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Senators leave Washington confused about path forward: Republican senators say they are making progress on partially repealing and replacing Obamacare, but some lawmakers don’t know which bill they will be voting on next week, assuming they vote on something. The confusion stems from uncertainty on which path GOP leadership will take on healthcare reform. GOP leaders have signaled they will hold a vote early next week to start debate on a House bill, passed in May, that would partially repeal Obamacare. But it is not clear if leadership will then strip out the House bill and replace it with a 2015 bill that guts Obamacare but leaves it in place for two years while Republicans craft a replacement or another bill that would partially repeal Obamacare and immediately replace it. Sen. John Thune, R-S.D., a member of leadership, provided some clarity when asked whether the Senate will vote on repeal and delay or the replacement bill, which is called the Better Care Reconciliation Act. “I think probably straight repeal,” he replied. But GOP leadership doesn’t have enough votes for either measure to pass. Sen. Mike Rounds, R-S.D., said the Senate needed to advance the motion to proceed to debate and then move on to any legislation “that we have 50 votes for.”
300 billion reasons why this ain’t over: The Senate’s healthcare bill to partially repeal and replace Obamacare, the Better Care Reconciliation Act, would result in 22 million more people becoming uninsured and a deficit reduction of $420 billion by 2026, according to a report released Thursday by the Congressional Budget Office and the Joint Committee on Taxation. The uninsurance numbers are the same as a previous estimate, published June 26, but the deficit reduction is greater as the latest version keeps more of Obamacare’s taxes in place, which more than offsets the new increases in spending. That means Senate Majority Leader Mitch McConnell, R-Ky., has an additional $300 billion to spend to try to lure holdouts who oppose the bill, as reconciliation instructions say that the Senate bill couldn’t add more to the deficit than the House-passed bill, which reduced deficits by $119 billion. The score does not include an analysis of an amendment advanced by Sen. Ted Cruz, R-Texas, which would allow insurers to sell plans with fewer medical provisions as long as they offer one plan that meets the full range of consumer protections required under Obamacare.
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Senate Majority Whip John Cornyn: It’s a ‘luxury’ for Republicans to know what they are voting on healthcare. The Texas Republican said that members should vote for the motion to proceed to debate because there can be endless amendments to the bill. The senator was then asked if senators should know what the plan is before they vote on it. “That’s a luxury we don’t have,” Cornyn responded. A spokesman for the senator later clarified that Cornyn was referring to the open amendment process. Cornyn said the vote next week will be to start debate and then there can be endless amendments. Leadership is expected to offer a first amendment with either the Obamacare replacement bill called the Better Care Reconciliation Act or the 2015 repeal bill.
Medicaid change discussed to woo GOP centrists on healthcare. Senators told reporters Thursday that the proposal, being called the Medicaid “wraparound,” would allow states to use Medicaid funding toward the health expenses of low-income people who face high healthcare costs but aren’t enrolled in the program. They discussed the plan Wednesday with Centers for Medicare and Medicaid Services Administrator Seema Verma. Under the plan, $200 billion would be added and states also could use funding from tax credits and another $132 billion from the state innovation fund.
Cruz presses for action on Obamacare repeal: Ted Cruz said the GOP would face major blowback in the 2018 midterms if they don’t pass Obamacare repeal. “I’ve said many times if we fail to get this done, I think collectively Republicans will look like fools,” he said on “Fox and Friends” Friday. “You can’t have your central promise for seven years be we’ll repeal Obamacare, and then you show up and vote not even to take up the bill to consider repealing Obamacare.” Cruz added that politicians who campaigned “promising one thing, then they do something different in office. What I’m urging my colleagues? It’s not rocket science. Let’s do what we said we would do.”
Sen. Rand Paul says he’s willing to vote to get on the bill, but with a catch. The Kentucky Republican has been a stalwart opponent of the Senate’s replacement bill for Obamacare, but he signaled to reporters he may get on board if leadership adopts his approach to amendments. Paul said he would support a motion to start debate on the House-passed Obamacare bill if Senate leaders agree to at least have a vote on clean repeal, according to a report in the Hill. But then he said that leadership also could guarantee votes on other proposals, such as a bill created by Sens. Bill Cassidy of Louisiana and Susan Collins of Maine. “I think they’re pretty equal in support. Let’s do a random selection,” he said in the report. “Let’s have three or four of them, put them in random order, the first day, equal billing. I think that’s a compromise. I’m willing to get on the bill.”
Parliamentarian meeting with senators today: Elizabeth MacDonough will advise members about which provisions may not pass the Byrd rule under reconciliation. Her advice could affect which portions of the bill are included in a final draft, such as a prohibition that tax credits go toward insurance plans that cover abortions and a provision that would cut off federal family planning funding from facilities that also provide abortions. She concluded earlier this month that the provision that would allow for cost-sharing reduction subsidies met reconciliation rules.
