With the end of this year’s budget less than 30 days away, three Republican lawmakers are scrambling to finish another healthcare proposal.
It is the last healthcare bill left standing after the Senate rejected four separate repeal plans this summer. It’s also the most extreme.
Here are the details:
• Ends ACA Medicaid expansion
• Ends ACA tax credits and cost-sharing subsidies
• Ends the mandate to purchase coverage
• Requires that all insurance plans accept applicants regardless of health condition
• Gives states a lump sum to do with as they please (but states must contribute to that sum in order to access it)
Such a block-grant approach has wide appeal among Republicans, including Senator John McCain, who effectively killed the GOP's repeal attempt in July with his "no" vote.
The bill, co-sponsored by Republican Senators Lindsey Graham (SC), Bill Cassidy (LA), and Dean Heller (NV), is being pushed as a compromise that would return power to the states. McCain's support will be a key factor in the potential success of the bill.
McCain would "love to get money and power out of Washington,” explains Graham. “But we’ve got to get formulas worked out that work for each state, including Arizona.”
McCain has expressed support for the bill, but says he won't say yes until he sees a finished product with support from state governors. “I think it’s a good proposal and I think we ought to support it,” says McCain. "As I have said all along, any effort to replace Obamacare must be done through the regular order of committee hearings, open debate and amendments from both sides of the aisle.”
Cassidy has suggested that states who like Obamacare can use their money to maintain it, but opponents argue that the bill's funding formula would make that approach too expensive. “We need to let states take care of themselves and give power back to patients,” argues Cassidy. “Let a blue state do a blue thing and a red state such as mine take a different, conservative approach.”
The bill is facing serious opposition from activists and Democrats, not to mention lawmakers who are focused on tax reform and don't want to revisit healthcare.
Graham-Cassidy would "substitute a block grant for the funding that now provides states with resources for Medicaid expansion, premium tax credits, and cost-sharing reduction subsidies,” argues Judith Solomon of the Center on Budget and Policy Priorities. “People don’t have a guarantee of meaningful coverage. It’s totally different.”
Opponents point out that Graham-Cassidy does not require states to spend money on low-income populations. This is a huge shift from Obamacare, which tried to focus on helping these populations by expanding Medicaid and doling out giant tax credits.
Graham-Cassidy would also take all current Medicaid expansion spending from the 30 participating states and divide it among all 50 states. This would benefit some states and seriously disadvantage others.
Andy Slavitt, administrator for the Center for Medicare and Medicaid Services under President Obama, says the bill is "out of step with where the American public and many in the Senate are moving to now – small bipartisan steps to move us forward and make healthcare more affordable for millions of Americans.”
Despite the pushback, Graham and Cassidy plan to head to the White House this Wednesday to discuss the plan. “Stay tuned,” Graham said. “It’s coming out and it’s coming out this week.”
Last week, White House adviser Kellyanne Conway said Trump was “ready with pen in hand to sign healthcare reform if, say, Graham-Cassidy moves forward.”
In the meantime, a bipartisan group of lawmakers is working on a package to strengthen Obamacare markets before enrollment begins on November 1st. Susan Collins (R-ME), who joined McCain in killing the GOP’s last repeal effort, says the Senate is much more focused on this second bill.
“The fact is we’re going to have four hearings, and then by the end of the week, I think you’ll see the outlines of a bill emerging from the committee,” says Collins.
Republican lawmakers are running out of time. The 2017 budget ends at the end of the month, and if they don’t get a healthcare bill passed before September 30th their efforts will be stymied by a Democratic filibuster.
Editor's note: McCain is being a pain in the ass on this, but I have every confidence that a bill will eventually be passed. There is too much riding on this for the GOP.