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Senate Majority Whip John Cornyn had a colorful way to describe the secretive process of crafting a healthcare bill during an interview on Monday.
“It’s like having a baby. It’s not here yet, but it’s coming,” Cornyn told Politico.
That due date comes soon. The GOP is closing in on a deal for a bill to repeal and replace the Affordable Care Act, the law colloquially known as Obamacare, outside of the public eye.
But before the bill debuts, a few key points of disagreements among Republicans need to be ironed out.
A hushed process and soft timelines
In an attempt to avoid the heavy backlash and ensure disagreements in the conference don’t spill out into plain – as was the case in the House GOP’s fight over the American Health Care Act – the Republican Senate majority is crafting the bill largely behind closed doors.
Senate Majority Leader Mitch McConnell and other leaders have reportedly been crafting the bill with a small group of GOP senators. But many members, even Republicans, have no idea what the text of the bill contains.
“I think we have to really take a look at this, and I think the American people need to take a look at it,” Johnson told Bloomberg.
This secretive process has infuriated Democrats, who are accusing Republicans of hiding behind closed doors because the House version of healthcare legislation became so unpopular with the American public.
“The Republican majority is afraid of the American people learning what is in their healthcare bill,” Senate Minority Leader Chuck Schumer said on the Senate floor Tuesday. “They don’t want the American people to know how much they cut and destroy Medicaid, or how fat of a tax break they give to the wealthiest few, because they know the backlash will be severe. In short, by their actions it seems our Republican colleagues are ashamed by this bill.”
According to Politico, it is unlikely that the bill will be public for long before it is brought to the floor for a vote.
Leadership desires to get a vote on the bill before a week-long July 4 recess, meaning there would be little time between the bill’s release and a vote.
Reports have suggested a few major problems preventing Republicans from coming together behind one bill and advancing it to the floor for a vote.
While the bill is likely to look similar to the House AHCA on many major aspects, several key issues will decide whether Senate Republican leaders can get the bill passed.
Among those problems include how long to continue funding for Obamacare’s Medicaid expansion. The program allowed states to increase the threshold for Medicaid enrollees to 138% of the federal poverty limit. Many states controlled by Republicans took the extra funding from the federal government, so the House bill’s repeal of the funding in 2020 has gotten pushback from senators in those states.
Conservatives like Sens. Ted Cruz and Rand Paul have also come out against a slower phase-out of this funding, making a compromise more difficult.
Other problems include funding for tax credits to allow people to gain access to insurance coverage and maintaining Obamacare’s essential health benefits, which mandate a minimum of health procedures that insurance plans must cover.
With only a 52-seat majority, Republicans have little wiggle room to have members turn against the bill.