Wednesday, June 21, 2017

The Senate Is Close to a Health Care Bill, but Do Republicans Have the Votes?


 

This makes much more sense if you click on the "graphic" link two lines down:

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The 52 Republican senators have been meeting several times a week behind closed doors to develop a bill to repeal and replace the Affordable Care Act. At least 50 of them must be on board for the bill to pass, and they could try as soon as next week.

Republican senators are arranged based on their ideology scores

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13 of them, highlighted below, are leading the effort. They are members of a working group created by Mitch McConnell of Kentucky, the majority leader. The group includes two of the most conservative senators – Ted Cruz of Texas and Mike Lee of Utah — but excludes several prominent moderates.
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AlexanderTenn.
BarrassoWyo.
CornynTex.
CottonArk.
CruzTex.
GardnerColo.
HatchUtah
LeeUtah
McConnellKy.
PortmanOhio
ThuneS.D.
ToomeyPa.
EnziWyo.
Mr. McConnell faces the same challenge that Speaker Paul D. Ryan confronted in the House. A bill that caters to conservatives risks alienating moderates.
Most senators want to make sure that people with pre-existing conditions are protected, but over all, they have different priorities. The fate of the health care bill could ultimately be decided by a handful of senators.

Some Senators Want to Push
the Bill Further to the Right

Mr. Cruz and Mr. Lee would rather have a full repeal of the Affordable Care Act. Rand Paul of Kentucky has said that he doesn’t think the House bill passed in May went far enough. He said he did not want to replace the Affordable Care Act with “Obamacare Lite.”
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PaulKy.
CruzTex.
LeeUtah
ToomeyPa.
Senator Pat Toomey of Pennsylvania wants to overhaul Medicaid and would go even further than the House bill to reduce future Medicaid spending. The House bill already ends Medicaid as an open-ended entitlement and slows the program’s growth.

Others Want to Soften the Medicaid Cuts

One of the most divisive issues among Senate Republicans is whether and how to end the expansion of Medicaid. In 31 states that have expanded the program, the federal government pays at least 90 percent of the costs for newly eligible beneficiaries. The House bill would end the extra contributions beginning in 2020.
Several Republican senators from states that have expanded Medicaid — Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Dean Heller of Nevada — want to reduce federal payments gradually, perhaps over seven years.
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CapitoW.Va.
HellerNev.
MurkowskiAlaska
GardnerColo.
McConnellKy.
PortmanOhio
Mr. McConnell has proposed phasing out federal payments over three years.
Senators Lisa Murkowski of Alaska and Cory Gardner of Colorado have also expressed reservations about cuts to Medicaid.

Some Want More Assistance
for the Old and the Poor

Several senators have been working on possible changes to federal tax credits offered in the House bill to help people buy insurance.
Senator John Thune of South Dakota is drafting a proposal to provide more financial assistance to low-income people and older Americans. He has said that Senate Republicans should make the bill “more helpful to people on the lower end.”
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CassidyLa.
CollinsMe.
ThuneS.D.
Senator Susan Collins of Maine, a moderate, and Senator Bill Cassidy of Louisiana, a doctor with a keen interest in health policy, also want to make sure that insurance is affordable for older people with lower incomes.
The two have written their own alternative to replace major provisions of the Affordable Care Act, which would give states broad discretion to keep or roll back parts of the law.
The 46 Democratic senators and two independents are all expected to vote against the bill, which needs 51 votes to pass, with Vice President Mike Pence breaking a tie, if needed.
Moderate and conservative Republicans disagreed over many details of the House bill. In the end, concessions were made to appease the Freedom Caucus, a group of hard-line conservatives, and to attract the votes of some moderates.

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