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Health Care Politics Serve as Senate Bill Text Prelude

Wednesday’s campaign fodder a preview of Thursday’s discussion draft

Senate Majority Leader Mitch McConnell is preparing to release a draft bill to rework the U.S. health insurance system he has assembled in secret. (Tom Williams/CQ Roll Call)
Senate Majority Leader Mitch McConnell is preparing to release a draft bill to rework the U.S. health insurance system he has assembled in secret. (Tom Williams/CQ Roll Call)

Senate procedural wonks huddled Wednesday with the parliamentarian’s office, making their case for whether Republican legislation to rework the health insurance system complies with the chamber’s rules, even as Washington braced for the release of the draft GOP measure. 

Over the next week, though, the debate will play out on both the procedural and political fields.

So while GOP senators began to discuss publicly what they thought would be the contours of the draft legislation to be released Thursday, Wednesday’s activity was heavy on the politics.

Republican campaign organizations seized on news that health insurance giant Anthem was going to pull out of offering insurance on the exchanges in both Indiana and Wisconsin.

Those two states are represented by senators from each party. And, as it happens, the respective Democrats, Joe Donnelly and Tammy Baldwin, face voters in the 2018 midterm elections.

“Instead of working across the aisle to find solutions for our country’s health care system, Tammy Baldwin has been an obstructionist politician who has defended Obamacare at every turn,” said Katie Martin, communications director for the National Republican Senatorial Committee.

The NRSC is using a similar message against other Democratic senators up for re-election next year, including Donnelly and Claire McCaskill of Missouri.

Democratic groups have countered by arguing that the real cause for insurance companies such as Anthem wanting out of the exchanges set up under the 2010 health care law is uncertainty over how the Health and Human Services Department will provide funding and payments to insurers under the law.

“Donald Trump is sabotaging the Affordable Care Act marketplaces and the people of Wisconsin are going to pay the price,” Shripal Shah of the liberal super PAC American Bridge said in a statement, referring to the 2010 law by its given name. “Trump’s efforts to deliberately undermine the insurance markets are hurting people right now, and his reckless behavior is unconscionable.”

Sen. Rand Paul, who rather famously carted a copy machine around the House side of the Capitol looking for that chamber’s version of the health care legislation earlier this year, expressed similar concern about secrecy in the Senate process.

The Kentucky Republican announced he would again propose a resolution to require bills sit on the calendar for an extended period of time based on their length, even if such a proposal might have little practical effect under the expedited reconciliation process.

“Legislation is too often shoved through Congress without proper hearings, amendments, or debate, as the secrecy surrounding the Senate’s health care bill and the pressure to vote for it with little time to fully evaluate the proposal once again remind us,” Paul said. “If we are to answer to the American people, it is imperative we pay close attention to the legislation we pass.”

There will likely be about a week for lawmakers and outside interests to review the discussion draft text before a final version comes up for a vote on the floor following a marathon amendment process (the so-called vote-a-rama), provided courtesy of the budget reconciliation process Republicans are using to advance the health care legislation.

While that process has its own hurdles, such as requiring that measures used in reconciliation have a budgetary effect, all under the watchful gaze of the parliamentarian, it does allow the majority party to avoid other Senate procedural pitfalls, such as the filibuster. 

With that one-week timing in mind, advocates for keeping the 2010 health care law on the books have been working the hallways of the Senate office buildings and at times baking under the sun outside the Capitol.

For instance, Wednesday brought children dressed in superhero costumes to the Capitol complex as part of an effort by an assortment of liberal groups to rally opposition among Democrats to the Republican-led rollback of the 2010 law.

The organizations represented included abortion rights groups such as NARAL Pro-Choice America and Planned Parenthood.

“In the dead of night and behind closed doors, Republican leaders are plotting to take away health care from millions of women and families across the country,” NARAL President Ilyse Hogue said.

Inside the Capitol Visitor Center, Democrats met with advocates as well, staging an event that resembled a real congressional hearing. And one look at the witness list showed the intentions of the minority party.

Witnesses hailed from Alaska, Maine, Nevada, North Dakota, Ohio and West Virginia. Every one of those states is represented by at least one Republican senator, and those lawmakers are viewed by critics of the GOP health care draft as potential opponents once Senate Majority Leader Mitch McConnell of Kentucky brings the legislation to the floor.

Chuck Duarte, the CEO of a federally qualified health care center in Washoe County, Nevada, was called upon to talk about the possibility of the Silver State facing Medicaid cuts.

“The ACA and Medicaid expansion provided an influx of revenue to often cash-strapped rural hospitals and providers. This has meant improvements in access to health care,” Duarte said. “In addition, these health care providers are one of the top employers in the area and represent a significant portion of economic activity in these counties.”

That Democrats would bring in a witness from North Nevada should be no surprise.

The Nevada State Democratic Party has been particularly aggressive in challenging GOP Sen. Dean Heller, up for re-election next year, over the possibility that he could support the Senate bill, especially given that Nevada expanded Medicaid under popular Republican Gov. Brian Sandoval.

Such groups follow the opposition of other major senior and health care organizations such as the AARP and the American Medical Association. 

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