Jul 27, 2017

It's time to vote, and the health care bill isn't finished

Lazaro Gamio / Axios

We're hours away from a series of votes that will culminate, we think, with a brand-new bill to repeal part of the Affordable Care Act. Of course, no one's seen it. Senate Republicans don't know where they're headed, but they're putting the pedal to the metal to get there.

The Senate's health-care process (such as it is) is somehow both a flat circle in which everything we have done, we will do over and over and over again forever; and a rushing river that's never the same from one second to the next, in which it's barely possible to keep your head above water.

Here's where things stand this morning:

  • Majority Leader Mitch McConnell is still working on the latest ACA repeal bill, after two other versions have already failed. Like its predecessor, this one — "skinny repeal' — is also being written in secret with little to no outside input.
  • Even key Republicans don't know what's in the bill: "There is no definition to any of it right now," Sen. Lisa Murkowski said yesterday.
  • While they try to figure out something they can pass with 50 votes, Republicans will burn a little time today trolling Democrats about single-payer.
  • Democrats, for their part, have said they won't offer any amendments until they see the "skinny repeal" bill.
  • This could all be over — somehow or another — in about 24 hours. Not because Republicans agree on any one policy, or even on the broadest set of principles about what's good or bad in the health care system, but because they'll run out of time.

It's going great.

The last resort: If the Senate's going to pass anything, it looks increasingly like that would have to be "skinny repeal" — which, in addition to being a terrible name, is also not yet a finished bill and has not been officially scored by the Congressional Budget Office. But we know it would probably repeal the Affordable Care Act's individual and employer mandates, along with the medical-device tax, and maybe some additional taxes.

The appeal: "Skinny repeal" only touches the most unpopular parts of the ACA — and unlike the rest of the Senate's proposals, it comes with a built-in insurance policy against total failure.

Conservatives still want to repeal more than just these two mandates. But passing something and getting into a conference committee with the House looks increasingly like the only way to keep that dream alive.Even if that process falters, who wants to be the Republican standing in the way of repealing the individual mandate? McConnell's argument about a binary choice — pass this or live with the ACA — gets stronger the closer he gets to his last resort. And he's getting pretty close. Skinny repeal wouldn't directly cut Medicaid, which will help reassure Sens. Dean Heller and Shelley Moore Capito (though if it goes the conference-committee route, conservatives would likely take another stab at Medicaid cuts).The catch: Repealing the individual mandate would probably cause premiums to spike and some markets to deteriorate. Industry doesn't like it, either. Insurers have always said the individual mandate needs to be retained or replaced, and the American Medical Association came out against the idea yesterday.Where it stands:Sen. Ted Cruz said he wants lawmakers to be "focusing like a laser on lowering premiums" — which skinny repeal would not achieve. But he hasn't ruled it out.But House Freedom Caucus Chairman Mark Meadows is against it.Several other senators said they couldn't comment because they didn't know what was in the bill. Which is true, but that didn't stop the motion to proceed to this debate. And "skinny repeal" is in some ways comparable to a new motion to proceed — to another unknown and secretive process, but with a little bit of repeal as a backstop.

Go deeper

South Korea and Italy step up measures as coronavirus cases spike

Data: The Center for Systems Science and Engineering at Johns Hopkins, the CDC, and China's Health Ministry. Note: China numbers are for the mainland only and U.S. numbers include repatriated citizens.

The novel coronavirus has spread to more nations as South Korea and Italy in particular scramble to deal with spikes in their countries.

The big picture: COVID-19 has killed at least 2,446 people and infected almost 79,000 others, mostly in mainland China. South Korean President Moon Jae-said country would increase its infectious disease alert to red, the highest level possible, the New York Times reports, as the number of cases in the country soared to 556 and the death toll to five. Italy's government announced emergency measures Sunday after infections rose to 79.

Go deeperArrowUpdated 18 mins ago - Health

Bernie Sanders wins Nevada caucus

Democratic presidential candidate Sen. Bernie Sanders waves to supporters at a campaign rally on Friday in Las Vegas. Photo: Mario Tama/Getty Images

Sen. Bernie Sanders is projected to handily win the Nevada Democratic primary caucus, becoming the clear frontrunner among 2020 Democratic presidential primary election candidates.

Why it matters: Nevada is the first state with a diverse population to hold a nominating contest, highlighting candidates' abilities to connect with voters of color — particularly Latino voters.

Go deeperArrowUpdated 44 mins ago - Politics & Policy

Heat wave melts 20% of snow cover from Antarctic island in days

The effects of February's record heat wave on Eagle Island in Antarctica. Photo: NASA

Antarctica's Eagle Island now has a side that's almost ice-free following this month's searing heat wave in the region, images released by NASA show.

Why it maters: "The warm spell caused widespread melting on nearby glaciers," NASA said in its report. It's the third major melt event of the 2019-2020 Southern Hemisphere summer, following warm spells in January and last November, according to the United Nation's World Meteorological Organization (WMO).