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As American as apple pie and high-deductible health plans

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.

Senate Republicans are still stuck. They are home for the July Fourth holiday without a health care plan that can win 50 votes.

They currently have a bill under which 22 million fewer Americans would have health insurance and Medicaid would be cut by $772 billion versus Obamacare. Yet neither wing of the Senate GOP conference is happy.

The moderates want less severe Medicaid cuts, though they're mostly okay with ending Obamacare's Medicaid expansion and placing a federal spending cap on the program. They want to keep some of the health care law's taxes so they can in turn boost financial aid for private coverage.

Conservatives want to unwind more of Obamacare's insurance regulations and they're wary of keeping the law's taxes that they promised to repeal.

Here's a nifty chart, courtesy of Vox's Bella Lucy, to make sense of the debate:

What GOP senators what in the health care bill

I've been told Mitch McConnell describes the search for a plan that 50 of his 52 Senate Republicans would support like solving a Rubik's Cube. In those disparate and opposing dots, he is trying to find a balance.

He might not pull it off. Even if he does, it will likely result in a plan where many Americans pay more for health care than they do under Obamacare and millions fewer people have health insurance.

Right now, one key component to resolving that riddle is Ted Cruz's proposal, which would allow health insurers to sell non-Obamacare plans as long as they also sold plans that did comply with the law. If the Senate conservatives can get what they want in the "insurance mandates" column, they may be more willing to compromise on Obamacare's taxes and the Medicaid cuts.

McConnell has asked the Congressional Budget Office to evaluate the Republican bill both with Cruz's amendment and without it, Axios reportedover the weekend. That's big — both for the headlines about premiums and coverage losses and for figuring out whether the provision is allowed under the Senate's procedural rules. More on that Wednesday.

So we should learn more after tomorrow's (actual) fireworks. But as we await the Senate's next move, this is the playing field.

Chart of the Day

Javier Zarracina/Vox

The racial disparity of maternal mortality. Black women are increasingly more likely to die in childbirth than white women in the United States. Vox's Julia Belluz took a look at North Carolina, one state that is reversing that trend.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

  • "GOP senators warming to repeal then replace on ObamaCare": “As the Senate majority leadership struggles to obtain enough support to pass healthcare legislation, some senators on Sunday argued it might streamline the process to split the bill into two. Sen. Rand Paul (R-Ky.), who has been a vocal critic of the Senate GOP's healthcare bill — largely because he does not believe it's a full repeal of former President Obama's signature healthcare law — suggested Sunday the ObamaCare repeal and replace bills be separated.” —Rebecca Savransky, the Hill
  • “Manchin: Dems want to work with Trump on health care”: “Sen. Joe Manchin on Sunday said members of his party are willing to work with Republicans and President Donald Trump to find a bipartisan solution on health care. Manchin, a moderate Democrat from West Virginia who has been seen as a potential partner on parts of Trump's agenda, made the comments in an interview on 'Fox News Sunday.'” —Connor O’Brien, Politico
  • “Republican Senators Face Pushback From Governors on the Health Bill”: “Republican senators back home on recess this week are hearing from some influential critics of their health-law effort: GOP governors, many of whom are urging them to push back on the legislation because it would cut Medicaid funding. Governors of states including Ohio, Nevada and Arkansas, which stand to lose billions of dollars in Medicaid funding under the Senate bill, want senators to keep as much of that money as possible.” —Kristina Peterson and Michelle Hackman, Wall Street Journal
  • “Senate asks for CBO score with, without Cruz proposal”: “Senate Republicans have asked the Congressional Budget Office to analyze Sen. Ted Cruz's proposal for further health insurance deregulation, and they've asked for one estimate of a health care bill that includes his changes and one that doesn't, according to a GOP aide familiar with the discussions.” —Caitlin Owens, Axios

Analysis and longer reads

  • “Medicaid Worsens Your Health? That’s a Classic Misinterpretation of Research”: “It appears that proponents like Ms. [Seema] Verma have looked at research and concluded that having Medicaid is often no better than being uninsured — and thus that any private insurance, even with enormous deductibles, must be better. But our examination of research in this field suggests this kind of thinking is based on a classic misunderstanding: confusing correlation for causation.” —Aaron E. Carroll and Austin Frakt, New York Times
  • “The gap between black and white infant mortality is creeping up again, leaving researchers puzzled”: “From 2005 to 2012, the infant mortality rate dropped for both black and white babies, with the decline much steeper for black babies. Then, in 2012, something changed. The mortality rate for white babies continued its steady drop, but for black babies (defined in the study as non-Hispanic), things plateaued. By 2015, the latest year for which data is available, it had even bumped up.” —Catherine Caruso, STAT
  • “California Joins States That Protect Patients Against Nasty Surprise Bills”: “Starting next month, many Californians will be protected against such surprise medical bills from out-of-network providers, also known as “balance billing.” California is among 21 states with consumer protections against balance billing, says Betsy Imholz, director of special projects for Consumers Union.” —Emily Bazar, Kaiser Health News

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