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Senate starts long process for health bill
McConnell appoints working group to craft an alternative to House version
WASHINGTON — It took plenty of blood, sweat and tears for Republican leaders to finally push their health care bill through the House last week. Don’t expect the process to be less complicated in the Senate, though more of the angst in that more decorous chamber will likely be behind closed doors.
No one expects a new bill to be written quickly, but Senate Majority Leader Mitch McConnell, R-Ky., has started a process for producing one. Republican senators have made clear their measure will differ markedly from the House legislation, which has drawn withering criticism from Democrats who view it as a pathway to winning a House majority in the 2018 elections.
“This process will not be quick or simple or easy, but it must be done,” McConnell said Monday.
McConnell doesn’t like surprises or drama. Both characterized the House’s chaotic four months of work on its bill, which saw revolts by conservatives and moderates derail initial versions of the legislation and humiliate President Donald Trump and Speaker Paul Ryan, R-Wis.
McConnell has included himself in a group of 12 GOP senators essentially tasked with privately producing a bill that can pass the Senate. Republicans control the chamber 52-48.
Democrats are virtually certain to unanimously oppose the Republican effort to repeal much of President Barack Obama’s health care overhaul. So Republicans are using a special process preventing a Democratic filibuster that would require 60 votes to end. McConnell will need 50 GOP votes to pass a bill, a tie that Vice President Mike Pence could break. Majority Leader Mitch McConnell has named 12 senators, including himself, to a group that will write the Senate version of the health care bill. The group lacks any female members.
That means McConnell can lose just two Republicans, so his group has a strategically shaped membership.
Sens. Lamar Alexander, R-Tenn., Mike Enzi, RIdaho, and Orrin Hatch, R-Utah, chair pivotal committees. Sens. Rob Portman, R-Ohio, and Cory Gardner, R-Colo., are from states that used Obama’s law to add hundreds of thousands of beneficiaries to Medicaid, an expansion they want to protect but the House bill would end. Gardner chairs the Senate GOP’s campaign committee.
Sens. Ted Cruz, R-Texas, and Mike Lee, R-Utah, are conservative firebrands who represent states that didn’t expand Medicaid but want additional funds for that program. Sens. John Cornyn, R-Texas, John Thune, R-S.D., and John Barrasso, R-Wyo., are in the Senate GOP leadership, and Tom Cotton, R-Ark., frequently criticizes the House measure.
Democrats and liberal activists have lambasted McConnell for appointing a group with no female members.
Portman is among Republicans whose states dislike the House’s Medicaid cuts because they’d face a wave of constituents losing coverage under the health care program for the poor. The House would end the extra federal money states get for new beneficiaries under Obama’s Medicaid expansion by 2020, and some GOP senators want a delay.
Medicaid money is used to combat the illegal use of opioid drugs. That’s another reason for GOP senators from hard-hit Midwestern and Northeastern states to oppose such cuts.
Obama’s law helps millions buy private insurance with federal subsidies geared to income and policy premiums. The House instead links its aid to age, with older people getting larger tax credits. Thune and others want the subsidies to be more generous for lower earners and older people, who could also face far higher premiums under the House legislation.
In addition, the special process Republicans are using requires that legislative provisions be related to raising or decreasing the federal deficit, and not primarily driven by policy changes. Conservative health care analyst James Capretta says the odds for survival “are low” for House language letting states permit insurers to boost premiums on some people with pre-existing conditions.
Also in jeopardy: a provision forbidding consumers to use federal subsidies to buy insurance covering abortion.
Underscoring political sensitivities, critics attacked Rep. Raul Labrador, RIdaho, for saying at a town hall meeting that “nobody dies” from lack of health care. He later said that “wasn’t very elegant.”
The nonpartisan Congressional Budget Office is expected to release its analysis of the House bill this month.
No one is certain when the Senate might write and pass its bill, though some following the process think that could come by July 4.