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Senate Takes Baby Steps on Health Care Overhaul

Meetings have focused on ‘brainstorming’ and sharing ideas

Senate Majority Leader Mitch McConnell is giving his caucus a wide berth in discussing health insurance legislation. (Tom Williams/CQ Roll Call File Photo)
Senate Majority Leader Mitch McConnell is giving his caucus a wide berth in discussing health insurance legislation. (Tom Williams/CQ Roll Call File Photo)


Senate Republicans remain in the very early stages of revamping a House bill to repeal the 2010 health care law: the ideas stage, as one of them puts it.

Many concede it could take some time to work through the daunting task.

The chamber has no other major legislation on the horizon as the first year of a Republican-controlled Congress nears the midway point. Huge questions surrounding the surprise firing of former FBI Director James B. Comey and the ongoing investigation into Russian influence in the 2016 election will likely overshadow any Senate action.

But Republicans who are trudging ahead on their seven-year quest to repeal the 2010 health care law continue to caution that any major legislative activity could take weeks, possibly months. Substantial action will have to wait until at least the week of May 22, when the Congressional Budget Office is expected to release its analysis of the bill that narrowly cleared the House last week.

“Nobody’s put pen to paper. We’re just all — it’s brainstorming at this point,” Senate Majority Whip John Cornyn of Texas told reporters.

Those brainstorming sessions are taking place across various working groups within the caucus, as well as the weekly policy lunches. Senate leaders say the discussions are largely about sharing ideas and determining where divisions are.

“We’re making progress, we’re airing all the issues out. I think we’re trying to sort of, narrow the differences we have in the conference on some of these key issues and then we’ll probably start writing things up,” Senate Republican Conference Chairman John Thune of South Dakota said.

There is immense pressure on Republicans to produce a proposal in short order, both so they can move to other parts of President Donald Trump’s agenda and to provide assurances to insurance companies who must finalize their 2018 rates ahead of spring deadlines to get the information to states, some of which have already passed.

The major hurdle, several Republican senators said, is finding consensus among the 52 GOP members who all have different ideas of what the legislation should look like.

Senators in the working group tasked with crafting the bill by Majority Leader Mitch McConnell met Thursday to focus specifically on changes that would “lower premiums,” several attendees confirmed. In addition to the dozen or so members who have met a number of times on health care, Sens. Joni Ernst of Iowa, Ron Johnson of Wisconsin and Tom Cotton of Arkansas also attended.

Attendees across the ideological spectrum said the meeting Thursday focused more on ideas than specifics.

“We’re way too early to get into that level of detail. I’m still on the 30,000 foot level in terms of, what are the primary goals of our effort here,” Johnson told reporters leaving the meeting.

Some conservative hardliners in the working group, such as Sen. Mike Lee of Utah, have backed an idea that would eliminate some of the health care law’s insurance requirements, its so-called essential health benefits, for example, unless states chose to “opt-in” to the regulatory structure.

Sen. Lamar Alexander, who chairs the Health, Education, Labor and Pensions Committee, declined to say whether Republicans were considering repealing those benefit requirements in their legislation, a provision that some outside experts have said might violate the fast-track budget procedure known as reconciliation that the GOP is using as the vehicle for its health care revamp.

“The fundamental flaw in Obamacare is that Washington decided what kind of insurance policy you can buy and has therefore driven up the costs and reduced the choices,” the Tennessee Republican said. “We would like to move more decisions out of Washington and back to the states in terms of regulating insurance.”

The House-passed measure included an amendment from Rep. Tom MacArthur of New Jersey that would have kept the federal structure in place but let states seek a waiver to opt out of many of the same requirements.

None of the attendees, including Lee and Sen. Ted Cruz of Texas, would share further details of the “opt-in” proposal on Thursday.

“There are many ideas being discussed and I think it is most helpful to continue to discuss them in a collaborative fashion with the full conference … rather than battle them out in the press,” Cruz told reporters.

Some members of the working group have also brought up the idea of increasing the funding available in the legislation for so-called high risk pools, which House Republicans argue would help lower otherwise high costs for individuals with pre-existing conditions who don’t get their insurance through a job or another government program.

“There is a real desire to make sure that people with pre-existing conditions are covered, and if ensuring the high risk pools have more resources to make that happen — I think we’re open to all different ideas at the moment,” Thune said.

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