Senate health care bill negotiations: These are the big issues on the table

WASHINGTON — Majority Leader Mitch McConnell, R-Ky., delayed a vote on the Senate health care bill that would repeal and replace Obamacare after it became clear the legislation was lacking enough votes for even an initial motion to bring the bill to the floor Tuesday.

At least eight senators have come out against the bill, and a handful of others have raised concerns. Republicans can lose just two votes because no Democrats are expected to back the bill.

Getting a bill that appeases at least 50 senators is a difficult task because there are a variety of factions within the party. Something that makes one person happy could bleed votes on the other side. But it’s not impossible: The House version of the bill was declared dead before coming back to life after a couple of compromise amendments that narrowly squeaked it across the finish line.

Here are some of the key changes that could bring various factions of the party on board:

Unregulated plans

Conservative Sens. Mike Lee, R-Utah, Ted Cruz, R-Texas, and Rand Paul, R-Ky., have all said they want less regulation in health care coverage. Lee is looking for an addition to the bill that would allow insurance companies that are offering regulated plans to also be able to offer unregulated options.

Basically, that would mean that as long as an insurer offers plans that cover the minimum benefits required by the Affordable Care Act — including maternity care, substance abuse treatment and prescription drugs — the insurer could also offer policies don't which include these services.

Those plans would cost less because they don’t cover as many procedures.

The concern from moderates would be that healthier people would likely buy the cheaper plans with fewer benefits, leaving only the oldest and sickest people to buy the "regulated coverage," causing prices to go up. That would essentially do away with the ACA’s ban on insurers basing prices on a customer’s health status.

Longer phase-out of Medicaid expansion

Thirty-one states plus Washington, D.C., expanded Medicaid enrollment under Obamacare. Medicaid is a joint federal-state program that provides health insurance for the poor, disabled and elderly. Republicans want to decrease funding for the program. The current health care bill will decrease funding for the expansion over a three-year period. It will also cap funding for Medicaid overall.

For someone like Sen. Dean Heller, R-Nev. — whose state expanded Medicaid and whose Republican governor has been a vocal opponent of any legislation that would hamper the expansion — a longer phase-out or more money for Medicaid may help get him on board.

“I have made clear that I want to make sure the rug is not pulled out from under Nevada or the more than 200,000 Nevadans who received insurance for the first time under Medicaid expansion,” Heller said last week.

But of course, a longer phase-out means more federal spending. Conservatives feel the Senate health care bill is already expensive enough and not a true repeal of Obamacare; it's not clear whether they'd back even more spending to keep an ACA provision in place longer.

More money for opioid addiction

Sens. Shelley Moore Capito, R-W.Va., and Rob Portman, R-Ohio, have both expressed concerns about the impact of the GOP bill on the opioid crisis, which has taken a horrific toll on their home states.

The Affordable Care Act’s Medicaid expansion allowed those states to dramatically increase access to addiction treatment for low-income, childless adults who have been heavily affected by the opioid crisis. Phasing out the Medicaid expansion would mean less money for addiction treatment.

Portman and Capito had been pushing for a gradual, seven-year phase-out of Medicaid expansion and adding $45 billion over 10 years in funding for opioid treatment. The current Senate bill would provide $2 billion in opioid treatment for one year and a three-year phase-out of Medicaid expansion. If McConnell plumps up the addiction funding, that could help bring Capito and Portman on board.

Drop effort to defund Planned Parenthood

Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, have both expressed concern that the legislation would pull Medicaid funds from Planned Parenthood centers because they also provide abortion. It is currently against the law for federal dollars to fund abortions, but anti-abortion activists want to stop all funding to Planned Parenthood, even for its non-abortion services.

If McConnell removes the funding cut from the bill, he may get support from Murkowski and Collins — though both have expressed concerns over other issues like Medicaid, as well — but he risks alienating conservatives who believe such a provision is a requirement for their vote. 

Contributing: Maureen Groppe and Deirdre Shesgreen

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