Nine questions we have about the Senate health care bill

Eliza Collins | USA TODAY

Show Caption Hide Caption Obamacare replacement bill expected to be made public this week Repealing and replacing Obamacare has been a centerpiece of the Republican party for years. The House already passed their version of the American Health Care Act back in May and now it's the Senate's turn.

Senate leaders are expected to release their bill to repeal and replace Obamacare Thursday. It’ll be the first time that most senators see the legislation that they're supposed to vote on by next week.

So once the bill is out there, what will be in it and can it actually pass? Here are nine questions USA TODAY has about the bill.

Will the Senate bill be less “mean” than the House bill?

This is a big one. President Trump may have celebrated the House bill after it passed — he had a big party in the Rose Garden of the White House — but since then he seems to have changed his tune. In a meeting with Senate Republicans this month, he requested that they create a more generous package with “heart” compared to what he said was a “mean” House bill.

It’s not clear what Trump would qualify as a nicer bill, but some senators have raised objections to the way the House bill handles pre-existing conditions. The House bill makes it so that insurance companies can charge more for people with pre-existing conditions, but added a pool of money it hoped would offset increased costs. The Senate prides itself on being the "cooling saucer" for the "hot tea" of the House’s more extreme positions. So the question is: How cool — or, by some accounts, "weak" —will the tea be when it emerges from the Senate?

What will happen with Medicaid funding?

Obamacare gave states the option to expand Medicaid enrollment with federal money paying most of the costs. More than half of states — including some with GOP governors — accepted that deal. Now, Republicans want to roll back that deal. But some GOP senators from states that accepted the funds have said “wait, wait not so fast.”

Ohio Sen. Rob Portman and a few other Senate Republicans are pushing for a seven-year phase-out of Medicaid expansion, starting in 2020, that would gradually reduce the federal match to states. The idea is to give states an extended “glide path,” as Portman has called it, to help states adjust their Medicaid programs. The House bill would end the federal match for the Medicaid expansion population — low-income able-bodied adults — abruptly on Jan. 1, 2020.

Portman and other Republicans are also seeking a new pot of money — $45 billion over 10 years — devoted specifically to make sure addicts who gained insurance under Medicaid can keep receiving opioid addiction treatment after the program is rolled back.

Will the bill have abortion restrictions?

The bill that passed the House in May had a provision that would stop Planned Parenthood from receiving reimbursements from Medicaid for one year because some of the clinics provide abortions. It was a section that House conservatives demanded be added and Senate conservatives want to keep.

But in the Senate, Sen. Susan Collins, R-Maine, and Sen. Lisa Murkowski, R-Alaska, have both expressed concern over cutting funding from the women’s health organization. Senate leaders risk losing votes whichever way they draft this portion of the bill.

Senate Finance Chairman Orrin Hatch, R-Utah, was asked by reporters Wednesday about Planned Parenthood funds: “I don’t know about that, but it’s always a problem as you know.”

The House bill also has a provision that would bar people from using health care tax credits to pay for abortions, but that might create a procedural issue for the bill. Republicans are trying to push the bill through the Senate under a procedure that only requires 51 votes, instead of the 60 votes normally needed to move a bill, but Senate rules limit that procedure to budget bills. The tax credit provision may not qualify as a budget measure.

Will Rand Paul accept anything less than a full repeal?

Kentucky Sen. Rand Paul has been vocal about his desire for a full repeal of Obamacare — none of this “Obamacare-lite” stuff with federal aid for insurance purchases. If Senate Majority Leader Mitch McConnell, R-Ky., wants to keep moderate votes, it’s very likely the Senate bill won’t be a full repeal and Paul will have to decide whether he can support it.

Earlier this month Sen. Lindsey Graham, R-S.C., said Paul was assumed to be against the bill. Paul spokesman Sergio Gor responded to USA TODAY: “While we do have a press assistant opening in the Communications Department, Senator Graham has not applied and should not make public statements on behalf of Senator Rand Paul.”

On Wednesday afternoon, Paul reintroduced his "read the bills" resolution in response to the way the health care bill process had gone. The resolution would mean that bills, amendments, and conference be out for one day for every 20 pages of text.

“Legislation is too often shoved through Congress without proper hearings, amendments, or debate, as the secrecy surrounding the Senate’s health care bill and the pressure to vote for it with little time to fully evaluate the proposal once again remind us,” Paul said.

Where does Susan Collins fall?

Maine Sen. Susan Collins is widely regarded as one of the most moderate members of the Republican Party. She has previously voted against legislation that would defund Planned Parenthood, so if that makes it in the bill it could be problematic. But she also has other concerns, including rolling back Medicaid expansion.

How much of a compromiser is Ted Cruz willing to be?

Conservative Sen. Ted Cruz didn’t used to be known as the type of guy who party leadership could count as a guaranteed vote, but the Texas Republican has been changing his strategy. Cruz was the guy who brought together the original group of senators to talk through their issues on health care and has been careful not to speak out against the closed-door process that Senate leadership has used to draft the bill. Cruz is normally associated with fellow hardliners Paul and Sen. Mike Lee, R-Utah, but this time around he may not be ready to throw himself on the tracks to stop the bill.

Even if it passes, will conservatives in the House be OK with it?

It’s pretty widely assumed that the bill that comes out of the Senate will be different than the House. If the chambers pass different versions of legislation, they’ll have to come together to compromise on legislation. Already, some House conservatives are raising the alarms about letting a bill get too moderate. USA TODAY obtained a copy of a letter that the Republican Study Committee, which has more than 150 Republican House members, plans to send to McConnell warning him not to make the bill too moderate.

How do Democrats respond?

Democrats have been braying about the fact that the bill was drafted in secret. On Tuesday, three senators showed up at the Congressional Budget Office — which will analyze the bill to see how much it will cost and how it’ll affect Americans — to see whether they could get a look at CBO's copy. Big surprise: No dice. But now that the bill is public, Democrats will have to figure out a new tactic. It’s likely that they’ll focus on the content of the legislation and the fact that senators are racing to vote on a bill they have not had time to fully consider.

When is the vote?

Sen. John Cornyn, R-Texas, the majority whip, told reporters Wednesday that the Senate would "get it all done" before they break for July Fourth recess at the end of next week. But that means that lawmakers will only have about a week to read the bill and solicit constituent feedback. Some lawmakers have expressed concern over such a quick timeline.

"I have a hard time believing anybody will have enough time to have a true evaluation and get (public) input on this by next week,” Wisconsin Sen. Ron Johnson said in an interview with the USA TODAY Network on Wednesday.

Contributing: Deirdre Shesgreen