Divided Senate Republicans Turn to Health Care With a Rough Road Ahead
The top Republican in the Senate, Mitch McConnell of Kentucky, has a reputation as a shrewd tactician and a wily strategist — far more than his younger counterpart in the House, Speaker Paul D. Ryan.
So the Senate majority leader’s decision to create a 13-man working group on health care, including staunch conservatives and ardent foes of the Affordable Care Act — but no women — has been widely seen on Capitol Hill as a move to placate the right
.. The prospect of higher premiums for older Americans living in rural areas will also loom larger in a legislative chamber where Republicans from sparsely populated states hold outsize power.
.. The Senate Republican working group on health care includes the party’s top leaders, as well as three committee chairmen and two of the most conservative senators, Ted Cruz of Texas and Mike Lee of Utah.
Mr. McConnell’s decision to include himself and his top three lieutenants — but not Ms. Collins, Ms. Murkowski or more junior women Republicans like Deb Fischer of Nebraska and Shelley Moore Capito of West Virginia — speaks volumes about his direction and has raised eyebrows.
.. By excluding Ms. Collins and Mr. Cassidy, perhaps viewed as potential troublemakers for the bill, Senate leaders may have inadvertently created a dangerous alliance. The two senators now have no obligation to fall in line behind the working group’s final product and will almost surely continue to work on their own ideas. Together, they and their allies could hold near-veto power.
.. Beyond neglecting Republican women, Senate Republican leaders overlooked Senator Tim Scott of South Carolina, the only black member of their conference. Before his congressional career, Mr. Scott sold insurance and was owned one of the most successful Allstate insurance branches in South Carolina.
.. Mr. McConnell also left out of the group the only two Republican senators clearly in the Democrats’ cross hairs for 2018 — Dean Heller of Nevada and Jeff Flake of Arizona. With re-election campaigns looming, they will have their own political calculus to make. Both states have expanded Medicaid under the Affordable Care Act, providing coverage to hundreds of thousands of people.
.. Hospital executives, among the most outspoken critics of the House bill, are in town for the annual meeting of the American Hospital Association and will lobby the Senate this week. Thomas P. Nickels, an executive vice president of the association, predicted that the Senate would produce an “utterly different version” of the legislation.
.. The House bill would roll back the expansion of Medicaid, which has provided coverage to about 11 million people. The Congressional Budget Office said the bill’s Medicaid changes would save more than $800 billion over 10 years.
.. Mr. Thune, not wanting to create a new middle-class entitlement, would like to provide more financial assistance to lower-income people and less to higher-income people.