A Guide: Understanding Congressional Confusion on Health Care – NBCNews.com
Remind me what’s going on with health care?
The House passed the American Health Care Act in early May in a dramatic and sudden vote after abandoning a similar effort in March. Now it’s in the hands of the Senate, which has been hammering out its own legislation with a small and secretive working group of Republicans. Because they’re using a procedure called budget reconciliation, they can pass a bill with a bare majority — meaning they don’t need votes from Democrats, none of whom are likely to support their bill. If the Senate passes something, lawmakers will have to find a way to reconcile their differences with the House to get a bill to the president’s desk.
Is the Senate going to pass a health care bill soon?
They sound close. Republican senators say they hope to pass legislation before the July 4 recess, which means a vote could come within the next two weeks. There’s no firm deadline, though, and it’s quite possible the process drags on longer. There are 52 Republican senators and they can only lose two votes, so getting to 50 won’t be easy, but members sound more optimistic that they can reach a consensus than they did just weeks ago.
So what’s in this bill they’re so close to passing?
Here’s the thing: We have no idea.
Republican leaders have been negotiating the measure in secret, with talks led by a small 13-member working group that’s consulting with the broader GOP caucus, and leaks are few and far between. Even though a bill may be coming to a vote in two weeks or less, there’s no draft floating around to evaluate or even an outline of the legislation’s main features for the public to consider. Rank-and-file members say they’ve still only seen a broad menu of policy options in their meetings, rather than a concrete plan with legislative language.
This is a stark departure from the ordinary process, including the one used to pass the Affordable Care Act in 2009 and 2010, which is to have relevant committees draft legislation while holding public hearings with key industries, patients who might be affected by a bill, and policy experts who can weigh in on the details. The House took a similarly secretive approach with their own bill, which they voted on within 24 hours of releasing final text and without an assessment of its cost or impact by the Congressional Budget Office.
Even some Republican senators complain that they’ve been kept in the dark — Sen. Rand Paul (R-Ky.) jokingly asked NBC News to find him a copy of the bill — and some have said that they’d prefer a more open approach. But so far their grumbling hasn’t translated into action that would force the drafting process into the open.
Are there hints of what’s in the bill?
Based on interviews with senators and their public statements, we can get a loose sense of some of the policy debates going on between members, even if we don’t know all the specifics.
It’s likely the broad formula for legislation will be similar to the House bill, which offered less generous subsidies to buy insurance and pay out-of-pocket costs than Obamacare, cut Medicaid significantly and changed its structure, and used the savings to eliminate taxes that primarily affect wealthy Americans and the medical industry. Like the House bill, the Senate plan is expected to eliminate the individual mandate requiring everyone to buy coverage or pay a penalty.
The Congressional Budget Office estimated the House bill would spend $1.1 trillion less on health care and reduce deficits by $119 billion over a decade. But the effects on the individual insurance market would be dramatic: 23 million fewer people would have insurance in 10 years versus current law, premiums would soar for older and low-income Americans, and many customers would face higher deductibles and out-of-pocket-costs. On the flip side, some younger, healthier and higher-income customers could find less comprehensive insurance at cheaper rates.
Republican senators declared the House bill dead on arrival and it’s likely they produce legislation that’s somewhat less far-reaching in its cuts or spaces them out over more time. President Donald Trump publicly embraced the House bill when it passed, but then called it “mean” in a meeting with GOP senators last week and suggested on Twitter he was open to spending more money on care.
Who’s most likely to vote against a bill?
The toughest moderate votes at the moment appear to be Sen. Susan Collins (R-Maine) and Sen. Lisa Murkowski (R-Alaska), who have a wide range of objections to the House bill. Alaska has astronomically high healthcare costs compared to the rest of the country, which makes it a somewhat unique situation. The toughest conservative votes appear to be Sen. Rand Paul (R-Ky.), who may be impossible to win over, and Mike Lee (R-Utah), who is taking a more active role in talks.
Various other senators have raised concerns as well and should not be taken for granted as “yes” votes, but they usually sound more amenable to passing a bill in the end. As was the case in the House, don’t be surprised if some members make noise about voting “no” at the last minute as a prelude to cutting a deal that addresses one of their complaints.
What are the biggest issues they need to work out?
One visible area of contention between camps is how much to spend on Medicaid. The House bill would end Obamacare’s expansion of Medicaid and change its funding formula to cut the program further, eventually reducing overall spending by over $800 billion.