Health care state of play: All-important Tuesday for Republicans

Sen. Ernst grilled about health care
Sen. Ernst grilled about health care

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Story highlights

  • The mood for Republican senators has not improved since returning from the July 4 recess
  • GOP leadership still wants to unveil a health care bill by Thursday and have a vote next week

(CNN)Tuesdays are always important in the US Senate because the members gather for lunch, and there's usually some news about what's next for health care. Well, this Tuesday, in particular, is gearing up to be very important.

Senate Republicans are expected to get some more insight of what is in the revised health care bill at the lunch.
That, in turn, should give GOP leaders the information they so desperately need: will they come close to getting to 50 "yes" votes they need to pass their health care plan? With open talk about leaving repeal of the Affordable Care Act behind and moving onto a bipartisan track, needless to say, this is a make-or-break moment for the Senate bill.

    The mood -- it's not great.

    If Republican senators and aides were feeling deflated pre-July 4, things aren't any better now after a brutal week-long recess. Simply put: Congress is now back in town, and so far, it's truly not clear what has changed to fix the fact that that Majority Leader Mitch McConnell has 42 "yes" votes -- by only a very generous interpretation of what senators have said publicly.
    "It's easy to get to 40 or 42 yes's," one aide to a GOP senator closely involved in the negotiations said. "Getting to 50? I don't know."
    This aide's reaction to Sen. John McCain, an Arizona Republican, saying Sunday that the bill could be "dead" was a shoulder-shrugging: "To me his statement is acknowledging reality at this time. I wouldn't say dead, but at this time, they're not close, let's put it that way."

    Big picture: "Repeal" slipping away?

    There is a bit of a sinking feeling that the idea of repealing Obamacare -- or doing anything close to that -- could be slipping away from Republicans.

    How the next few days are likely* to unfold:

    Today's lunches: As always, but particularly so this week, the GOP lunch will be key. One aide says leadership is expected to present "specs" of the revised bill at the luncheon and take the temperature on where that leaves them. If members throw up their hands again, that's not great for leadership.
    Thursday: Leadership wants to unveil a draft of revised bill.
    Monday: Leadership hopes to see CBO score of revised bill.
    Later next week: A vote, according to Sen. John Cornyn, the Senate's GOP whip.
    Keep in mind, things are very fluid, and what was even a half-baked plan earlier in the week could be gone/different by Wednesday or Thursday.

    What will the revised bill look like?

    Here are some potential revisions to the bill that are being considered and that, according to various congressional staffers, were sent to the Congressional Budget Office for updating scoring. Of course, it's not clear which of these could ultimately end up in the final bill.
    Sen. Ted Cruz's amendment: This would let insurers that offer Obamacare plans to also offer plans unregulated under the ACA. Conservatives like it. Moderates have concerns. Sen. Roger Wicker of Mississippi summed it up nicely: This isn't a "game changer." This won't be the miracle solution that get members to 50 votes.
    Health savings account flexibility: This provision would give people more flexibility on how they can use health savings accounts, including using those funds to pay for premiums. Conservatives also like this.
    Opioid treatment funding: A key issue for senators like Rob Portman of Ohio and Shelley Moore Capito of West Virginia, we expect to see $45 billion additional funding for opioid treatment funding in the bill.
    Net investment tax: This originally was going to be repealed. It's a tax break for the wealthy, but members have expressed deep concerns about the optics of repealing the tax for the wealthy and then leaving some lower income people with less affordable health care coverage. Sen. Bob Corker of Tennessee said before the recess he expected this to be addressed. We will see if leadership actually addressed it.

    What about Medicaid?

    As of Monday afternoon, one aide to a GOP senator closely involved in the health care talks said they were not aware that concerns raised by a number of moderates about Medicaid (expansion is phased out too quickly, cuts to the program are too deep) are being addressed in the next iteration of the bill. This is big, if true, but as with anything in this legislation, this could certainly change.

    Is repeal-only a viable back up plan for the GOP as Trump and Pence have advocated?

    Not according to Sen. Roy Blunt of Missouri, a member of the GOP leadership, who went horseback riding with the vice president last weekend. Blunt says passing a repeal without have a replacement ready will be a non-starter even in the Republican-controlled Senate.
    "Don't think it could work at all," Blunt said. "I just don't think you could possibly get 50 Republicans to vote just to repeal."
    He added that he would vote for such an approach.

    So, what did he and Pence talk about on their horseback ride together?

    "We just talked about how difficult it is to get people together on anything that impacts every family as much as health care does," he said.

    So are we close to Republicans and Democrats working together?

    No. We have a ways to go. Sen. Joe Manchin, a West Virginia Democrat, said he spoke with some GOP moderates right before the recess, but that all agreed that Republicans have to keep trying and failing before there is any incentive for anyone to come to the negotiating table.