Republicans have revived Obamacare repeal from the dead and are sprinting towards passing a new repeal bill by the end of next week.
At the moment they appear to be short of the 50 votes needed to pass the bill, which was chiefly developed by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. But they are close enough that two committees are going to hold hearings on it and the Congressional Budget Office will release a “preliminary assessment” early next week.
“I think the odds have improved. I just told Bill Cassidy he’s the grave-robber. This thing was six feet under and I think he’s revived it to the point where there’s a lot of positive buzz and forward momentum,” said Sen. John Thune, a member of the GOP leadership team.
The bill would essentially repeal some major regulations of Obamacare and allow the state's to decide what to do with what remains. It would get rid of the Affordable Care Act’s Medicaid expansion, the individual and employer mandates, and its subsidies that were designed to help lower-income people afford insurance. All of that spending would be given to the states in a block grant program to spend as they choose. The bill would allow states to undo broad swaths of Obamacare, but it does mandate that states must maintain access to affordable coverage for people with pre-existing conditions.
The Congressional Budget Office, which has estimated the effects of past Republican health care plans, will not include any analysis of what will happen to premium prices or how many people will be covered under the new bill before September 30, when Republicans must act or start all over again oh health care; the CBO says it needs weeks more time for that. But it will fulfill the technical requirement of a CBO score, by estimating how much it will cost. That opens the door to a possible vote next week ahead of the deadline.
Dodging a full CBO score likely help’s the bill’s chances of passage. Previous versions of the bill were hit with waves of backlash after the CBO repeatedly found they would lead to tens of millions more uninsured people than leaving Obamacare in place. Next week’s report will only look at the new bill’s impacts on the federal budget.
But the Cassidy-Graham proposal still faces long odds. Republicans have to pass it before next Saturday to move it through the Senate with only 50 votes and the House with a majority. After that point, Congress's budget reconciliation process expires and they would need to hit the normal 60-vote threshold in the Senate, which would require at least eight Democrats to agree.
The party can only lose two of their 52 senators. The three who killed the last repeal effort in July — Susan Collins of Maine, Lisa Murkowski of Alaska, and John McCain of Arizona — have not ruled out voting for Graham-Cassidy but they have also held back on supporting it.
A fourth senator, Rand Paul of Kentucky, has come out loudly against the bill, bashing it on Twitter and in interviews as “Obamacare lite.” Even when approached on Twitter by Cassidy to discuss the bill's effects last week, Paul responded: “No thanks.”
“This keeps 90% of the spending, keeps 90% of the taxes, and it reshuffles it from Democrat states to Republican states. To me it’s a nakedly partisan bill that doesn’t do anything,” Paul said Monday evening.
All throughout the day Monday there were conflicting signals on the bill’s chances. Collins said it was “problematic” to pass a health reform bill without a full CBO score. McCain, who has repeatedly called for a return to regular order, which would include Senate hearings, amendments, and a longer debate time, called the rapid process “very disturbing.”
But McCain also did not close the door on supporting Graham-Cassidy, and noted his state’s Republican governor, Doug Ducey, endorsed the bill Monday.
House Freedom Caucus chair Mark Meadows, whose group threw up numerous roadblocks on health care in the House and rejected previous Senate proposals, said that the House would pass the Graham-Cassidy plan if the Senate sends it over to them. This is a significant departure from earlier Freedom Caucus positions. The arch-Conservative group previously blocked an early repeal bill for not repealing enough of the Affordable Care Act.
A major impact of previous Obamacare repeal bills was that they took hundreds of billions of dollars out of health care for the predominantly poor and funneled those savings into tax breaks for the predominantly rich. Graham-Cassidy does cut federal funding compared to Obamacare, but keeps most Obamacare taxes in tact. Instead, it transfers federal money from mostly blue states to mostly red states.
The bill undoes the expansion of Medicaid and distributes that money across all 50 states on a per-capita basis. That means states that expanded Medicaid will get less money, while those who didn’t will get more. The details of how that will play out are still in dispute. An analysis by the Center on Budget and Policy Priorities found that 35 states plus the District of Columbia would lose out on federal health funding, but Cassidy insisted the actual number was only 10 states and Washington, DC.
This could be a massive factor because several Medicaid expansion states are represented by Republican senators. These include Arizona, Alaska, West Virginia, Ohio, Nevada, and Cassidy’s home state of Louisiana.
Asked her thoughts on the bill Monday evening, West Virginia Sen. Shelley Moore Capito said she had just gotten the numbers and was beginning to analyze them.
Senate Republicans will huddle on Tuesday, as they do every week over lunch. The meeting could be pivotal in deciding whether Graham-Cassidy will get a vote and if it can pass. The September 30 deadline is cutting close in the Senate, where Democrats can force Republicans to spend days debating the bill, but — if some of the maybes and leaning no votes can be persuaded — it is possible that Republicans could repeal Obamacare by the end of next week, fulfilling some of Democrats’ worst fears as the deadline approaches.