Senate Republicans are making are taking a second crack at their healthcare bill, but it’s unclear if proposed compromises will be enough to get the bill across the finish line.
Members of the conference have been meeting constantly since Majority Leader Mitch McConnell delayed a vote on the bill, the Better Care Reconciliation Act, until after the week-long July 4 recess.
Reports have suggested a slew of ideas bandied about to bridge the divide between centrist members of the party and more conservative members, but an agreement has yet to be reached.
Republican leaders sent the Congressional Budget Office the outline of a new bill to get preliminary feedback on the ideas when they get back from recess. That would likely speed up the CBO’s process when Senate leaders send a full bill.
While sending something to the CBO is a minor victory for a divided party, the biggest policy disagreements still need to be hammered out. Moderates are demanding more funding for various healthcare initiatives, while conservatives want to gut funding even more and repeal more of Obamacare’s regulations.
Here’s a rundown of the ideas being discussed:
- More funding to fight the opioid crisis: The BCRA included $2 billion to fight the growing crisis, much lower than GOP senators from states hit hard by the crisis were hoping. Discussions have included raising the funding level to $45 billion. That would be a carrot for moderates like Rob Portman of Ohio and Shelley Moore Capito of West Virginia.
- Allow insurers to sell plans that do not follow Obamacare’s regulations: Sen. Ted Cruz has proposed an amendment appealing to the conservative wing that would allow insurers to offer plans that did not qualify under Obamacare’s essential health benefits and community rating provisions, as long as they maintained at least one plan that did qualify. That would allow young and healthy people to buy skimpier plans that cost less while maintaining high quality, more expensive plans for those that needed them. But the community rating provision prevents people with pre-existing conditions form being charged more, so a change has faced resistance.
- Keep some of Obamacare’s taxes: Senators are discussing leaving some of the taxes included in Obamacare in place, potentially freeing up more funding for programs like Medicaid and the opioid crisis. The biggest could be the 3.8% net investment income tax on people incomes of more than $200,000 a year.
- Expand the use of health savings accounts: A discussion among GOP senators would allow these nontaxable accounts to be used toward premiums.
Whether or not those changes would be enough to get 50 senators on board is unclear. Cruz’s proposal would face resistance from moderate members who saw the public backlash after the House included a proposal that would’ve allowed states to gut preexisting conditions protections.
“If Cruz succeeds in putting it in the bill, the bill dies. Period. End of sentence, end of paragraph, end of story,” a GOP aide told Axios.
Senate leaders also want to expand funding for various proposals to cut down the number of people the CBO projects would be without insurance under the BCRA. Monday’s CBO score showed 22 million more Americans would go without insurance by 2026 than under the current baseline. Of those, 15 million would come off the Medicaid rolls, according to the report.
On the other hand, leaving some of the taxes in place or upping the spending on Medicaid and the state stability fund included in the bill might be non-starters for conservatives like Sen. Rand Paul of Kentucky.
Greg Valliere, chief strategist at Horizon Investments, said the longer the disagreement continues on the bill, the more likely it is to fail.
“It’s too early to declare the bill dead, but it’s on life support,” Valliere told Business Insider in an email. “The longer it lies in the July sun, rotting like a dead fish, the more difficult it will be to win public support.”
But Valliere said “the wily McConnell will keep dealing until the August recess; if there’s no compromise by then, the dance will be over.”
Getting the two sides to an agreement soon is paramount to finish the push before the month-long August recess.
Once Congress returns from the summer break, it will have just one month to deal with raising the nation’s debt ceiling, moving a funding bill to keep the government from shutting down, and a slew of other necessary legislation.