Collins’ deal with Obamacare faces the moment of truth



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Senator Susan Collins launches into another health care confrontation with her own party. But this time, she might not have the influence to get what she wants.

Republicans who saw Collins lead the rebellion over rejection of the GOP Obamacare just three months ago are playing hard on another high-stakes bill, betting that they can dispense with the moderate vote of Maine and still claim a narrow victory end-of-year legislation on tax reform.

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Collins joined the tax bill that repeals Obamacare's individual mandate after Senate Majority Leader Mitch McConnell pledged to approve a couple of bills by propping up wobbly insurance markets of Obamacare, including a bipartisan agreement that resumes payments to key subsidies that President Donald Trump stopped in October.

But President Paul Ryan has made it clear that he is not subject to the agreement, and there is little urgency among Republicans in the House of Representatives to do much of everything related to health care before the end of the year. On Thursday, the chairman of the Republican Studies Committee, Mark Walker, said the Conservatives received badurances that talks on a spending package to keep the government open will not address Obamacare.

"The three things they told us will not happen as part of our agreement: no CSR, no DACA, no debt limit," he said, referring to efforts to fund Obamacare cost-sharing subsidies.

That could cost Collins' support after she pointed out that her vote on the final project could depend on the fate of the health care measures.

She told a member of Maine CBS on Thursday night that she would wait to see the final language of the conference committee working on the tax bill before committing her vote.

"I will not make a final decision until I see what that package is," Collins told CBS WABI 5.

A bill, known as Alexander-Murray, would temporarily reinstate subsidies to insurers. The second would finance a two-year reinsurance program that would help health plans for particularly expensive patients.

Senate Republicans can only afford three desertions and still approve the tax using an expedited procedure that requires a simple majority, with Vice President Mike Pence is ready to cast the deciding vote. The margin would be reduced if Collins resisted, and Sen. Bob Corker maintains his opposition because of concerns about the bill's impact on the deficit.

However, House Republicans remain upset over the failure of the Senate to repeal Obamacare insist they will not bow to Collins' demands. And while Senate Republicans are trying to keep Collins in the fold, so far there is little apparent concern that their opposition would sink the tax effort.

"I think you have to find something else to worry about," said the Senator. Tim Scott, one of 17 Republican lawmakers badigned to merge versions of the House and Senate tax plan.

Senator Lamar Alexander, who was a co-author of Alexander-Murray and has defended his inclusion in an end-of-year agreement, also ruled out the need to put pressure on House Republicans on the issue.

"The house knows our position," he said. "When they see that they can reduce premiums by 18 percent … reduce the debt, reduce the amount of money allocated to the Obamacare subsidies, I think it will be a Christmas gift that they will want to give to their constituents."

One of the few moderates at a Republican conference that strictly controls the Senate, Collins regularly used his voice and vote to obtain concessions from Republican leaders and ensure that he is a central figure in the negotiations.

During the debate on health care, he urged the Republican Party to protect Medicaid and preserve more subsidies for people to buy insurance. When they remained true to his plan, Collins joined fellow Republicans Lisa Murkowski and John McCain in a dramatic vote that killed the proposed repeal of months.

And in the run-up to the Senate tax ballot, it secured three late changes to the bill, including the extension of a provision that allows people to deduct considerable medical bills that House Republicans had voted to eliminate by full.

That was above McConnell's "ironclad commitment" to address the two health care bills at the end of the year, measures that Collins says will help offset the premium increases from the repeal of Obamacare's mandate that most of Americans are insured.

Collins said Thursday that he believes the House's approval of those Obamacare bills is part of that commitment, although McConnell has only publicly agreed to "support the pbadage" of them and can not force the House to take legislative action. .

Ryan did not officially rule out the possibility, but refused to commit to transfer any of the bills to future spending agreements. Conservatives have strongly opposed any help for Obamacare, and even moderates who support the stabilization of the health law have shrugged off at the exact moment.

"What is the vehicle to pbad it through the system, in the House and the Senate? I leave it to our leadership," said Rep. Tom Reed, who co-directs the bipartisan Problem Solvers Caucus.

Collins insists he is adopting the long-term vision, citing progress on Thursday in trying to beat House Republicans during rounds of private negotiations.

"I remain confident, despite their skepticism, that we will eventually succeed," she said.

And as the GOP learned during the recall debate, the bad count could change suddenly. Senators Jeff Flake and Ron Johnson are still wild cards, and could possibly join Corker and Collins to torpedo the tax bill if they do not like the final version.

For now, however, Republican leaders are signaling once again that Collins may not get everything he wants about medical care, and gambling will not cost them a second time.

"I think these are separate issues," said Senator David Perdue. "I hope that does not derail this [tax bill]we have to get this done and put it on the president's desk."

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