MEDICAID

Care Act, Senate Republicans said Thursday they were seriously considering proposals to keep one of the law’s taxes on high-income people while providing more money to combat the opioid epidemic and a new incentive for people to establish tax-free savings accounts for medical expenses. Collins said Republican leaders and Trump administration officials had agreed to $45 billion for a dedicated opioid treatment fund.

Republicans also said they were considering a proposal that would allow insurers to sell cheaper, less comprehensive health plans if they also offered at least one plan that complied with consumer protection standards like those in the Affordable Care Act.

The talk of leaving in place a tax on investment income was a big break from the House-passed health bill and from the Senate’s approach. And it was championed by reliably conservative Republicans who acknowledged the tough choices that the bill could force on lower-income Americans.

“It’s not equitable to have a situation where you’re increasing the burden on lower-income citizens and lessening the burden on wealthy citizens,” said Sen. Bob Corker, R-Tenn. “That’s not a proposition that is sustainable, and I think leadership knows that.”

But for every concession made to one senator, another senator seemed to balk.

“We pledged that we would repeal Obamacare. I don’t remember anybody going around saying, ‘Oh, except for these job-killing tax increases,”’ Sen. Patrick J. Toomey, R-Pa., said of the talk of leaving the investment tax increase in place. “So I expect that we’ll be repealing all of the taxes in Obamacare.”

The negotiations themselves are attracting controversy, and personal strains are showing.

McConnell dressed down Sen. Rob Portman, R-Ohio, this week over the Medicaid cuts. Senate Republicans bristled after an outside group tied to Trump went after one of their own, Dean Heller of Nevada, for opposing the bill. Adding to the insult, one of the top officials of that group, Nick Ayers, was named Vice President Mike Pence’s chief of staff on Thursday — after the blowup.