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Still not seeing a health care game changer

Lazaro Gamio / Axios

What did Senate Majority Leader Mitch McConnell get for the extra two weeks of work on the Senate health care bill? A revised bill, to be released Thursday morning, that's likely to leave Senate Republicans in about the same place they were before: divided and stuck.

And then they'll vote next week — or maybe they won't, if they can't approve the procedural motion to take up the bill. That's a real possibility, if there are no game changers between now and then. And you know what McConnell doesn't have right now? A game changer.

Here's where the health care effort stands:

  • The bill as described to Senate Republicans yesterday doesn't sound that different from the one they had before, Caitlin Owens reports. The Medicaid spending limits, in particular, are likely to be unchanged — a blow to moderate Republicans who thought the bill would squeeze the program too hard.
  • One change that might appeal to the moderates: The bill will drop plans to repeal two ACA taxes on high earners. Bloomberg reports that the new bill will keep the law's 3.8 percent tax on net investment income and a 0.9 percent Medicare tax, both aimed at wealthy people.
  • That might be used to beef up the "stability fund" to help states reduce premium costs, The Hill reports — but that's still not going to matter to the moderates as much as the Medicaid spending limits.
  • It's not clear that the conservatives will get much, either. There's no decision on whether to include a proposal by Sens. Ted Cruz and Mike Lee to let insurers sell some health plans that don't comply with all of the Affordable Care Act rules, as long as they also sell plans that do.
  • The fate of that proposal may depend on the Senate parliamentarian, who's deciding this week what ACA rewrites are allowed under Senate budget rules. If the Cruz proposal doesn't comply with the budget rules, it can't be part of the bill, and it would need 60 votes to pass — which it wouldn't get.
  • If the bill doesn't pass next week — or if the Senate can't even get the votes to take it up — don't write off the possibility that the Senate could follow up with a repeal-only vote. Jonathan Swan reports that Senate GOP leaders are leaving that door open, and White House officials are urging them to take that vote. And they're ready to twist the arms of any moderates who voted for full repeal in 2015 but wouldn't do so now.

Between the lines: In laying out the schedule to reporters yesterday, McConnell talked about the release of the bill on Thursday, a CBO score at the beginning of next week, and then a vote on the motion to take up the bill. The part he didn't say: "And then we'll vote on the bill and pass it."