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The Senate really, really doesn’t want to repeat the House’s health care mistakes

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

This is the web version of VoxCare, a daily newsletter from Vox on the latest twists and turns in America’s health care debate. Like what you’re reading? Sign up to get VoxCare in your inbox here.

Passing a health care bill in the House was messy, if you didn't notice. It took months of very public bickering and negotiating to get the moderate and conservative wings of the House to agree to a plan with enough votes to pass.

Senate leadership is trying to avoid a similar calamity. They convened a 13-member working group to work on a Senate health care bill, with members from the middle (Rob Portman of Ohio) and the right (Mike Lee of Utah).

The idea is to hash out the policy differences between the two extremes of the conference behind closed doors; the group met for about 40 minutes in the Capitol today. That would prevent a repeat of the sloppy process that led to the House's health care bill.

"If this group can agree, they can pass a bill," one Republican health care lobbyist told me.

Today's meeting focused on Medicaid, likely to be one of the most contentious issues for the Senate. The moderates are worried about cutting off Obamacare's Medicaid expansion too quickly; conservatives want to unwind one of the law's core provisions as soon as possible.

But as senators streamed back into the Capitol hallways after the meeting, the vibes were positive.

"You've got a group of people that want to get to 'yes,'" Sen. Ron Johnson (R-WI) told reporters.

When I caught up with Sen. Shelley Moore Capito (R-WV), who has been particularly focused on Medicaid, she took one big potential problem off the table by saying she's receptive to the spending caps for the program included in the House bill.

"Gotta make sure it's adequate," she said, "but I think there's some real interest there."

Capito sounded optimistic that she and her peers could find common ground.

"I think there's a sweet spot somewhere," she said.

Then again, what else are they going to say? This was the first public meeting since the House passed its bill — and there were no firm answers to the sticky questions the Senate needs to resolve. What are they going to do with Medicaid? What about the financial assistance people receive to buy health insurance? Are they going to allow states to roll back Obamacare's consumer protections?

Senators and their staff have cautioned that this is going to be a months-long process. There is plenty of time for fissures to emerge. You can already see some potential for such friction, despite Senate leadership's best efforts.

Portman is leading a separate group of senators focused on Medicaid, according to Sen. Susan Collins (R-ME). She and Sen. Bill Cassidy (R-LA) are also reaching out to lawmakers about their own health care bill, which would allow states to choose whether they want to keep Obamacare.

It's still early. But competing "health care working groups" (better name TBD; submit your ideas for what Vox should call the group here) could lead the Senate down the same path as the House.

Meanwhile, in Tennessee…

Last month, Sarah Kliff wrote about the people in parts of Tennessee who were at risk of having no health insurance offerings through Obamacare in 2018.

But they got some good news today: Blue Cross Blue Shield is going to step in and sell plans in those areas next year.

That's good for Tennessee residents. But the insurer had some conditions, which friend of VoxCare David Anderson helpfully annotated on Twitter.

Chart of the Day

Anti-vaccine fearmongering and a measles outbreak. Anti-vaxxer activists have stoked fears among Minnesota's Somali community about the debunked link between vaccines and autism. Their work led to a drop in immunizations. Now the state is dealing with a measles outbreak. Read more from Vox's Julia Belluz here.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

  • "Republicans are just starting the hard part on health care": “If repealing Obamacare was a marathon, Republicans have only made it past the first few mile markers. They face a long, steep road ahead in the Senate, filled with procedural and political potholes that could derail them at every turn.” —Paige Winfield Cunningham, Washington Post
  • "Republicans scold Tom Price for 'potentially illegal' HHS memo": “Two top congressional Republicans are warning Health and Human Services Secretary Tom Price that a memo to HHS employees restricting their communications with Congress is 'potentially illegal and unconstitutional' and could have a chilling effect on whistleblowers.” —David Nather, Axios
  • "Abortion politics trip up blue-state GOP governor": “Republican Bruce Rauner insisted he had no social policy agenda when he campaigned for Illinois governor in 2014, and even showcased his socially liberal wife in TV ads to prove it. Earlier this year, the governor took another step to remind his blue-state constituents of his distance from the national GOP: He and his wife cut a $50,000 check to Planned Parenthood. But if Rauner thought that would insulate him from the roiling abortion politics of the moment, he was wrong.” —Natasha Korecki, Politico

Analysis and longer reads

  • "As they fight the opioid crisis, addiction counselors see a grave new threat: the GOP health plan": “As passed, the House bill would roll back the Medicaid expansion that 31 states, including West Virginia, took advantage of under the ACA and cap federal contributions to the Medicaid program beyond the expansion. Millions of people would be expected to lose their coverage, and those who maintain some sort of plan might find it more expensive to get substance abuse treatment.” —Andrew Joseph, Stat News

"Life Expectancy Can Vary By 20 Years Depending On Where You Live": “In 2014, there was a spread of 20.1 years between the counties with the longest and shortest typical life spans based on life expectancy at birth. In counties with the longest life spans, people tended to live about 87 years, while people in places with the shortest life spans typically made it to only about 67, the researchers found.” —Rob Stein, NPR

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