Latest ACA repeal bill returns for one more Senate audition; will McConnell, other GOP leadership put it to a vote?

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The News:

Powerful healthcare groups continued to denounce the Graham-Cassidy bill Wednesday (September 20, 2017), including AARP and the American Hospital Association, both of which urged a “no” vote. But it was unclear whether the opposition would ultimately derail the attempt, as key Republican senators including Lisa Murkowski of Alaska said they had yet to make up their minds, says the Washington Post.

The measure denotes the last breath of Republican attempts to dramatically gut Obama’s Affordable Care Act, which has added millions of people to the ranks of the insured through a combination of federally subsidized marketplaces and state-level expansions of Medicaid, leading to record lows in the number of those without health insurance. The Graham-Cassidy bill–named for Sens. Lindsey Graham (SC) and Bill Cassidy (LA)–would convert funding for the ACA into block grants for the states and would cut Medicaid dramatically over time.

What is striking about this time at bat is the degree of haphazardness and lack of specificity that infuses the entire process, the Post’s Jennifer Rubin notes. Experts on different sides come up with wildly different numbers–all derived in good faith–and from the Graham-Cassidy numbers, which seems to lack the analytical precision one would expect of something so serious.

The implications of the bill are obscured by carefully customized talking points. Yes, the bill leaves in place the ACA’s provision requiring insurers to offer coverage for preexisting conditions. But states can easily obtain waivers to charge more for certain services. Preexisting exclusions were quite common before Obamacare scrapped them.

Additionally, some analyses do not calculate the impact of a per capita limit on the Medicaid program; that’s a tough calculation, says Rubin. For all of these reasons, it is especially important to have a complete Congressional Budget Office scoring–something the bill’s sponsors will not have in hand before the vote, if it comes, next week.

“It is the leader’s intention to consider Graham/Cassidy on the floor next week,” a spokeswoman for Mitch McConnell (R-KY) said.

McConnell has told colleagues he will only bring up the bill if it will succeed. The statement does leave some wiggle room to not proceed with a vote, says Politico.

Once again, it’s still anyone’s guess whether the bill’s backers can get to 50 votes. One Republican senator even suggested that McConnell may ultimately decide to bring the bill up for another failed vote, in part to show GOP donors and President Donald Trump that the Senate GOP tried again.

Sens. Rand Paul (R-KY) and Susan Collins (R-ME) are viewed as hard “no’s.” And Sens. John McCain (R-AZ) and Lisa Murkowski (R-AK), who opposed a previous iteration of repeal in July, are not sold on the proposal.

In an interview, McCain sounded like he could end up wrecking a bill written by Graham, his close friend.

“Nothing has changed. If McConnell wants to put it on the floor, that’s up to McConnell,” McCain said. “I am the same as I was before. I want the regular order.” Asked if that means he’s a “no” vote, McCain said: “That means I want the regular order. It means I want the regular order!”

The party’s chief vote-counter, Majority Whip John Cornyn of Texas, said party leaders are delivering an urgent message to wavering Republicans.

“It really seems to be picking up some momentum. And I think it’s happening pretty quickly,” Cornyn said in an interview. “We don’t have long to act so that’s why things seem to have sprung up here after people thought health care was dead. This is our last opportunity.”

Steve’s Take:

So far, President Trump has given a relatively feeble expression of support to the latest GOP effort to repeal Obamacare. That makes me wonder whether the president is really interested in another stinging defeat, which has been the history of the GOP’s attempts over the past seven years to scrap the Affordable Care Act. Seems to me, in his heart of hearts, Trump is giving Graham-Cassidy nominal support because he made the ACA repeal his chief campaign pledge, but he doesn’t really believe the votes are there to pass it.

Although saying what some have called “warmish” things about Graham-Cassidy in a tweet, we haven’t yet heard Mr. Trump actually voice anything about the last-ditch repeal plan. His level of involvement so far appears to have been one or two phone calls to the bill’s backers. So, he hasn’t really thrown the full weight of the White House behind the bill. Still, this minimal, mostly token effort could signify that Trump is willing to give the effort one final shot.

Many observers find it intriguing that this 11th-hour endeavor has arisen outside of the GOP’s senior leadership. Senators Graham and Cassidy were the ones really pushing this. None of the other GOP leaders have been all that excited about the effort and not taking it all that seriously until Tuesday, when it suddenly looked like Graham-Cassidy may go to a vote after all.

It is clear today (Wednesday) that the necessary 50 votes to pass the bill are not a slam dunk yet.

The real question for many of us observers is why the GOP would set itself up for an additional failure on top of all the others, especially without having a good feeling it will in fact pass. And that’s exactly why leaders have not been getting behind this effort with a push to pass it. Even the statement by McConnell recently that Graham-Cassidy was “an intriguing idea,” is hardly a strong endorsement.

Meanwhile, senior GOP leadership has not made a final decision to go through with another vote; we’re not going to see a full score of the bill from the Congressional Budget Office, so we’re not going to see a full estimate of the resulting coverage and cost implications. At best, it will be an abridged version of the score, full of estimates, just to determine whether it conforms with the Senate rules that are allowing Republicans to pass legislation with only 50 votes.

There likely will be changes to the bill, negotiated with other Republicans, that might require the Parliamentarian to strip portions out of the final version. All of which requires adept management of all the various moving parts to pass the bill before September 30.

And then there’s the sad, recurring fact that very few legislators understand what’s in the bill, so they don’t have a clear sense as to what the legislation would actually do.

Steve's Take: Proceeding on Graham-Cassidy without full hearings/scoring is disgraceful Click To Tweet

What an appalling way to govern. More than with any previous healthcare proposal, the level of complexity coupled with the level of uncertainty here with Graham-Cassidy make proceeding without full hearings and scoring particularly disgraceful.

As I’ve said before, the best way to convey your support for or against Graham-Cassidy is to call your representative’s office and let him or her know exactly where you stand. A tweet or email, although better than nothing, doesn’t have anywhere near the same impact. The clock’s ticking, and time’s running out.