Health

Usual Suspects: 3 GOP Senators Hold Back Obamacare Repeal

The three Republican senators that struck down the party’s seven-month push to repeal and replace Obamacare in July are threatening to once again thwart a last-ditch effort to upend the American health care system.

Sens. John McCain of Arizona, Lisa Murkowski of Alaska and Susan Collins of Maine are all signaling that they might vote against their party’s latest proposal to repeal Obamacare. A few of their Republican colleagues — Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin — released legislation Wednesday to repeal and replace major portions of Obamacare with a system of block grants.

McCain hinted last week that he could possibly support the bill, but he would need to see the text of it first. The senator told reporters Monday that he wants the legislation to go through regular order, harkening back to his impassioned speech on the Senate floor after he announced his cancer diagnosis.

McCain admonished his fellow Republicans for not pushing their reform proposals through regular order, which requires Republican leadership to whip 60 yes votes for the measure to pass and allows Democrats the opportunity to filibuster. If McCain were to support the bill through the Senate’s budget reconciliation process, which allows leadership to pass a piece of legislation with 50 yes votes and bypasses the filibuster, he would be going against his prescription entirely.

McCain could still come around to a yes, a possibility made all the more likely with Arizona Republican Gov. Doug Ducey’s endorsement of the Graham-Cassidy bill Monday afternoon. The senator told reporters Monday that he may “reluctantly” support the bill if Ducey threw his weight behind it.

Murkowski told reporters Monday that she is still undecided on Graham-Cassidy, but she is reportedly close to a yes vote. The senator notably withheld her support for all three Republican proposals to reform the U.S. health care system in late July, and she has not yet shown she is willing to give a thumbs up to this bill.

Collins also has yet to take a decided stance on the Graham-Cassidy bill. She told reporters Monday that she still has “a number of concerns” with the proposal, and noted that the legislation’s cuts to Medicaid and the possibility of repealing the pre-existing conditions mandate as her main hangups.

Another senator to watch during this process is Sen. Rand Paul of Kentucky, who has opposed every Republican proposal thus far, citing that all failed to institute a full, clean repeal of Obamacare. Using the same acronyn for Graham-Cassidy that he did throughout the Senate’s health care debates during the summer, Paul called the measure “Obamacare-Lite.” He continued his attacks on Twitter Monday:

The Graham-Cassidy bill replaces Obamacare’s Medicaid expansion, subsidies for private insurance companies (cost-sharing reductions) and tax-credits for middle-income Americans with block grants. Effectively, the legislation changes the funding mechanism for Obamacare and tries to promote state innovation in the implementation of health care.

The new funding mechanism would start in 2020 and would provide states with the opportunity to apply for grants from a pool of $136 billion. That pool would grow nearly 50 percent in six years, reaching $200 billion in 2026. The legislation does not provide permanent funding for the block grant program, and funding would have to be addressed again in 2026.

The bill also repeals the individual and employer mandates, and cuts the 2.3 percent tax on medical devices. All three of these features are likely to be big wins with consumers and business, who have lamented these provisions of Obamacare as onerus and costly.

Repealing the individual and employer mandates, while popular among Republican constituents, would cause major fiscal problems for the Obamacare state exchanges. The mandates require that consumers purchase health insurance, which in turn ensures that the marketplace has healthier people participating to pay out against older, typically sicker, enrollees. If younger, healthier consumers can forgo insurance coverage without paying something into the system, it could likely spark a death spiral, wherein insurance companies raise premiums exorbitantly and people withdraw from the market.

Graham-Cassidy definitely has some chance of making its way through the Senate. Cassidy told reporters Friday morning that his bill to replace Obamacare is only two votes shy of passing the Senate.

“I am pretty confident we’ll get there on the Republican side,” Cassidy said. “We’re probably at 48-49 and talking to two or three more.”

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