President Donald Trump has publicly backed Senate Republicans’ latest bill to repeal and replace Obamacare, but in private, the president and members of his administration doubt that the bill can pass both chambers of Congress.
Members of Trump’s White House and congressional sources told Politico Friday that both the president and administration officials harbor serious concerns about whether the latest iteration of Obamacare repeal can make its way through Congress.
Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, along with Sens. Dean Heller of Nevada and Ron Johnson Wisconsin, put forth a bill that would repeal major portions of Obamacare and replace the system’s funding mechanism with block grants in an attempt, according to the senators, to promote state innovation in the implementation of health care.
While the bill is eliciting a great deal of optimism among conservative members, Senate Republicans are roughly four votes short of passing Graham-Cassidy, with Sens. John McCain of Arizona, Lisa Murkowski of Alaska, Susan Collins of Maine and Rand Paul of Kentucky serving as the key holdouts. Republicans need 50 “yes” votes to pass the bill under the Senate’s budget reconciliation, and they currently have roughly 48 senators behind the bill, according to Cassidy.
The president spent much of his free time this past week at the United Nations, making calls to wayward senators to try and garner their support behind the party’s eleventh-hour campaign to do away with Obamacare. Members of the administration believe that Trump’s ability to whip votes this time around is rather limited, because the president does not have much clout with McCain, Murkowski and Collins.
Trump also publicly lambasted Sen. Rand Paul of Kentucky for once again coming out against the Republican repeal effort, which the senator did on a number of occasions in the chamber’s last push to overhaul the American health care system in July.
Paul told The Daily Caller News Foundation that he does not support either the Graham-Cassidy bill or the bipartisan proposal that was expected, until its recent withdrawal, to make its way out of the Senate HELP Committee.
Murkowski became the subject of Trump’s outbursts in July, after she voted against all three Republican proposals to repeal and replace Obamacare. Trump said that Murkowski really “let the Republicans, and our country, down,” when she voted to keep Obamacare as the law of the land.
Trump even tried to sway Murkowski during the last Republican efforts to upend Obamacare. The president reportedly gave her a phone call, which the senator described as “not a very pleasant call,” before the Senate voted on the various health care reform bills.
Murkowski is still looking at the bill and waiting on more analysis before she makes her final decision. Alaska is one of the costliest states under Obamacare, and any serious cuts the state’s Medicaid funding could cause Murkowski to give a thumbs down to Graham-Cassidy. If she, or McCain, end up voting no, the bill is dead.
“I’m still looking for data that walks me through how Alaska actually does,” Murkowski told reporters. “If it can be shown that Alaska is not going to be disadvantaged we gain additionally flexibility then I can go back to Alaskans and I can say ‘ok let’s walk through this together’ … I don’t have that right now.”
Alaska could see as much as a $1 billion cut to the state’s federal health care funding from 2020 to 2026, according to research from consulting firm Avalere. That works out to roughly a $1,350 cut per resident.
McCain told reporters Tuesday that for him to support Graham-Cassidy he “would need assurance that this bill would help the state of Arizona and would be good for the country.” The Arizona senator has been adamant that any major health care bill needs to go through regular order, which forces a bill to get 60 “yes” votes and provides Democrats with the opportunity to filibuster. McCain and Trump also have a rather contentious history from the campaign trail, with the senator and president jabbing one another on a regular basis.
A White House spokesman told The Daily Caller News Foundation in mid-August that the president wants the Senate to fulfill its promises to repeal and replace Obamacare, and inaction is not an option. White House officials told Politico that the president has his mind set on signing a bill, as long as it can be referred to as “repeal and replace.” Effectively, it appears that passing a bill, any bill, that would reform health care and that can be sold as “repeal and replace” is what the administration is pursuing.
Conservative groups that have championed repealing Obamacare since nearly its inception have their doubts that Cassidy-Graham constitutes anything close to a repeal and replace bill.
“While no one should be under the illusion that Graham-Cassidy delivers on the Republicans’ seven-year campaign promise to repeal and replace Obamacare,” Heritage Action said in a statement released to TheDCNF. The group did provide a caveat that the bill could, despite its flaws, “make important improvements over the status quo.”
The National Association of Medicaid Directors (NAMD) warned Senate lawmakers late Thursday evening that passing the Graham-Cassidy bill would place potentially extreme financial burdens on states.
“Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history,” the NAMD board of directors wrote in a statement. “With only a few legislative days left for the entire process to conclude, there clearly is not sufficient time for policymakers, Governors, Medicaid Directors, or other critical stakeholders to engage in the thoughtful deliberation necessary to ensure successful long-term reforms.”
America’s Health Insurance Plans, the leading lobbying organization of national insurance providers, and Blue Cross Blue Shield came out against Graham-Cassidy Wednesday, which could cause the senators some problems going forward.
Blue Cross Blue Shield said that while it is “committed to ensuring that all Americans have access to health insurance coverage” and it approves of “providing states with greater flexibility in shaping health care options for their residents,” the company “share(s) the significant concerns of many health care organizations about the proposed Graham-Cassidy bill.”
“The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans. Legislation must also ensure adequate funding for Medicaid to protect the most vulnerable,” the company said in a statement.
In a letter released to TheDCNF Wendesday from AHIP President Marilyn Tavenner to McConnell and Senate Minority Leader Chuck Schumer, Tavenner said the organization “cannot support this proposal.” Tavenner went on to say the bill would “have real consequences on consumers and patients,” including reducing health coverage and protections for those with pre-existing conditions.
Despite the backlash from conservatives and industry groups, Senate Republicans aren’t slowing their last-ditch effort to reform health care.
The administration is relying heavily on Graham to rally Republicans around his bill. Graham told reporters Tuesday that he had already been on the phone “five times” with the president since Monday, and continues to be in constant communication with the administration. Graham is also working with Senate Majority Leader Mitch McConnell to ensure the bill makes its way out of the Senate.
The Senate Finance Committee is slated to hold a rushed hearing on the legislation Monday, which is likely an effort to satisfy McCain’s call for the bill to go through public hearings to allow Democrats to have their say.
Senate leadership has roughly eight legislative days before the Senate’s budget reconciliation rules expire. After Sept. 30, senators would have to pass the bill through regular order.
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