It Doesn't Sound Like Senate Republicans Are Anywhere Close To A Deal On Obamacare Repeal

"Where do I start?" one senator said when asked what the holdup was on health care negotiations.

WASHINGTON 鈥 It took the House months of infighting and a failed first attempt to ultimately pass a bill to repeal and replace the Affordable Care Act. More than two weeks later, Senate Republicans are nowhere near reaching an agreement on a bill of their own.

As scandal after scandal piled up for the Trump administration last week, Republicans were given some cover. Rather than being flooded with questions as they exited multiple meetings about their own disagreements on how to repeal and replace Obamacare, they were asked about the firing of FBI Director James Comey and the investigation into Russia鈥檚 meddling in the presidential campaign.

But even with some of the pressure off, they appear to have made only a little headway 鈥 enough to identify the key issues dividing them but not to make much progress on resolving those differences.

A substantial number of Senate Republicans have made it clear they cannot vote for the House bill, which would reduce regulations on health insurance, rearrange tax credits for people buying health insurance and dramatically cut funding for Medicaid 鈥 leaving many millions of Americans without health insurance while exposing older, sicker people to some combination of higher premiums and out-of-pocket costs.

The Medicaid cut is a big sticking point for senators from states such as Ohio and West Virginia that have expanded the program and have come to rely on it to finance treatment amid an opioid addiction epidemic.

Asked if she still had concerns about the health care talks, Sen. Shelley Moore Capito (R-W.Va.) said her problems haven鈥檛 changed from weeks ago when the House passed its bill.

鈥淲ell, still the Medicaid expansion piece, and whether the tax credits are sufficient at the lower end,鈥 she said, referring to credits afforded to older Americans who face higher premiums under the House bill. 鈥淭hose are the two biggest.鈥

Sen. Rob Portman (R-Ohio) backed up Capito鈥檚 complaints and added that the House bill goes too far in 鈥渘ot protecting鈥 communities reeling from the opioid epidemic. Still, Portman wouldn鈥檛 offer details on where talks are headed.

And scaling back the Medicaid cuts or bolstering tax credits for older consumers 鈥 a priority for many GOP senators 鈥 costs money. And the Republicans don鈥檛 have a lot of money at their disposal.

Under the rules of the budget reconciliation process 鈥 a procedural mechanism Republicans are using to avoid a Democratic filibuster 鈥 the Senate鈥檚 bill can鈥檛 increase the deficit. The only way to free up money would be to keep more of Obamacare鈥檚 taxes in place 鈥 and doing that risks losing the support of more conservative members who, all things being equal, would rather the Senate bill look more like the House bill, not less.

The parliamentary math for GOP leaders is difficult. Even under reconciliation rules, which allow Republicans to pass legislation with just 50 votes assuming Vice President Mike Pence breaks the tie, leadership can afford to lose only two members. And there are plenty more than two members who seem convinced the Senate is far from agreeing on anything.

Asked to share what major sticking points are holding up the talks, Sen. Jeff Flake (R-Ariz.) laughed and said: 鈥淲here do I start?鈥

鈥淚t鈥檚 totally fluid.鈥

- Sen. Bill Cassidy (R-La.) on the health care talks

Sen. Bill Cassidy (R-La.) told HuffPost he isn鈥檛 even sure where negotiations are headed.

鈥淚t鈥檚 totally fluid,鈥 he said, adding that he has no clue when the Senate would even be ready to bring a bill to the floor.

鈥淚鈥檓 not ducking. I just can鈥檛 answer it,鈥 Cassidy said. 鈥淚 don鈥檛 know.鈥

And the current disagreements among Republicans could only become worse once the Congressional Budget Office releases its projection on the effects of the House bill.

The CBO score, which is expected Wednesday, is 鈥渧ery important,鈥 Cassidy said. He stressed that it will help 鈥渋nform policy decisions鈥 facing Republicans in the Senate, and he appeared hopeful that it would steer his colleagues away from the House bill.

鈥淭here鈥檚 still some idea that we might use the House plan as a basis for which to proceed,鈥 he said.

Of course, the prospects for getting a repeal bill through the House looked bleak until it didn鈥檛. After House leaders pulled the bill in March because it didn鈥檛 have the votes, senior members began negotiating quietly on their own until they鈥檇 worked out a deal capable of 鈥 just barely 鈥 getting enough votes to pass.

It looks as if Senate Majority Leader Mitch McConnell (R-Ky.) is trying to do the same thing by having his caucus work out a deal behind closed doors and then bring it to the floor right when he is within striking distance of a majority. Sen. Bob Corker (R-Tenn.) is among the senators who aren鈥檛 happy about the process. On Tuesday, that irritation came to a boiling point for him.

鈥淚t鈥檚 a very awkward process, at best,鈥 Corker said. 鈥淭here are no experts. There鈥檚 no actuarials. 鈥 Typically, in a hearing, you鈥檇 have people coming in, and you鈥檇 also have the media opining about if a hearing took place and X came in and made comments.鈥

Later Corker called the entire saga 鈥渧ery difficult at best,鈥 adding that there鈥檚 been 鈥渁 lot of progress in understanding the problems鈥 senators have with the House bill, and between each other, 鈥渂ut there鈥檚 no bill written.鈥

But leadership hasn鈥檛 indicated a desire to move negotiations out into the open, and it鈥檚 not so hard to imagine how, eventually, they could work out a deal that would get them close to the 50 votes they need 鈥 while still keeping the guts of the House plan and its dramatic effects on insurance coverage.

Leaders might try to win over holdouts like Sen. Lisa Murkowski (R-Alaska), who has said she wants to protect her state鈥檚 Medicaid population, by offering extra money for Alaska 鈥 much as Democrats in 2009 used special funding for Nebraska to bring along then-Sen. Ben Nelson (D-Neb.) in what became known as the 鈥淐ornhusker Kickback.鈥 Maybe they could win over Capito and Portman with extra money for opioid treatment as a way to replace a little bit of the money their states would lose from Medicaid.

On the Medicaid expansion front, Sen. John Thune (R-S.D.) offered some insight into where the talks are at, saying there鈥檚 an interest among many Republicans to have a 鈥渓onger tail on [repeal] phase-out.鈥 Under the House bill, the extra federal funds for Medicaid expansion would phase out starting in 2020. Senate Republicans could push back that date or find some other way to make the transition more gradual, although, notably, the debate seems to be over when 鈥 and not whether 鈥 to end federal funding for the expansion.

There鈥檚 also the issue of pre-existing conditions and the tax credits, which are sticking points for Thune himself.

鈥淲e鈥檝e had a lot of members who鈥檝e made statements and are very committed to having a solution in place for pre-existing conditions. There are just a lot of ideas about how to do it,鈥 Thune said.

And the tax credits are a 鈥渨ork in progress,鈥 Thune said. A big concern there, he said, is that the House bill 鈥 unlike the Affordable Care Act 鈥 doesn鈥檛 tailor the tax credits to income, making it a lot harder for the poor and even some middle-class consumers to afford coverage.

A lot depends on whether external political events, like the upcoming special House elections in Georgia and Montana, change the political calculus of Republicans 鈥 so many of whom seem convinced that the political cost of doing nothing is worse than the political cost of doing something that appears to be highly unpopular.

About the only sure thing seems to be that neither GOP leaders nor members want to be dealing with health care forever. They continue to say they would like a vote no later than the August recess, even though the possibility of reaching a deal by then seems highly uncertain.

As Thune put it, 鈥淎t some point we need to vote, and so that day of reckoning will come.鈥

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