law, the Congressional Budget Office said Wednesday.

The legislation, which was posted shortly before the CBO released its score, tracks closely with a bill that Congress passed and then-President Barack Obama vetoed in early 2016.

The CBO report also said that premiums would double by 2026 under the Senate legislation, which eliminates the Affordable Care Act’s taxes, insurance subsidies and Medicaid expansion, but keeps its regulatory regime in place.

The repeal of the subsidies and expansion would go into effect in 2020, while the elimination of individual mandate would take place right away.

The analysis predicted that insurers would flee the exchanges under those conditions:

In CBO and JCT’s estimation, under this legislation, about half of the nation’s population would live in areas having no insurer participating in the nongroup market in 2020 because of downward pressure on enrollment and upward pressure on premiums. That share would continue to increase, extending to about three-quarters of the population by 2026.

The CBO predicted that the Medicaid expansion elimination would reduce Medicaid spending by $842 billion over the next decade, and the government would save $454 billion from getting rid of the subsidies. Those savings would be partially offset by the repeal of the taxes — which costs the government $613 billion in revenue—and the end of mandate, for a net deficit reduction of $473 billion.

The analysis comes as Senate Republicans consider whether to vote on the so-called “clean repeal” bill, after their legislation known as the Better Care Reconciliation Act saw enough defections this week to sink it.

In theory, Republicans say, they will work out a replacement plan in the two years before repeal of the ACA subsidies and Medicaid expansion kicks in. However, CBO’s analysis highlights that even in that ideal scenario, some of the legislation’s ugly effects will kick in pretty quickly.

The CBO predicted that in 2018, 10 percent of the population would be living in areas where no insurers would be participating in the individual market. It also said premiums for what are known as “silver plans” under the ACA would rise by 25 percent in 2018, because fewer people would chose to enroll without the mandate and because the mix of those individuals who would remain would be costlier.

In 2018, 17 million more people would not have health insurance coverage than under current law, 10 million of those losses coming from the nongroup market. While those increases are largely fueled by the end of the mandate, the increase in premiums and the departure of insurers from the marketplace would also play a role in reducing coverage, the CBO said.

Come 2020, 27 million fewer people will have coverage compared to current law, and that number would grow to 32 million by 2026. Of the 32 million, 19 million would be due to Medicaid cuts and 23 million to changes in private insurance.

Leaving Obamacare’s regulatory regime in place while taking away its government assistance is partly to blame for those high numbers. The CBO found if the regulations were also repealed, 23 million fewer people would be insured in 2026 compared to current law, instead of 32 million.

Overall, the CBO painted a picture of major instability if the legislation became law, culminating in three out of every four Americans living in an area with no insurers by 2026.

Read the report below:

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