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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
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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
- “Senate G.O.P. Leaders Unveil Health Care Bill to Try Winning Over Skeptics”: “With the revised bill, the majority leader, Mitch McConnell, Republican of Kentucky, is trying to keep alive his party’s seven-year quest to dismantle the health law that is a pillar of former President Barack Obama’s legacy.” —Robert Pear and Thomas Kaplan, New York Times
- “From hospitals, doctors and patients, a last gasp of opposition to the Senate health-care bill”: “In recent weeks, a last gasp of advocacy has come from an even wider range of groups and individuals trying to block the Senate health-care bill.” —Juliet Eilperin and Paige Winfield Cunningham, Washington Post
- “Despite doomsday rhetoric, Obamacare markets are stabilizing”: “For the first time ever this year, insurers selling plans in Obamacare’s markets appear to be on a path toward profitability. And despite the drumbeat of headlines about fleeing insurers, only about 25,000 Obamacare customers live in communities facing the prospect of having no insurer next year.” —Paul Demko, Politico
- “California Sued For Allegedly Substandard Medi-Cal Care”: “The complaint claims that beneficiaries of Medi-Cal, the state’s version of the Medicaid program, often experience delays in care or are denied care altogether. And, it says, they may have to travel longer distances to find medical providers who are willing to see them.” —Ana B. Ibarra, Kaiser Health News
Analysis and longer reads
- “What's Inside Mitch McConnell's Latest Health-Care Proposal”: “The revised Senate health-care bill that Republican leaders released on Thursday morning seemingly has something for everyone — but perhaps not enough for anyone.” —Russell Berman, the Atlantic
- “Groundbreaking New Leukemia Treatment Will Save Lives and $Billions”: “The decision by a panel of the Food and Drug Administration to recommend the approval of a new therapy for a common form of leukemia could have a huge impact on the cost of treating a disease that costs billions of dollars per year to manage in the United States alone.” —Rob Garver, Fiscal Times
- “Mobile App Designed To Prevent Pregnancy Gets EU Approval”: “There are more than a dozen medically approved methods of birth control, including condoms, the pill and implants. Now for the first time, a cell phone app has been certified as a method of birth control in the European Union.” —Lauren Silverman, NPR
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