WTF Is Going on With the Secret Senate Version of Trumpcare?

Negotiated behind closed doors and primed for fast passage, the Republican bill could ruin your life

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WTF Is Going on With the Secret Senate Version of Trumpcare?
Senator Chuck Schumer asks Republicans to show them the Republican health care bill.

We've been hit with an avalanche of news over the past week: Trump under investigation for obstruction of justice! House Whip was shot at baseball practice! Attorney General Sessions stonewalls Intel committee! Tower inferno in London! As a result, the Senate GOP's campaign to advance Trumpcare is flying beneath the radar – exactly as Majority Leader Mitch McConnell wants it.

The Senate GOP's secret plan to restructure one-sixth of America's economy, offer a massive tax cut to the wealthy and likely deprive tens of millions of Americans of health insurance – stripping the coverage guarantees of Obamacare from millions more – could hit the Senate floor for a lightning-fast vote before July 4th.

Here's what you need to know.

Hold up. Remind me what the House Trumpcare bill would do.
This is not a bill to improve health care; it's a bill to repeal taxes on very wealthy people.

The House-passed version of the American Health Care Act would strip $834 billion from Medicaid, deprive 23 million Americans of health insurance over a decade and spike premiums in the individual insurance market by 20 percent in the first year alone, according to the nonpartisan Congressional Budget Office. The legislation would leave many Americans with pre-existing conditions without access to affordable coverage, the CBO concludes, "if they could purchase it at all." In addition, the House bill would allow insurers to jack up premiums on rural and older-working-age Americans. In rural Alaska, a 60-year-old would be hit with insurance premiums of $28,000 a year.

The only real winners in Trumpcare are Americans in the top 0.1 percent, who would receive a $200,000 tax break.

This can't be popular.
It's not. A June 8th Quinnipiac University poll found Trumpcare wins just 17 percent support, and fails to even attract a majority of GOP support (42 percent). Half of Americans "disapprove strongly." A separate Kaiser Family Foundation poll found that just 8 percent of Americans want the Senate to pass the House bill as written. Even President Trump, who celebrated the House passage of the bill with an all-laughs Rose Garden ceremony, called that version of the bill "mean" in a visit to the Senate this week.

Is the Senate starting from scratch?
Nope. The Senate bill will be different, but it must build from the House bill. Both bills must:

1) Stick to budget restrictions known as "reconciliation" that allow the bill to pass without a filibuster – with the support of just 50 senators and a tie-breaking vote by Vice President Mike Pence.

2) Retain a basic framework that enables a House and Senate "conference committee" to forge the competing bills into a single piece of legislation that could reach Trump's desk.

So what's in the bill?
Only the all-male team of 13 senators negotiating the legislation behind closed doors knows for sure. From what little is leaking to the media, the Senate appears to be making tweaks around the edges of the House bill. The senators are debating, for example, not whether to preserve Obamacare's Medicaid expansion, but whether to throw it off a cliff (the House version revokes funding in two years) or roll it down a ramp (senators are pushing for as long as seven years).

Will the Senate bill be as "mean" as the House package?
McConnell has a political incentive to pass the "meanest" bill he can muster. The House passed its version of the bill by appeasing hardcore conservatives. Were the Senate bill to move dramatically toward the center, it could create a crackup in the conference committee that needs to reconcile the two bills.

Does McConnell have a clear path to 50 votes?
Opponents of Trumpcare may find hope in the ideological dysfunction of the Senate. McConnell can lose only two GOP votes, and he starts out with a handful of unreliable senators – including a faction that could abandon the bill if it's too harsh, and another that could defect if it's not harsh enough.

On the far right, McConnell must contend with the trio of Sens. Rand Paul, Mike Lee and Ted Cruz, who could bolt if the Senate bill is too generous, particularly in the refundable tax credits it offers Americans to defray insurance premiums. Paul insists he rejects these credits totally. "I'm not willing to vote for new Republican entitlement programs," he told reporters last week. (Cruz and Lee are on the task force crafting the bill.)

At the center, Sen. Susan Collins is already on the record saying she can't support anything like the House legislation, insisting "a bill that results in 23 million people losing coverage is not a bill that I can support." And Lisa Murkowski, a proponent of Medicaid expansion whose rural Alaskan constituents could be hit with massive premium spikes, said, "I just truly do not know" if she can support the Senate's overhaul.

So when will the Senate's Trumpcare bill get a public airing?
There will not be a public airing – at least not one that compares to the 80 days it took for Obamacare to clear the Senate in 2009.

McConnell is a master of the chamber's arcane rules. For Trumpcare, McConnell has invoked "Rule 14," which allows a bill to move to a vote on the Senate floor without committee hearings. The GOP strategy is to rush the legislation to a vote while keeping the public in the dark as long as possible. That includes not making the bill public until the CBO has already scored it, according to John Thune, the Senate's third-ranking Republican.

If this strategy succeeds, the public would have almost no time to digest the contents of the bill. "The question is how many hours will there be to review the actual text & CBO score before the vote," tweeted Andy Slavitt, who ran Medicare and Medicaid under President Obama. "It can be done in 28 – 8 hours of review + 20 [hours] debate," he estimated.

Can the Trumpcare fast-track be slowed in the Senate?
The only thing that could change McConnell's course is public outcry.

Pressure on Republican senators could force any one of them to condition their vote on a more open and deliberative process.

Pressure on Democratic senators could get any one of them to withhold "unanimous consent" on Senate business, grinding the chamber to a halt – at least long enough to grab a headline or two away from the Trump-Russia investigations.

What Republicans are trying to put into law is wildly unpopular. The health care of millions of Americans hangs in the balance. Senate Republicans' only ally is darkness.

It's time to shine a spotlight.