What Went Down On Health Care This Week

The Senate may be preparing to include changes to some complicated but consequential waivers in the “skinny bill” it’s writing. A little explanation about what those are: One provision of Obamacare was that states can apply for waivers to many of the health insurance regulations in the law if they want to experiment with different models of health coverage. They can be used to waive the Essential Health Benefits, or to change the subsidies to help low-income people buy insurance. The trick is that in order to be approved, states must show that at least as many would be covered as under the normal rules, and that the coverage would be at least as affordable and as comprehensive, all without increasing the federal deficit. A previous iteration of the Senate bill (one that effectively failed earlier this week) included changes to those waivers. Under that plan, states would have been able waive the regulations so long as they showed it wouldn’t increase the federal deficit. States would only need to write a description of how the new model would address the other issues of who is covered, how much it would cost and what that coverage would look like. It’s not yet clear whether the provision in the bill being written today would be similar.

The Senate reportedly hasn’t written the draft legislation for the “skinny bill” we’ve been talking about for the last couple of days, but information is starting to trickle out on what it might include. The bill is widely expected to include a repeal of the individual mandate. According to Axios, it would also defund Planned Parent for a year and expand waivers that states can apply for in order to get around the regulations on the insurance market imposed by Obamacare, though it’s not clear what those waivers would allow. There are at least two problems in there for the GOP: One, the Senate parliamentarian has said defunding Planned Parenthood doesn’t comply with Senate rules, meaning it would need 60 votes to pass. And two, the parliamentarian has also ruled that the waivers don’t comply with the rules.

Let’s talk about the role that the opioid crisis plays in this health care bill debate. Many places that went strongly for President Trump are also in the throes of a heroin crisis. Among these are West Virginia and Ohio, both Trump states with senators who have said they are wary of potential cuts to Medicaid funds that are helping cover the cost of addiction treatment.

Shelley Moore Capito of West Virginia and Rob Portman of Ohio are two key votes that have been silent thus far on how they’ll vote on the “skinny repeal” option. “Skinny repeal” doesn’t touch Medicaid, but it does get rid of the individual mandate, and some worry that fewer Medicaid-eligible people will discover their eligibility because of this. There’s talk that Republicans could add opioid-specific funds to the bill, though it’s unclear how much. Portman has said he’s open to the “skinny repeal,” so long as he has a guarantee that a replacement option will be in the works. Moore Capito said she “did not come to Washington to hurt people” in a statement earlier this month but voted this week to advance debate on the health care bill.