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WASHINGTON — Senate Republicans regrouped Wednesday for another round of health care negotiations after their first effort was stalled by deepening divisions that caused at least eight Republicans to come out against the current bill.
After Tuesday's delay, they are facing another self-imposed deadline to move forward on legislation that would fulfill a seven-year-long campaign promise to undo the Affordable Care Act.
As Republicans try to find solutions to bridge some big divisions, here is what you need to know about where the GOP health care bill stands:
Is the bill dead?
Remember, this happened in the House of Representatives just a couple of months ago when House leaders pulled their health care bill from the floor minutes before it was to be voted on. House Speaker Paul Ryan went to the White House to tell President Donald Trump he didn’t have the votes and the party's promised effort to repeal and replace Obamacare appeared to be all-but finished.
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The Senate bill faces opposition from both moderate and conservative Republicans — just like the original House bill. But members from each side fashioned a compromise on the House bill and the American Health Care Act passed the lower chamber less than two months after the cancelled vote. It's possible things could go that way in the Senate, too.
What happens next?
Individual senators are already jockeying to get their concerns addressed while Senate Majority Leader Mitch McConnell, R-Ky., is pushing to have a new version of a bill by Friday to send to the Congressional Budget Office for analysis.
In the meantime, members plan to use every opportunity to express their list of demands that they hope will be added to a new version of the bill. Senators critical of the bill filed into McConnell's office Wednesday afternoon for individual meetings with the leader, including Sens. Shelley Moore Capito, R-W.Va., Dean Heller, R-Nev., and Bill Cassidy, R-La.
Sen. Rand Paul, R-Ky., who has mostly been shut out of health care discussions because his positions are so far from where the current bill stands, wrote a letter to McConnell outlining his demands. He said when he presented his demands to his colleagues, Paul said they took it "not very well" — like a "lead balloon."
Senate staff, led by McConnell’s office, are going to work up a new bill. While some components of the current legislation are going to remain the same, expect changes to the bill in an effort to shore up the support of conservatives, moderates, senators from both Medicaid expansion and non-expansion states, and those from states dealing with an opioid crisis.
"We're not going to make everybody happy; this is not a perfect bill," said Sen. David Perdue, R-Ga.
But others are skeptical of the quick timeline. When asked if a new bill by Friday is possible, Sen. John McCain, R-Ariz., said "if pigs fly."
How long could it take?
McConnell's goal is to reach an agreement on a bill by Friday to give the CBO up to two weeks to put out a new analysis. The Senate goes on break for the week of July 4th and returns the week of July 10, giving lawmakers just three weeks before the Republican-imposed deadline of August 1 — when members head to their home districts for a month — to make any additional changes to the bill, pass it and send it to the House, where it must also be passed.
What could change?
Medicaid: Senators from states that have expanded Medicaid spending under Obamacare are concerned about the dramatic cuts to the program beginning in 2021 and accelerating in 2025. The CBO estimated that, overall, Medicaid spending would be cut by 26 percent, something that worries Sens. Capito, Heller, Rob Portman, R-Ohio, Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska.
Opioid funding: Some of the senators mentioned above are also concerned about reductions related to treatment for people addicted to opioids, a growing crisis in the nation, as part of the Medicaid cuts. The current Senate bill offers only $2 billion worth of funding, an amount that senators from states dealing with the crisis say is woefully inadequate.
Affordability: Conservatives say that the Senate bill doesn’t do enough to lower the cost of health insurance because, they argue, it keeps in place too many of the Affordable Care Act’s insurance coverage requirements. Sen. Ted Cruz, R-Texas, is proposing that states be allowed to adopt non-compliant health insurance plans with less coverage — or what would essentially be a catastrophic coverage plan. Many senators support this idea.
Is this an opening for bipartisanship?
Democrats say they’d be happy to work with Republicans on health care as long as they don’t repeal all of the Obamacare taxes or make large cuts to Medicaid, which are the two main components of the GOP bill.
Rank-and-file Republicans, including moderates like Sens. Collins and Murkowski and some conservatives like Sens. Lindsey Graham, R-S.C., and John McCain, R-Ariz., say that they’d be open to working with Democrats.
“It's certainly going to be difficult, but it's certainly worth a try,” said Collins. “It is never good to pass major legislation without the input in both parties. That was the mistake President Obama made with the Affordable Care Act, and I don't think we should repeat that mistake. “
But McConnell has all but closed the door on working with Democrats, even using the possibility as an argument to persuade Republicans to reach an agreement themselves.
“Either Republicans will agree to change the status quo or markets will continue to collapse and when I have to sit down with Sen. Schumer," McConnell told reporters Tuesday. "Any negotiation with Democrats will include none of the reforms that we would like to make both on the market side and the Medicaid side."
What is Trump doing?
McConnell has largely held the president at arm's-length during the Senate process, instead taking the main lead in working with his conference.
Trump, meanwhile, became more engaged this past weekend by calling some of the conservative members and meeting with Sen. Paul, though he convinced none of them to support the bill. Paul said that he believes Trump wants to make the bill more conservative. But after Trump met with almost all the GOP senators at the White House Tuesday for discussions on the bill, the moderates say that they think Trump has concerns similar to theirs, including that too many people will lose health care.
Publicly, Trump continues to talk of the issue with little specificity. The president spoke briefly Wednesday about the White House meeting.
"There was a great, great feeling in that room yesterday and what also came out is the fact that this health care would be so good, would be far better than Obamacare and would be much less expensive for the people and actually much less expensive also for the country. So those are a lot of good factors," he said. “Overall I have to tell you, this will be a tremendous plan … you’re going to have a lot of very, very happy people in this country if we can get it done.”
But some senators remain skeptical of the president's role in crafting the bill. When asked if Trump understands how complicated health care is, McCain demurred: "I don't know whether he does or not."
What if it fails?
If the Senate effort fails, Republicans and Democrats will likely have to come together and address the individual market in some rural areas where insurance companies have stopped or dramatically reduced their health coverage options.