Democrats prepare for a hard bargain on health care if GOP bill fails

The next few days will be critical for Senate Republicans' effort to repeal and replace key parts of the Affordable Care Act. Senate Majority Leader Mitch McConnell will release a new version of the bill Thursday, and aims to hold a key vote on it early next week.

If that process fails, McConnell has floated the idea of working with Democrats on a bipartisan measure. "No action is not an alternative," he said in Kentucky during the July 4th recess. "We've got the insurance markets imploding all over the country."

Democrats aren't exactly sitting by the phone waiting for that call.

"I don't think they'll do it until they're sure they can't do it their way," said Sen. Claire McCaskill, D-Mo.

But if it does happen, Democrats are prepared to drive a hard bargain. A broader measure would need 60 votes to advance, not 50 like the current GOP measure. That means moderate Democrats would suddenly be the key swing votes who have leverage over the bill's language.

Democrats like North Dakota Sen. Heidi Heitkamp and Montana Sen. Jon Tester are both up for reelection next year in deep red states. Both say they'd be happy to deal — but that Republicans would need to drop their push to scale back Medicaid spending. "That has to come off the table," said Heitkamp. "We cannot be turning back the clock on Medicaid."

"If eliminating Medicaid, or trimming it back, or however they want to put it is the price for admission, then it's going to be very difficult," said Tester.

Interestingly, Tester doesn't have as firm a line on another defining aspect of Obamacare — its mandates, like the one requiring that every adult American purchase health insurance.

"I hate them," Tester said. "But they're there for preexisting conditions and lifetime caps, and insurance for 26-year-olds. If you figure out a different way to do it, my ears are open."

Most other Democrats are a bit more definitive than Tester on the law's trademark coverage mandate — they wouldn't deal if it were threatened.

The third key Democratic demand is ditching the tax breaks in previous versions of the Republican bill. "Of course not," said Vermont Sen. Bernie Sanders, an independent who caucuses with Democrats. "This is a health care bill. What does that have to do with tax breaks?"

But there's one increasingly popular Democratic idea that senators say they wouldn't bring to the negotiating table: Single-payer health care.

In recent years, more and more Democrats have rallied around a large, government-run health care program as their preferred position. Even a majority of Americans approve of such a system according to a Kaiser Family Foundation survey.

While party leaders aren't quite embracing single-payer, it's become the default starting point on health care policy for large swaths of the party's base, as well as many rank-and-file lawmakers.

"It's irrelevant. It's irrelevant for us," said Sen. Sherrod Brown of Ohio. "The issue is stopping Medicaid cuts and stopping this awful bill."

Sanders has championed the single-payer push, but agrees that in the current political environment, it's a fight for another day. "I have no illusions that under a Republican Senate and a very right-wing Republican House, and an extremely right-wing president of the United States, that suddenly we're going to see a Medicare-for-all, single-payer pass. You're not going to see it. It's obvious," he said.

Sanders does plan on introducing a single-payer bill in the coming weeks, but said, "Right now, my immediate concern is that thousands of people, every single year, do not die when we throw 22 million people off of health insurance." He was referring to a Congressional Budget Office estimate that the original version of the Senate GOP bill would result in 22 million fewer Americans with coverage in 10 years, compared to current law.

Minority Leader Chuck Schumer and other Democrats say they'd focus on stabilizing current health insurance markets, and expanding options for people stuck in markets with limited coverage options.

Of course all this remains hypothetical, unless McConnell isn't able to round up the votes he needs to pass a GOP bill under special budget rules that only require 51 votes.

While he does that, Democrats will continue making their case to voters, raising their warnings about people losing health insurance and hoping to keep enough Republicans from voting for the bill they settle on in the coming days. Copyright 2019 NPR. To see more, visit https://www.npr.org.