There was more optimism than progress for the Senate health care bill Wednesday as Republicans regrouped after kicking a health care vote until after the July 4 recess.
Thursday, we’ll see another Republican conference lunch and lots of one-on-one meetings between senators.
Here’s the state of play:
Where negotiators are closer to a compromise (or at least narrowing the gap)
On opioid funding — while they haven’t agreed to a final level yet, Sens. Rob Portman, R-Ohio, and Shelley Moore Capito, R-West Virginia, will at least get the $45 billion over 10 years they requested.
On health savings account flexibility, one of the key issues conservatives have raised — the ability for people to have more flexibility in what they can use HSA money for, including paying premiums.
Politico first reported Wednesday night that there was an agreement to add these two elements.
Don’t get too excited just yet
These changes, which haven’t been formally locked in yet, but are essentially there, are not a silver bullet.
Capito said opioid funding wasn’t enough to get her vote. She needs a softer landing for Medicaid and/or faster growth rate. For conservatives, they view the HSA flexibility as an important carrot, but curbing more Obamacare regulations are still the whole farm for them. (And why only take a carrot when only the whole farm will do?)
Speaking of conservatives…
What they want would put pre-existing regulations back in play. That was a disaster in the House — and conservatives want to go even further (the House limited their opt out to community rating, essentially the price protections for pre-existing conditions. Conservatives want more than that). Pre-existing has been an absolute non-starter for GOP leaders, who watched what happened in the House and learned an important lesson about the political blowback that came in waves after it was put on the table. How they try and reconcile this will be very interesting to watch (and that’s before you have to reconcile any opt-out provisions with wary moderates…)
Keep an eye on the tax cuts
More and more Senators talking about postponing or not repealing at all some of the Obamacare taxes — most notably the 3.8% tax on net investment income for people who earn more than $200K (which would be repealed retroactively in the Senate bill).
Nobody from leadership has pitched this, it’s an anathema to conservatives who have touted repealing Obamacare taxes as a key component of the bill, and it would be a complete non-starter for outside conservative groups. But enough rank-and-file members are starting to talk about it (Sens. Bob Corker, Mike Rounds, Susan Collins, Capito), that it may have some legs.
Of note, repealing that tax costs about $170 billion over 10 years, so if you put that in play, that’s another big pot of money to work with.
On the “bipartisanship” talk
Just to make something on this clear — McConnell has been using this as a *threat* to his members. As in, if we don’t get this done, President Donald Trump and some members of our conference will go work with Democrats and the end result will be *significantly* less conservative.
But an online New York Times headline (“As Affordable Care Act Repeal Teeters, Prospects for Bipartisanship Build”) has some asking the question: Is a bipartisan “fix Obamacare” proposal a possibility if repeal/replace is dead and in the ground?
Senate health committee Chairman Lamar Alexander, R-Tennessee, has been very active on this front. Particularly when it comes to some kind of short-term market stabilization bill (and taking the uncertainty off the table on CSRs), there are people on both sides who would work together.
There’s a core group of GOP moderates and Democratic moderates who talk a good game about coming together (they even had a meeting once!) But they’re nowhere near the point — in either party — where an effort like this has real legs. Oh, and even if/when it does, it will need leadership approval to move forward.
On the Democratic side, they’ve repeatedly said there’s no interest in doing something if Republicans talk about repealing Obamacare. And a senior Democratic aide to a moderate member emphasized again Thursday morning that nothing can happen until this Republican bill fails.
“There are no conversations,” the senior Democratic aide said. “No Democrat is going to sit down with a Republican until this thing is done.”
Oh, and Trump nuked Senate Minority Leader Chuck Schumer again Wednesday night at his fundraiser, for whatever that’s worth.
Trump promised a “big surprise” on health care. What did he mean?
According to senior GOP Senate aides: ¯_(?)_/¯