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Tierney Sneed

Tierney Sneed is a reporter for Talking Points Memo. She previously worked for U.S. News and World Report. She grew up in Florida and attended Georgetown University.

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Thursday will be a deja vu moment on the Senate-side of the Capitol. Senate Republicans will gather in a private room off the Senate chamber to go over a freshly unveiled health care bill they hope they can pass to fulfill their years’ long promise of dismantling the Affordable Care Act.

Just like they did in June.

But, like the morning they went through this exercise a few weeks ago, deep disagreements remain among the conference over how to replace Obamacare and whether that effort should include a gutting of Medicaid. There’s been no sign yet that Majority Leader Mitch McConnell (R-KY) has hit the sweet spot. He needs to win 50 out of 52 Republican votes to pass the legislation. Yet he has previewed a quick turnaround time between unveiling his revisions to the Better Care Reconciliation Act and a vote on the bill, with a Congressional Budget Office score coming as early as Monday, and an initial procedural vote also next week.

Here are the five big unknowns going forward:

Did McConnell change enough to get rid of the old bill’s stench?

It was obvious that McConnell didn’t want to send members home for the July 4 recess without taking a vote on the legislation, and last week, while they were home, it became clear why. Very few Republicans aggressively promoted the legislation—many spent their recess in hiding—and those who did make public appearances distanced themselves from the effort.

Rank-and-file Republicans like Sen. Jerry Moran (R-KS) and John Hoeven (R-ND) came out against the old draft, and high-profile defectors like Sens. Shelley Moore Capito (R-WV) and Susan Collins (R-ME) defended their opposition.

Now, whether they can come back around will depend on if the revised bill at least looks different enough for them to justify supporting it. So far though, the sense is there hasn’t been a major overhaul—beyond Obamacare taxes for high-earners being preserved and extra funding for opioid programs.

“I don’t think there’s going to be that many dramatic changes,” Sen. Ron Johnson (R-WI) admitted to reporters Wednesday, after a Senate GOP lunch.

What the hell is going on with the Cruz amendment?

Perhaps the most substantive change to the legislation on the table is a proposal by Sen. Ted Cruz (R-TX) to let insurers sell unregulated plans as long as they offer an Obamacare-compliant plan as well. Cruz, however, could not tell reporters Wednesday when the CBO would be done scoring the provision, if it would be included with the legislation being unveiled Thursday or even when the text of his proposal will be made public.

Nonetheless, he indicated that he’d vote against advancing the bill, including on the first procedural vote, if it wasn’t part of the base legislation.

Other Republicans have raised concerns about Cruz’s idea, because it would likely to gut pre-existing protections many GOP lawmakers vowed to protect. The insurance industry agreed with their sentiments, in a statement bashing the Cruz proposal Wednesday.

Thus, other Republicans like Sen. Mike Rounds (R-SD) and Sen. Bill Cassidy (R-LA)  have been suggesting tweaks to Cruz’s proposal to make it more workable. Here again, the details are sparse. It’s unclear how far along they are in writing adjustments to Cruz’s amendment, whether those tweaks would solve the major policy problems, or how making those adjustments would fit in the aggressive timeline McConnell has laid out for passing the legislation.

Will moderates swallow big Medicaid cuts?

Enough Republicans opposed the draft bill’s deep Medicaid cuts to kill it. Yet, it’s expected that those provisions — which both scale back the ACA’s Medicaid expansion and gut the traditional program — will remain largely unchanged in the latest version.

Its passage, thus depends at least three of the following—Sens. Capito, Collins,  Dean Heller (R-NV), or Lisa Murkowski (R-AK)— flip-flopping on their previous requests that the cuts be softened.  Rounds suggested that tweaks to the Medicaid formulas could be made in the amendments process known as vote-a-rama that will occur on the Senate floor some time after next week’s expected procedural vote on the bill. There’s some skepticism, however, as to whether that would really result in substantive changes to the bill, since McConnell will still tightly control the process. (Hence, Cruz’s insistence that his proposal be included in the base text.)

“A fully amendable bill after the motion to proceed should give everyone a sense that they’ll have an opportunity to make whatever point they want to make,” Sen. Roy Blunt (R-MO), a member of the GOP leadership team, said.

Can they get the bill past the first hurdle?

We could know as soon as Tuesday whether the GOP repeal effort is doomed. McConnell has been insistent that a vote on the motion to proceed—which advances it procedurally to consideration, before a final vote—will come some time next week.

Some Republicans are arguing that, despite their or other GOP lawmakers’ reservations, they should at least vote for this initial step.

“I just can’t imagine not voting to proceed to a bill when you’ve got an open amendment process and you can offer any amendment you wish and you still have a vote at the end of the process,” Sen. Bob Corker (R-TN) said Tuesday.

Already one Republican, Sen. Rand Paul (R-KY), has said he’ll vote against it there, so it would only take two more GOP members to kill next week’s motion, perhaps if they see no point in taking politically tough votes during the vote-a-rama. The prospect of a failed motion to proceed was what McConnell was facing when he delayed a vote last time.

Is the timeline just too fast?

Which brings us to the next unknown: what happens if the votes aren’t there next week, but there’s a path to securing them in the future. McConnell has already delayed the August recess by an extra two weeks. Though he has said health care is still an agenda item for next week, there still is that extra time as a fallback. And by keeping some of Obamacare’s taxes on high-earners, McConnell has some money to work with to try to make things work. Will an extra two weeks be enough to settle on a version of the Cruz amendment that the broader GOP conference is willing to swallow? Or to make some adjustments to Medicaid provisions that expansion state senators can claim as their victory?

