clock menu more-arrow no yes mobile

Filed under:

What’s the price for a Senate health care vote these days?

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.

Mitch McConnell has no more room for error. After Senate leaders released a revised health care bill, Sens. Susan Collins (R-ME) and Rand Paul (R-KY) both said they would vote to block debate from starting on it.

If just one more senator joins them, this bill is doomed.

The ones to watch are the moderates, many of whom are opposed to the bill's Medicaid cuts. The revised plan doesn't do much to assuage their concerns: It still ends the generous federal funding for Medicaid expansion and places a spending cap on the program with an even lower growth rate than the House bill did.

We know McConnell is trying to reassure these senators that the deepest Medicaid cuts will never take effect. But it will likely take more than that to get their votes. Sen. Shelley Moore Capito (R-WV), for instance, said after the revised bill's release that she still had "serious concerns."

So it will be Christmas in July in the United States Senate. This is what we know:

  • McConnell will have money to spend. He already had funding to play with under the original bill, and now he has decided to keep some of the Obamacare taxes of the wealthy.
  • We don't know how much, but it could be $100 billion or more. Some of the available funding is already promised to stabilization funding, to the opioid crisis, and for health savings accounts. We'll know exactly how much is still left when the next CBO score comes out.
  • The majority leader has already shown a willingness to cut senator-specific deals to try to win votes.

The bill already includes $45 billion for the opioid crisis, a concession to Capito and Sen. Rob Portman (R-OH), though the former said that wouldn't be enough for her vote without some additional changes to Medicaid. More money could be headed for Ohio and West Virginia, and some lobbyists think McConnell could still bend on the spending cap's growth rate.

As Bloomberg reported, the revised bill also includes a funding stream that should help Alaska. Sen. Lisa Murkowski (R-AK); she's one of the toughest votes for McConnell, and she is fixated on Medicaid too. It's not clear if the provision highlighted by Bloomberg is enough, or if she'll need more.

(By the way, the official Vox style for any Alaska-targeted provisions will be "the Kodiak Kickback." Thank you.)

McConnell also needs to win over Sen. Dean Heller (R-NV), whose state's Republican governor, Brian Sandoval, is fiercely opposed to the Medicaid cuts. The Nevada Independent reported Sandoval was still concerned about the revised bill, meaning McConnell may have to also convince a governor the bill is good enough to vote for. A Silver State Sweetener might be coming out of the leadership slush fund.

McConnell met with the Medicaid-minded moderates in his office for nearly two hours Thursday. They didn't say a lot when they left; Portman didn't reveal much more than he was "still looking at it."

These payoffs, plus the partisan pressure for Republicans to pass something after such a painful legislative process, seem like the only way the bill could pass. McConnell has to sweep the remaining undecideds to pull it off. But money talks.

Chart of the Day

Urban Institute/Brookings Tax Policy Center

The Senate bill isn’t quite so regressive anymore. By keeping some Obamacare taxes, the revised plan doesn’t explicitly cut taxes for the wealthy at the expense of the poor. But it does still include a big corporate tax cut while cutting benefits for low-income Americans, and it expands the use of health savings accounts, which generally benefit people with higher incomes more.

Kliff’s Notes

Your daily top health care reads, with research help from Caitlin Davis

Today's top news

Analysis and longer reads

Join the conversation

Are you an Obamacare enrollee interested in what happens next? Join our Facebook community for conversation and updates.

Sign up for the newsletter Sign up for Vox Recommends

Get curated picks of the best Vox journalism to read, watch, and listen to every week, from our editors.