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Here's What We Know About The Senate GOP Health Care Bill

Senate Majority Leader Mitch McConnell says Republicans will release a discussion draft of their version of the health care bill on Thursday, with a vote likely next week.

Private health care talks have been underway in the Senate for weeks. McConnell tapped a 13-member working group last month to hash out senators' differences over the House-passed American Health Care Act. McConnell's office has since taken the lead drafting the Senate version of the party's long-promised legislation to dismantle the Affordable Care Act.

Senate Republicans have been coy — or simply out of the loop — on the specifics in the Senate plan, but here is what we know about what might be in the bill and where it could be headed:

It Sounds A Lot Like The House Bill

After the House passed AHCA in early May, leading senators asserted that the Senate would go their own way. "We're writing a Senate bill and not passing the House bill," Sen. Lamar Alexander, R-Tenn., said then. "We'll take whatever good ideas we find there that meet our goals."

In the end, those goals appear to be aligned.

The structure of the Senate bill, as described by GOP senators and aides, appears fundamentally the same as the House-passed plan.

The Senate bill is also expected to repeal the individual mandate and all or most of the ACA's taxes, phase out the Medicaid expansion as well as change how the Medicaid program is funded, establish a system of tax credits to help people buy insurance if they choose, and make it easier for states to opt-out of the ACA's mandates for preexisting conditions and minimum insurance coverage mandates.

There will be changes. For instance, the Senate version is expected to include more generous tax credits to make sure older, poorer Americans don't get hit with higher costs. Republicans are also battling over how best to remake the Medicaid program, with key vote senators like Shelley Moore Capito of West Virginia sounding skittish about Medicaid reductions.

Other Republicans are excited by the bill. Sen. John Barrasso, R-Wyo., has been one of the most vocal advocates for Obamacare repeal. "People didn't want to have to buy this product. This is a sinking ship, people are ready to jump off," he said Tuesday. Republicans like Barrasso see the bill as a win for the GOP and for the promises they made on the campaign trail.

"We eliminate the individual mandate. You'll see more people as free citizens making a decision to not have Obamacare insurance, but certainly have more freedom," Barrasso said.

The Process Stinks

"Can you say it was done openly? With transparency and accountability? Without backroom deals and struck behind closed doors? Hidden from the people? Hell no you can't! Have you read the bill? Have you read the reconciliation bill? Have you read the manager's amendment? Hell no you haven't!"

That's not Senate Minority Leader Chuck Schumer in 2017, that was former Minority Leader John Boehner in 2010 before House Democrats passed the Affordable Care Act.

Republicans vilified Democrats seven years ago for negotiating the final details of Obamacare behind closed doors. Today Senate Republicans' response could be: We learned it from watching you.

The Senate has not held any public hearings on their health care bill (the House did), senators involved in the talks have been tight-lipped on the substance, and the public will only have a few days to see it before it gets a vote.

McConnell brushed off questions about transparency. "They'll have plenty of time," he told reporters Tuesday. "We've been discussing all the elements of this endlessly for seven years. Everybody pretty well understands it. Everybody will have adequate time to take a look at it."

That argument rings hollow with some of his fellow Republicans. "We used to complain like hell when the Democrats ran the Affordable Care Act. Now, we're doing the same thing," Sen. John McCain, R-Ariz., told CNN.

"If you're frustrated in the lack of transparency in this process, I share your frustration," Sen. Mike Lee, R-Utah, said in a Facebook video for his constituents. Lee is a part of the 13-member working group, but he said he hasn't seen the draft bill. "I just haven't been able to see it yet and as far as I know the overwhelming majority of my colleagues haven't been able to see it either."

Failure Is An Option

McConnell has been quietly leading Republicans' to a vote next week but that doesn't mean it's going to pass.

"We're going to make every effort to pass a bill that dramatically changes the current health care law," McConnell said when asked if he has the votes.

"I think the leader has made it pretty clear we're going to vote, one way or another, and hopefully we'll have 50 votes when that time comes," Senate Republican Conference Chairman John Thune said when asked if he believed McConnell would bring a bill to the floor that didn't have the votes to pass.

While no Republican senator has yet come out opposed the bill, McConnell has only a two-vote margin of error with many senators voicing problems with the legislation.

"If our bill comes in with greater subsidies than Obamacare, it makes it hard for conservatives to support a bill that actually has greater subsidies than Obamacare," Sen. Rand Paul, R-Ky., told reporters in regards to the tax credits in the GOP plan. "That for me is a nonstarter."

Conservatives like Ted Cruz of Texas and Mike Lee have Utah have been skeptical about the bill's ability to ultimately lower premium costs for Americans. Both are seen as potential 'no' votes on the bill.

More moderate senators like Susan Collins of Maine and Lisa Murkowski of Alaska are also seen as potential 'no' votes on the other end of the spectrum.

Defeat of the House-passed bill wouldn't necessarily end the health care debate in Congress, but it would redefine it.

Wisconsin GOP Sen. Ron Johnson hinted at what that would look like at a constituent event last Friday. "I'm not sure if we're going to come up with 50 votes with a Republican solution. Let's stabilize the markets and then, long-term, work with the Democrats colleagues to actually fix the healthcare system," Johnson said.

The White House Doesn't Love It — Yet

The White House has maintained a light tough when it comes to shaping the policies in the health care bill, but President Trump reportedly told a group of senators last week that the bill passed in the House was "mean" and he wanted the final bill to do more to help needier Americans.

On Tuesday, White House Spokesman Sean Spicer told reporters the president "wants a bill that has heart in it" but did not offer any specific policies Trump wants in the bill. Spicer also said he didn't know if the president had seen a draft of the Senate bill.

If the Senate approves a bill next week, it still has more hurdles to go. The House either needs to pass the Senate bill as-is and send it to Trump's desk, or the House and Senate have to go into a third round of negotiations in which both chambers would have to vote again on a final, compromise bill.

Either way, the health care debate is likely to continue into July if the Senate can pass a bill next week.

Democrats Debate How Far To Take Their Fight

Senate Democrats can't filibuster the bill because it's protected under special budget rules and only requires a majority vote. They're all going to oppose it, but they can't ultimately stop it from eventually getting an up-or-down vote.

Democrats have started a series of protests this week that could intensify as the Senate approaches that vote. They held the floor Monday evening for a series of speeches in opposition to the bill. On Tuesday, they invoked a rule to block any committee hearings from taking place that afternoon to draw attention to their opposition to the health care bill.

Outside Democratic activists associated with Indivisible are calling for Democrats to use every procedural tactic available to slow down debate. Since amendments are unlimited on a bill like this, one activist has even called on Democrats to introduce 40,000 amendments to keep the Senate on the bill through the 2018 midterms.

It's unclear how Democrats will respond next week, but Schumer said Republicans should expect a fight. "If Republicans won't relent and debate their health care bill in the open for the American people to see, then they shouldn't expect business as usual in the Senate," Schumer said in a statement.

NPR congressional reporters Scott Detrow and Geoff Bennett contributed to this report.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Susan Davis is a congressional correspondent for NPR and a co-host of the NPR Politics Podcast. She has covered Congress, elections, and national politics since 2002 for publications including USA TODAY, The Wall Street Journal, National Journal and Roll Call. She appears regularly on television and radio outlets to discuss congressional and national politics, and she is a contributor on PBS's Washington Week with Robert Costa. She is a graduate of American University in Washington, D.C., and a Philadelphia native.