Or will McConnell decide that if he can’t draft a deal on health care now, a deal on health care is just not possible?

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The top insurance trade group on Wednesday came out against an amendment being pushed by some Senate Republicans in exchange for their support of the GOP Obamacare repeal bill.

America’s Health Insurance Plans (known as AHIP), said that the proposal by Sen. Ted Cruz (R-TX)—which would let insurers sell stingy, unregulated plans as long as they also offer at least one Obamacare-compliant plan—”would be infeasible and not solve the problems of an unlevel playing field” and would result in “unaffordable premiums for those with pre-existing conditions.”

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A group of 10 rank-and-file House Democrats released a white paper Wednesday with broad-stroke proposals to tweak the Affordable Care Act, as Senate Republicans enter their final crunch to pass an Obamacare repeal bill.

The proposals in the white paper range from codifying the insurer subsidies that President Trump has threatened to halt, to a Medicare buy-in for older consumers, to moving open enrollment to tax season, when Americans tend to be less cash-strapped than the current post-holidays enrollment deadline.

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Top Senate Republicans have indicated that it’s likely that the Affordable Care Act taxes on high-earners that the initial GOP repeal bill eliminated would be be put back in the latest draft expected this week.

“Well, that’s the current discussion, ” Sen. John Cornyn (R-TX), the No. 2 Senate Republican told reporters Tuesday afternoon, “that they will remain in there and the goal would be to provide more stability funds to help bring premiums down and more flexibility for the governors and legislators to deal with deductibles.”

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The tweaks that GOP leadership is making to its stalled Obamacare repeal legislation will not likely include a major rollback of its cuts to Medicaid, a top Republican told reporters Tuesday.

“What we had in the original bill has not changed with regard to Medicaid,” Sen. John Barrasso (R-WY) (pictured above), a member of the Senate GOP leadership team, said after a conference lunch where the revised bill was outlined in broad strokes. The text is set to be released on Thursday, with hopes for a new CBO score on Monday.

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Senate Majority Leader Mitch McConnell (R-KY) tamped down suggestions Tuesday that his announcement that the August congressional recess will be delayed for two weeks was a gambit to buy more time to pass an Obamacare repeal bill.

In a press conference after the delay announcement, McConnell said that the GOP was sticking with its timeline to try to pass the bill in the next two weeks or so.

“We’ll be on health care next week,” McConnell said, adding that the text of their revised bill will be released this Thursday, with hopes for a CBO score by early next week and a motion to proceed vote after that. He said the extra two weeks added to the work calendar in August were to process nominations that Republicans blame Democrats for delaying, as well as to deal with other legislative issues.

“We simply, as a result of all this obstructionism, don’t have enough time to address all of these issues between now and the originally anticipated August recess,” McConnell said.

He was later asked if the extra two weeks were a fallback for health care as well.

“We’re going to do health care next week,” McConnell insisted.

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Sen. Lindsey Graham (R-SC) said he is making moves on a health care plan and is seeking to work with Democrats. Graham’s new gambit comes as the Senate GOP struggles to break the current intra-conference impasse on its Obamacare repeal legislation.

Graham told reporters on Capitol Hill Tuesday that he was working on “a new approach to deal with how to replace Obamacare,” according to Politico.

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As Congress enters its final stretch before the August recess—the deadline the Senate has imposed on passing its Obamacare repeal bill—the next round of negotiations appears to be focused a proposal being offered by Sen. Ted Cruz (R-TX) that would put in jeopardy some of the Affordable Care Act’s protections for pre-existing conditions.

At least one conservative senator, Sen. Mike Lee (R-UT), has drawn a hard line in support of including the proposal in the final package, and outside groups are amping up the pressure to see it added. However, Republican rank-and-file and even GOP Senate leadership has hinted that tweaks to the amendment may be needed to get the broader conference to swallow it, amidst the other side deals being offered to earn 50 votes in support.

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President Trump’s latest addition to his sketchy elections commission is a former Justice Department official who accused the Obama administration of  “a lawless hostility toward equal enforcement of the law” and has spent the years since resigning in 2010 from the DOJ pushing restrictive elections laws and voter purges across the country.

The White House on Monday evening announced Trump’s appointment of J. Christian Adams, currently the president of the Public Interest Legal Foundation. Adams was hired to the DOJ’s civil rights division under President George W. Bush, and made a name for himself in his allegations that the Obama administration went too easy on two New Black Panther Party activists who were videotaped loitering outside a Philadelphia polling place during the 2008 election.

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The voting rights community isn’t holding its breath for a “report” expected out of President Trump’s sham election commission that advocates predict will be used as a cudgel for restrictive voting laws. They already have a good idea of how the Trump administration, led by Attorney General Jeff Sessions, will seek to scale back access to the ballot with an approach that has its antecedent in the scandal-plagued Justice Department of George W. Bush.

It was signaled clearly in a under-the-radar letter sent by the DOJ to most states late last month. The letter did not get as much as attention as the wide-reaching data request from the Trump election commission—which is being led by Vice President Mike Pence and hard-right Kansas Secretary of State Kris Kobach (R)—but voting rights advocates told TPM they find it just as concerning, if not more so.

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