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Secret Republican Senate Talks Are Shaping Health Care Legislation

Senate Majority Leader Mitch McConnell is flanked by Sen. John Barrasso, R-Wyo., (left) and Senate Majority Whip John Cornyn of Texas (right).  They are three of the 13 senators in the health care working group.
Jacquelyn Martin
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

The Senate is negotiating its own legislation to repeal and replace much of the Affordable Care Act in secret talks with senators hand-picked by party leaders and with no plans for committee hearings to publicly vet the bill.

"I am encouraged by what we are seeing in the Senate. We're seeing senators leading," said Sen. Ted Cruz, R-Texas, one of the 13 Republicans involved in the private talks. "We're seeing senators working together in good faith. We're not seeing senators throwing rocks at each other, either in private or in the press."

Senate Democrats have a different take. "Your morning reminder that under the cloud cover of the FBI story, 13 GOP Senators are still secretly writing a bill to destroy the ACA," Sen. Chris Murphy, D-Conn., tweeted Monday morning.

Senate Republicans have shrugged away criticism about their decision to avoid action in committees in favor of closely guarded meetings in the U.S. Capitol to craft legislation to repeal and replace key pillars of President Barack Obama's health care law and reshape Medicaid.

The working group has met four times, and it plans to continue to meet every Tuesday and Thursday. So far, its strategy appears to be selectively suggesting potential provisions of the legislation to the media.

For instance, Sen. John Thune, R-S.D., has floated pegging tax credits to help Americans buy health insurance to their income instead of their age like it does in the House version of the bill.

While the fallout over President Trump's decision to fire FBI Director James Comey consumes the news cycle, it has not had an impact on Republicans' health care talks. A GOP aide for a senator involved in the talks said it has even given the Senate some breathing room to negotiate with so much attention focused elsewhere.

Senate Majority Leader Mitch McConnell formed the negotiating team to take the lead on crafting health care legislation that can ultimately win the support of at least 50 of the chamber's 52 Republicans. No Democrats are expected to support any potential GOP health care bill. The legislation is moving under special budget rules known as reconciliation, which means it is not subject to usual filibuster rules and cannot be blocked by the minority party.

Republicans ditched the House-passed bill in pursuit of their own legislation, although the two chambers share the broad goals of repealing the ACA's individual mandates and taxes, restricting access to abortion services and overhauling the Medicaid system from an open-ended federal guarantee that covers costs to a system that gives states more flexibility to spend an allotted amount of money.

Conservatives like Cruz are also laying down what they say is a key marker for whether a bill can pass the Senate: "Do premiums go up, or do they go down?" Cruz said.

Sen. Ron Johnson, R-Wis., told reporters last week that Republicans are still in the early planning phase of crafting a bill. "We still need to agree on those goals and find out what's achievable," he said. Like Cruz, Johnson said for him lowering premiums is a top goal and he wants to repeal as much of the ACA as possible under the Senate's more strict budget rules.

Early talks suggest Republicans are optimistic they can ultimately pass a bill by the August recess. "We've got a group of 52 Republican senators, all of us want to get to 'yes,'" Johnson said.

Sens. Susan Collins, R-Maine, and Bill Cassidy, R-La., have introduced their own health care plan, and they have been prominent voices in the debate, but they were excluded from the health care working group.

Republicans were roundly criticized for not including any women in their core group, but the Republican women in the Senate who were asked about the omission said they didn't mind. "It doesn't bother me, the leaders have the right to choose whoever they wish," said Collins. "It doesn't mean that I'm not going to work on health care."

Cassidy and Collins have been moderating voices in the health care debate, and their support or opposition could be critical to Republicans' success.

The Cassidy-Collins proposal would let states keep the ACA, also known as Obamacare, in place if they wanted to, and it leaves in place the ACA's taxes and fees to have revenue streams to pay for their health care overhaul. However, their plan doesn't enjoy support among conservatives who don't believe it goes far enough to repeal and replace Obamacare — the party's signature campaign pledge.

The duo has been reaching out to Democrats, but Cassidy said his efforts have been rejected. Democrats see no policy or political upside to working with Republicans to dismantle the ACA. "Let me phrase this carefully. I've had seven or eight meetings with Democrats either in their office, maybe once my office or on the floor, and that was the consistent message I got," Cassidy said.

Most Republicans see no political advantage to attempting to craft bipartisan legislation that could aid vulnerable Red State Senate Democrats heading in to the midterm elections. In other words, there is mutual disinterest in bipartisanship when it comes to the fundamentals of Obamacare.

The GOP health care talks are expected to roll through the summer months in the Senate. The long-term strategy — according to senior GOP aides in both the House and Senate — is to pass a Senate bill and send it back to the House for an up-or-down vote.

While House passage of their bill was hailed by the president in an unusual Rose Garden ceremony earlier this month, Republicans are still a long way away from fulfilling their campaign promises on health care.

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Susan Davis is a congressional correspondent for NPR and a co-host of the NPR Politics Podcast. She has covered Congress, elections, and national politics since 2002 for publications including USA TODAY, The Wall Street Journal, National Journal and Roll Call. She appears regularly on television and radio outlets to discuss congressional and national politics, and she is a contributor on PBS's Washington Week with Robert Costa. She is a graduate of American University in Washington, D.C., and a Philadelphia native.