The Senate is out for the holiday, but the debate over its health care bill rages on in the states. Not so much debate, actually: Republicans seem to be hearing a very specific type of feedback. As Sen. Susan Collins (R-ME) told the Washington Post after a parade yesterday: “I heard, over and over again, encouragement for my stand against the current version of the Senate and House health-care bills.”
Behind the scenes, though, Senate leaders are still trying to amend the bill in such a way that it can flip a lot of GOP “no” votes to “yes” votes. How’s that going? Vox’s Dylan Scott and Jim Tankersley discussed the progress in a brief chat.
The July 4 recess is upon us, and — surprise! — Senate Republicans skipped town with no agreement on an amendment package that could get their health care bill anywhere close to the 50 votes they need for it to pass. Meanwhile, back home, that sound you hear amid the Independence Day parades is a pretty steady drumbeat against the bill from GOP senators' constituents. Dylan, you're working this week, even if the Senate is not! What's the latest on where things stand with the bill?
Well, the current bill has big problems. I can think of eight or so Republican senators who oppose the bill when they can only lose two — and the people who oppose are pulling the bill in opposite directions.
The one thing we know right now is [Mitch] McConnell is having the [Ted] Cruz amendment people might have heard about reviewed by the Congressional Budget Office. If he gives the conservatives that, I think he’ll pump a bunch of money into this bill and see if he can win the moderates over and maybe pass this.
So some big changes are coming to the bill, but until we know what they are, hard to know if leadership is making any progress.
Things don’t look great, though.
Okay, let's take those things in turn. The Cruz amendment basically relaxes some regulations on the individual market. Is it enough to bring Cruz on board? Mike Lee? Rand Paul??
I think that’s their big demand at the moment. As you say, it rolls back regulations and they think that will lower premiums — that’s been their No. 1 priority from the start. I think it’s more important to them that they get something on that issue than anything else, and it might make them more willing to compromise in other areas, like keeping some of Obamacare’s taxes.
Rand Paul is his own animal, but I think Cruz and Lee are pretty tightly locked on this.
But Rand Paul matters here. Let's come back to him in a second.
Now, the other side. The moderates. How much more money does McConnell need to bring them on board — either by delaying Medicaid cuts or by pumping more support for low-income folks into the individual exchanges?
Well, he’s gonna have about $200 billion more to play with if he keeps the Obamacare taxes on the wealthy, which a pretty broad spectrum of his caucus is on board with. One thing that’s not clear to me is whether he’ll put it all into the exchange subsidies or split it between Medicaid and the exchanges.
Whatever he does, it pretty clearly isn’t enough to reverse the collective cuts in the current bill to the exchanges and Medicaid.
So this will come down a little bit to how strongly the moderates feel they need to say they repeal Obamacare.
The news on that this week seems ... not helpful for McConnell. Both Susan Collins and Lisa Murkowski seemed to be playing the “defender of your health care” card in their respective July 4 parades.
Very much so!
There’s some safety in numbers at this point.
Heller, Collins, and Murkowski are very outwardly against this bill. (edited)
Heller held a press conference!
Which definitely complicates things for McConnell.
With his very popular Republican governor who’s been maybe the bill’s most prominent critic.
Zoom out for a second. Do those senators need the fundamental structure of this bill to change [in order] to support it?
If so, it seems like a lost cause for McConnell.
That’s what I’m not sure of. Some of them have gone a long way to leave the door open to eventually supporting it.
This is why these forthcoming changes to the bill will be important.
Are they enough to get anybody to switch? Or are the problems more, as you say, fundamental?
The biggest hurdle still seems to be how easy it is to count to three entrenched “no” votes.
Heller-Collins-Rand, or Collins-Murkowski-Heller, or any of a dozen other combinations.
And Rand and Collins want very different things.
And meanwhile, public opinion is still very strong against the bill. So what's McConnell up to over this recess? What fourth-and-goal-from-the-30 play is he drawing up to try to win this thing by mid- to late July?
The Cruz plan seems to be it, since it’s been sent to CBO. Give the conservatives that, keep the taxes, and hope enough moderates are persuaded by the new spending.
That has plenty of risks, not the least of which is there are big questions about what the Cruz amendment would do to the individual market.
But yeah, given the timetable, there’s not time for much else.