A Guide: Understanding Congressional Confusion on Health Care – NBCNews.com

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WASHINGTON — It’s crunch time for health care in the Senate, where GOP leaders could bring up a bill soon that would partially repeal and replace Obamacare. But the process is taking place behind closed doors and it’s often hard to keep track of what’s going on amid major news developments elsewhere. Here’s what you need to know about where things stand, which lawmakers could make or break a deal, and which policies might end up in a final bill.

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.




Image: Trumps speaks after the House voted to repeal and replace Obamacare

US President Donald J. Trump, along with GOP lawmakers, speaks after the House voted to repeal and replace Obamacare with a Republican version of the health care law in the Rose Garden of the White House in Washington on May 4, 2017. The Republican health care bill may never become law; it next goes to the Senate, where lawmakers will rework the bill and send it back to the House.