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GOP Wheeling and Dealing Takes Center Stage in Senate

A bonanza of options could signal a breaking point on health care negotiations

Texas Sen. Ted Cruz says Republicans are making "steady progress" toward bring their conference to agreement on their health care proposal. (Tom Williams/CQ Roll Call)
Texas Sen. Ted Cruz says Republicans are making "steady progress" toward bring their conference to agreement on their health care proposal. (Tom Williams/CQ Roll Call)

Deal-making was the name of the game Thursday as Senate Republican leaders met with skeptical lawmakers in an attempt to bridge deep policy divides among the GOP conference on their legislation to overhaul the U.S. health care system.

Vice President Mike Pence and Centers for Medicare and Medicaid Services Administrator Seema Verma were also on Capitol Hill, joining in the effort to rework a bill that would tighten the cap on federal funding for Medicaid over several years and alter the 2010 health care law’s subsidies that help individuals afford insurance.

While revised language appeared to be taking shape as lawmakers who are opposed to the current draft shuffled in and out of Senate Majority Leader Mitch McConnell’s office, a new report from the Congressional Budget Office detailing the 20-year impact of the Senate legislation on Medicaid spending could add to leadership’s woes.

The nonpartisan agency found that by 2036, federal funding for Medicaid would drop by 35 percent, a number that is sure to draw the attention of moderate GOP members already uneasy with the findings from the CBO’s prior ten-year analysis.

How McConnell navigates the divisions over Medicaid at this point remains unclear, as conservatives would be strongly opposed to removing the stricter growth rate the legislation imposes on the program, starting in 2025.

The Art of the Deal

But breakthroughs could come in other areas.

With nearly $200 billion in available revenue to spend based on the current proposals — and amid talk of removing the repeal of some of the 2010 health care law’s taxes to increase that pool of money — lawmakers are working through several options designed to reduce premiums across income groups and specifically to reduce health care costs for lower earning individuals.

“The discussion draft has been public now for several days. We may amend that draft and when it is, it’ll become public. And then we’ll get a Congressional Budget Office estimate of its cost and then it’ll be public again. And then we’ll have an opportunity for virtually unlimited amendments, but we don’t have that amended draft yet,” Senate Health, Education, Labor and Pensions Chairman Lamar Alexander of Tennessee said.

While members remained optimistic, the goal of coming to a consensus before they depart for the Fourth of July recess seems to be slipping further away. The hope, Republican senators say, is to have a preliminary analysis from the CBO on possible revisions before lawmakers return to Washington, D.C.

Leadership “talked about a whole range of concepts,” North Dakota Sen. John Hoeven told reporters after a Republican lunch meeting. “I got the idea they are going to have more things scored than would necessarily be in a final passage and then I don’t know if we’re going to go through an amendment process to see what can get enough votes.”

But the variety of concepts under consideration is politically diverse and it is unclear whether adjusting the policy levers one way or another would bring McConnell any closer to the 50 votes needed to advance the bill under the fast-track budget procedure known as reconciliation that the GOP is using.

Conservatives, for example, are pushing policy proposals designed to lower premium costs by bypassing several of the 2010 health care law’s current requirements on insurers.

One concept from Sen. Ted Cruz would permit insurance companies to sell plans that do not comply with the current law (which mandates that plans offer a minimum set of benefits), so long as they offer one that is compliant.

“I think we’re making steady progress towards bringing the conference towards agreement,” the Texas Republican said of his proposal.

But questions about whether such a measure would raise health care costs for sicker individuals or if the provision would even comply with Senate rules remain outstanding.

“I think people are still trying to understand it,” Hoeven said. “You have to do it in a way where you still manage risk.”

‘A lot more than tweaking’

Moderate Republican senators, who are concerned about the gradual rollback of the current Medicaid expansion and the stricter funding caps, are hoping to elongate that phaseout and put a more generous growth rate on the entitlement program.

“The bill needs a lot more than tweaking or tinkering around the edges. It needs a major overhaul so that we no longer have 22 million people losing their insurance, sweeping cuts in the Medicaid program,” Maine Sen. Susan Collins told MSNBC. “And we need also to focus on the cuts of not only premiums, but deductibles for lower-income people.”

Republicans are also considering beefing up a $50 billion stability fund included in the current draft that would help states reduce premium costs, among other possible changes.

Despite the policy disputes, GOP members continue to seek some sort of compromise that would bring on enough members to advance the bill out of the chamber.

“I’m real proud of my colleagues in there because nobody has dug their heels in and said, ‘No, no, no, I’m 100 percent against it.’ We’re trying to find ways around the big issues we’re concerned about,” Georgia Sen. David Perdue said.

Even members such as Nevada Sen. Dean Heller, whose support just days ago appeared to be out of reach for leadership, are trying to find agreement.

“We’re still having conversations,” Heller told reporters. “Lots of meetings is all I’m saying, trying to get to a comfortable place for Nevada.”

Sandhya Raman and Lauren Clason contributed to this report.