Friday, May 5, 2017

Senate's health bill could vary significantly from House's; process will be a test of McConnell's relationship with Trump

Photo by Mark Wilson, Getty Images
What will the U.S. Senate, led by Kentucky's Mitch McConnell, do with the health legislation that the House sent it Thursday?

"Senate Republicans were in no mood for celebration," like their House colleagues and President Trump did, The Washington Post reports. "Instead, they sent an unmistakable message: When it comes to health care, we’re going to do our own thing."

Republican senators are "driven in part by a sense that the House version made insurance cheaper for young people but costlier for older Americans—an influential, mostly GOP voting bloc," The Wall Street Journal reports. "Among the provisions senators are tackling is one that allows insurers to charge older Americans five times as much as younger people and lets states obtain waivers that could make that disparity even larger."

Larry Levitt, a senior vice president at the Kaiser Family Foundation, which focuses on health issues, told the Journal, “Older people buying their own insurance, especially those with lower incomes, are probably the hardest-hit group under this bill.”

McConnell, as leader of the 52-48 Republican majority, has created a working group of 13 senators, including one who has been his staunchest intraparty foe, Ted Cruz of Texas. “We have people who are conservatives, we have people who are much more moderate,” Cruz told a Texas radio station. “It frankly is the process I think the House of Representatives should have started with, and they didn’t.”

The other Texas senator, top McConnell deputy John Cornyn, told the Post, “It was designed by the leader to be a smaller group of people that represent the different perspectives and points of view in our conference. If that group can get to ‘Yes,’ then [we will] take it to the rest of the conference.”

The Journal reports, "The working group is essentially setting aside the House bill to craft a package they hope can attract at least 50 of the 52 GOP senators and avoid Senate procedural rules that could require 60 votes for passage, given that no Democrats are expected to vote for it."

That may require removal of some parts of the House bill that only set rules for health insurance and have no directly relationship to the federal budget. "Some House Republicans said that if the Senate can pass its own version of the health-care bill, it will face major challenges when it returns to the House and faces wary conservatives," the Journal reports.

President Trump suggested Tuesday that the Senate change its rules to simplify things, but McConnell rejected that out of hand. The bill will be a test of the McConnell-Trump relationship, report Sean Sullivan, Abby Phillip and Paul Kane of the Post.

"It will be as much a make-or-break moment for McConnell as for Trump," they write. "The Senate leader has so far been able to fly below the radar on health care as House Republicans worked through their disagreements before ultimately passing a bill. If he cannot do the same, he is likely to be blamed for the collapse of the effort to fulfill a signature GOP campaign promise."

"McConnell is cool and deliberative while Trump is hot and impetuous. But they have privately developed what people close to them say is a respectful relationship. In the 75-year-old majority leader, Trump, 70, sees a senior player in navigating the ways of Washington, in both age and experience. He views him as someone on his level — or at least more on his level than many other Republicans, including House Speaker Paul D. Ryan (R-Wis.). In some regards, McConnell has become a tutor to Trump. The two men speak regularly, with McConnell initiating some calls to guide the novice president. . . . Part of McConnell’s challenge will be convincing Trump that the methodical pace at which the Senate moves is necessary."

McConnell's working group "began meeting weeks ago, but it wasn’t clear until recently that the House bill would pass. It includes Republicans with varying health-care priorities," the Journal reports. But it doesn't include any women, and the women Republicans include two "whose votes are considered especially difficult to land — Lisa Murkowski of Alaska and Susan Collins of Maine."

In a possible change that would have major interest in Kentucky, "Senators are weighing pushing the phaseout of the law’s Medicaid expansion until 2022," instead of 2020, the Journal reports. "There is also some talk about nixing a provision that would change Medicaid funding from its current fixed system" of appropriations based on costs incurred by beneficiaries to a set amount per person.

Sen. Rand Paul of Kentucky is among the "wild cards," the Post reports. He told the newspaper, “I think that the House Freedom Caucus was able to make the bill a lot less bad. I think there’s still some fundamental problems that I have with it.”

For a detailed look at the bill from the Post, click here.

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