Tuesday, June 13, 2017

It’s not a sure bet, but they have a plausible path.

Behind closed doors, the Senate is drawing closer to passing a health care bill that looks a lot like the widely disliked version that cleared the House.

Any agreement currently on the table would almost certainly result in millions fewer Americans having health coverage, including low-income workers on Medicaid. It could roll back some Obamacare protections for people with preexisting health conditions.

The votes still aren’t there, but a path has opened to get them. Republicans have negotiated for a month inside back rooms of the Senate. They plan no public hearings on the legislation. Some of their members are eager to vote soon, acknowledging that public pressure against the bill is only likely to grow as the summer wears on.

The speed and secrecy have pushed GOP senators toward compromise on policy disagreements that once appeared too great to bridge. They are discussing how to end the ACA’s Medicaid expansion over a number of years. They are coalescing around cuts to the entire Medicaid program — the big question being how large those cuts might be.

Senate leaders are pushing a compromise on how much to unwind Obamacare’s protections for people with preexisting medical conditions — though it could still leave those patients vulnerable to losing the comprehensive coverage they receive now.

There’s broad agreement to increase the money the House bill would spend subsidizing Americans who buy insurance on the individual market. That increase would probably improve, at least somewhat, the Congressional Budget Office’s projection that the House bill would cause 23 million fewer Americans to have health insurance a decade from now.

The effort could easily fail. Any trio of conservative or moderate senators could sink the bill. The “budget reconciliation” procedure Republicans are using to pass their plan without any Senate Democrats restricts what policies they can include, which makes negotiations a little more difficult. Disagreements over provisions covering abortion and funding for Planned Parenthood could prove too much to overcome.

Still, Senate leaders appear more optimistic that a deal is in sight.

“Slowly but surely, I think we’re gonna get there,” Sen. John Cornyn (R-TX), the No. 2 Republican, told reporters on Thursday. “We’re coming together.”

The Senate negotiations are picking up and taking up shape

No public hearings are expected on the bill, as the Senate is undertaking a deliberately more secretive process after the House’s raucous, though abbreviated, debate.

Senate Majority Leader Mitch McConnell (R-KY) presented GOP senators with some concrete policy choices this week. They are the result of weeks of closed-door discussions of a working group of a dozen or senators, plus daily talks with the entire GOP conference.

McConnell’s offers, and the accompanying counteroffers from different segments of his conference, have helped to accelerate the health care talks.

“I think we’re closer because there’s a proposal out there, so that gives everybody an opportunity to weigh in,” Sen. Rob Portman (R-OH), who will be one of the weathervanes on the bill’s chances, told me on Thursday. “Whereas when it was just a wide open discussion, it was hard to come up with any consensus.”

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