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What To Expect in the Senate Health Care Bill

First Read is your briefing from Meet the Press and the NBC Political Unit on the day's most important political stories and why they matter.

Trump makes victory lap in Iowa after Republicans win special election 3:08

Here’s what to expect in the Senate health care bill

At 9:30 am ET, Senate Republicans will unveil the draft of their highly anticipated health care legislation to their members, per NBC’s Frank Thorp and Leigh Ann Caldwell. But the Washington Post gets an early glimpse, and here’s what the paper says is in the bill — with the important caveat that many of the details are still in flux. Like the House version that passed last month, the Senate bill will eliminate the current mandate that all Americans must have insurance; it will phase out Medicaid expansion; it repeals taxes on the wealthy; and it will eliminate funding for Planned Parenthood for one year.

Yet the Post says there are also some notable differences. “While the House legislation would peg federal insurance subsidies to age, the Senate bill would link them to income, as the Affordable Care Act does. The Senate proposal would cut off expanded Medicaid funding for states more gradually than the House bill but would enact deeper long-term cuts to the health care program for low-income Americans.” What about protections for pre-existing conditions? “[Senate Majority Leader Mitch] McConnell has told Republican senators that he wants to maintain protections for people with preexisting conditions under the law. But it was not clear to some lawmakers Wednesday what that would entail.”

To recap: The contours of the Senate bill that are very similar to the House’s, according to the Post:

  • The individual mandate is gone;
  • Medicaid expansion is phased out;
  • Obamacare’s taxes on the wealthy are eliminated;
  • Planned Parenthood funding is ended for one year.

But here are the differences with the House bill:

  • Subsidies for lower-income Americans are tied income (instead of age);
  • Medicaid is phased out more gradually, but benefits would be less generous (due to a slower growth index than the House bill uses).

The GOP’s dilemma on abortion

The New York Times also writes about another potentially thorny difference between the House and Senate bills — on abortion. “The repeal bill approved last month by the House would bar the use of federal tax credits to help purchase insurance plans that include coverage of abortion,” the Times says. “But senators said that provision might have to be jettisoned from their version because of complicated Senate rules that Republicans are using to expedite passage of the bill and avoid a filibuster. If that provision is dropped, a bill that has already elicited deep misgivings among moderate Republicans — and stiff resistance from Democrats, health care providers and patient advocacy groups — could also generate concern among abortion opponents, as well as conservative lawmakers.”

In other words, Senate Republicans are signaling they can’t include abortion provisions, because they would need 60 votes — not the 51 needed under reconciliation. Would conservative Senate and House Republicans walk away if the coverage of abortion was allowed under the legislation? Remember, abortion proved to be a tricky matter for Democrats during their health-care push in 2009-2010. Could the same thing happen on the GOP side?

The Senate Republicans to watch

“Different factions of senators are critical to the passage of the bill and all of the members below could easily vote against it,” NBC’s Leigh Ann Caldwell reports.

  • The Moderates: “Sens. Susan Collins of Maine, Lisa Murkowski of Alaska, Shelley Moore Capito of West Virginia and Rob Portman of Ohio. These members have various concerns but one similar thread is the threat of drastic cuts to Medicaid.”
  • The Conservatives: “Sens. Mike Lee of Utah, Rand Paul of Kentucky, Pat Toomey of Pennsylvania and Tom Cotton of Arkansas. Like the moderates, they all have different concerns but generally they want greater cuts to Medicaid and fewer mandates on coverage and less government assistance.”
  • The Vulnerable Republicans: “Sens. Jeff Flake of Arizona and Dean Heller of Nevada could have tough re-elections in 2018 and a vote for an unpopular bill could seal their fate.”

Trump takes a victory lap in Iowa: “All we do is win, win, win”

Holding yet another campaign-style rally in his first months in office, President Trump taunted Democrats about the GOP’s wins in the special congressional elections in Georgia and South Carolina. “They have phony witch hunts going against me — they have everything going,” he said. “And you know what? All we do is win, win, win.”

NBC’s Ali Vitali has more on Trump’s rally: “President Donald Trump said in a speech here Wednesday night he would soon introduce legislation that immigrants to America should not receive welfare benefits for at least five years. The new measure will stipulate that ‘those seeking admission into our country must be able to support themselves financially and should not use welfare for a period of at least five years,’ Trump said as the crowd of thousands at the campaign-style rally exploded into extended applause.” The one hitch here? “[T]hose requirements, or something similar to them, already exist.”

Democrats call for new leadership after special election results 2:33

Democratic knives are out for Pelosi

“As Democrats point fingers in the wake of Jon Ossoff's loss in a Georgia special election on Tuesday, some of them are aimed at Nancy Pelosi, the party’s longtime House leader, who appeared in almost every GOP attack ad broadcast in the most expensive House race in history,” NBC’s Alex Seitz-Wald writes. And here are some of the Democratic voices, as NBC’s Kristen Welker reported on “Today” this morning:

  • Rep. Filemon Vela (D-TX): "As long as Nancy Pelosi is the leader of the Democratic Party it is going to be very difficult to win ."
  • Rep. Seth Moulton (D-MA): “We clearly need to have the right message and the right messengers to show the American people that we can help."
  • Rep. Tim Ryan (D-OH): “The honest answer is in some areas of the country -- yes, [Pelosi] is [more toxic than Donald Trump].”