Sen. Bob Corker: GOP healthcare effort ‘beginning to feel a lot like how Obamacare came together.’ Corker made the remarks to reporters at the Capitol Thursday after Senate Republican leaders announced they would try to revive the Better Care Reconciliation Act after a meeting with President Trump at the White House. “I’m going to vote for the motion to proceed and anything Mitch decides to proceed to, OK? But I’m becoming concerned that it’s starting to feel like a bazaar,” Corker said. “It’s starting to feel like there’s a lack of coherency in what we’re doing. It’s almost becoming a bidding process. You know, ‘let’s throw $50 billion, let’s throw $100 billion here. Again, it may right itself, but it’s making me uncomfortable right now. It’s beginning to feel a lot like how Obamacare came together, if you want to know the truth, where it felt like they were bidding with various people to get them on board, but maybe there was a lack of coherence,” Corker continued. “Obviously … we can see the result of what was being done. Again, I’m not being critical, I just — the process is beginning to make me really, really uncomfortable,” Corker said.
GOP healthcare struggle spells trouble for unions. Union leaders for years have been trying to get Obamacare’s excise tax on expensive health insurance plans, known as the “Cadillac tax,” eliminated. The GOP’s repeal effort likely represents one of the best opportunities to do that. In an open letter to Senate Democratic leaders last week, D. Taylor, president of Unite Here, which represents more than a quarter-million people in the service industry, chastised Senate Democratic leaders for not using the Republicans’ push as an opportunity to eliminate the tax. “As Democrats, you should be fighting to relieve — not impose upon — the majority of American workers who are being asked to shoulder a disproportionate share of taxes commensurate with their income,” Taylor said.
Rep. Ron DeSantis to Trump: Cut Obamacare subsidies to pressure Congress. “If you make them live under Obamacare, my guess is that they will vote to quickly repeal Obamacare,” DeSantis, R-Fla., said Thursday on the House floor. That suggestion revived a Republican attack on a regulation promulgated under former President Barack Obama that allowed members of Congress and their staff to receive healthcare subsidies. The rule survived attacks by several lawmakers, but DeSantis argued Trump can use it to prod senators hesitant to get behind a healthcare bill. “The best way to restart the Obamacare repeal process is simple: make Congress live under it,” DeSantis said. “The president can make this happen.”
House Speaker Paul Ryan: GOP more unified on taxes than healthcare. In a brief press conference at New Balance’s Lawrence, Mass., factory, Ryan was asked why the public should have confidence that Republicans will pass tax reform when they have struggled to fulfill the promise of replacing Obamacare. “As Republicans, we are wired the same way on tax reform,” Ryan replied. In contrast with the party’s differences on healthcare policy, he said, “we are so much more unified on tax reform. I feel far more confidence of anything we’re going to do this year, that tax reform, which we’re going to do before the end of the year, is going to get done.”
Former CBO directors strike back: Former leaders of the Congressional Budget Office are defending the agency under scrutiny from the White House and Republican-controlled Congress. Eight former directors of the CBO sent a letter to Republican and Democratic House and Senate leaders on Friday. The letter was in response to attacks from Republicans in Congress and the White House questioning the integrity of the agency that has given poor marks to the GOP’s Obamacare repeal efforts. “We write to express our strong objection to recent attacks on the integrity and professionalism of the agency and on the agency’s role in the legislative process,” the letter posted on Medium said. White House Budget Director Mick Mulvaney said Thursday that the latest score on the Senate health bill, which says 22 million people would not have insurance by 2026, wasn’t fair because it used methodology from former Obamacare architect Jon Gruber.
RUNDOWN
New York Times Byrd bath: Seven provisions that could disappear from the GOP healthcare bill
Politico Under fire for opposing healthcare bill, Mike Lee hits back
Axios Why Trump’s $12 health insurance remark matters
The Hill Senate heads to healthcare vote with no clear plan
Associated Press Trump administration pulls health law help in 18 cities
NPR Why glioblastomas, the brain cancer John McCain has, are so hard to treat
Wall Street Journal Big Tobacco finds surprise allies in smokeless push
Reuters Abortion rights groups sue Texas to block procedure ban
Modern Healthcare Health groups seek alternative ways to kill ACA taxes if repeal fails
Calendar
MONDAY | JULY 24
Noon. 529 14th St. NW. National Press Club lunch even with the House Freedom Caucus. Details.
TUESDAY | JULY 25
10 a.m. 1225 I St NW. Bipartisan Policy Center event on “The Future of Comparative Effectiveness Research.” Details.
Noon. 2103 Rayburn. The American College of Preventive Medicine lunch briefing on “Transforming Medical Education to Prevent Chronic Disease.” Register.
WEDNESDAY | JULY 26
8:30 a.m. 660 North Capitol St. NW. Urban Institute event on “Addressing Housing and Health: How Cities Are Making a Difference. Details.
9:30 am. Dirksen 106. Special Committee on Aging hearing on ““Progress Toward a Cure for Type I Diabetes: Research and the Artificial Pancreas.” Details.
10 a.m. Congressional Black Caucus to host “Trumpcare Twitter Town Hall” using the hashtag #CBCOnHealthcare.
10:15 a.m. 2322 Rayburn. House Energy and Commerce hearing on “Examining the Extension of Special Needs Plans.” Details.
