After Texas Senator Ted Cruz revealed Sunday that he wouldn’t support Graham-Cassidy, effectively quashing the Republicans’ chances of repealing and replacing Obamacare before the crucial Sept. 30 deadline, Bloomberg reported that the GOP senate leadership was scrambling late Sunday to revise the bill to win support from a small but critical group of holdout senators and secure the 50 votes needed to allow the tie-breaking vote in favor cast by Vice President Mike Pence.
Cruz, who had previously said he supported a system of scrapping the Obamacare Medicaid expansion in favor of providing block grants to states, the crux of the Graham-Cassidy, told a crowd in Texas that he had changed his mind, but didn’t elaborate as to why. Meanwhile, Senator Rand Paul took to the Sunday shows to reiterate that he’s against the bill because he believes block grants would foster infighting over funding between the states.
Some of the changes, which come as the Sept. 30 expiration of the fast-track provision that forestalls a Democratic filibuster, are designed to appeal to moderate holdouts like Lisa Murkowski of Alaska, while others appeared tailored to lure conservative skeptics like Rand Paul of Kentucky. Trump has vowed to win the support of the Kentucky senator, although some theorize that, since the current system is popular in Paul’s home state, that he will invent libertarian-sounding objections to any bill the Republicans present.
Bill Cassidy and Lindsey Graham
But even if GOP leadership manages to change a handful of votes, the bill’s chances of passing remain low, virtually guaranteeing that the Republicans will be forced to accept the status quo after seven years of campaigning to scrap Obamacare. And although the GOP could still try to resurrect the health-care effort later this year, the effort’s collapse will raise serious doubts about Congressional Republicans’ ability to win legislative battles on behalf of the president.
As Bloomberg points out, even Trump appeared to concede that the outlook for repeal isn’t great, admitting as much during a press conference with reporters.
“Eventually we will win on that. My primary focus, I must tell you – has been from the beginning, as you can imagine – is taxes.”
Indeed, the administration appears to already be ceding ground on taxes after leaked highlights from the bill suggested that Republicans would shoot for a 20% corporate tax rate after Trump had called for 15%.
Meanwhile, the new version of Graham-Cassidy partially tries to win over holdouts by offering more federal funding for their states, including multiple provisions offering more money to Lisa Murkowski, or “Lisa M”’s Alaska. The revised bill also includes changes to controversial provisions about pre-existing conditions coverage.
Under the revised version, states would have to describe how their health plans "shall maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions." The original language said each state had to show how it "intends" to have adequate and affordable access to coverage.
The bill continues, however, to give states broad new authority to allow insurance companies to provide skimpier plans with far fewer benefits while charging higher premiums to the sick and the old.
Under the new version, states could let insurers impose deductibles that are higher than the limits set by the Affordable Care Act, or remove the health law’s limits on the costs that an individual family can incur in a year entirely. They could also offer coverage that lacks some of the ACA’s benefits, such as maternity care, prescription drugs or mental health. Plus, states could let insurers widen the gap between how much old people and young people are charged. And states could remove requirements that insurers cover preventive-health treatments and immunizations.
Democrats were quick to criticize the bill.
“Despite an attempt to appear to add money for a select few states, this bill is just as bad for those states and the rest of the states because it still contains a massive cut to Medicaid, and would throw our health insurance system into chaos while raising premiums,” Senate Minority Leader Chuck Schumer said in a statement late Sunday.
The health-care industry, another group that opposes Graham-Cassidy, mobilized on Sunday to convince senators who are on the fence not to vote for the bill.
The bill provoked an unusually strong backlash from the health-care industry as well. Groups representing doctors, hospitals and insurers signed a letter Saturday urging the Senate to reject the Graham-Cassidy bill.
The groups said the bill would undermine protections for patients with pre-existing conditions, result in dramatic cuts to Medicaid and “drastically” weaken the individual insurance markets. The letter was signed by the American Medical Association, the American Academy of Family Physicians, the American Hospital Association, and America’s Health Insurance Plans, which represents major insurers.
Republicans might have another shot at repealing some of Obamacare’s more controversial provisions later this year when they adopt a budget resolution that could allow room for Obamacare repeal provisions, although trying to combine the two complicated policies might make the overall package even harder to pass.
Senate Finance Chairman Orrin Hatch of Utah said last week that there’s a “chance” of pairing taxes with health-care provisions. “But it’s not easy,” he added.
Mitch McConnell still needs to decide whether to call for a vote on Graham-Cassidy.
McConnell still has to decide whether to go through with a vote, which would likely happen Wednesday. While Trump has urged GOP leaders to make every possible effort to repeal Obamacare, some Republicans will be reluctant to take a vote on a bill that many privately are uncomfortable with.
A CBO analysis of the bill is expected later Monday.
The nonpartisan Congressional Budget Office will release a partial analysis of the Graham-Cassidy proposal as early as Monday. It will examine the proposal’s impact on the federal deficit, but a full review of the effect on U.S. health coverage and costs won’t be ready for weeks. The Senate Finance Committee will hold the only hearing on the bill Monday afternoon, and it doesn’t plan to vote on the measure. Senate Republicans will have a private lunchtime meeting Tuesday, where GOP leaders can make a last plea for support.
The Brookings Institution estimated Friday that the Graham-Cassidy plan would reduce the number of people with health coverage by about 21 million a year from 2020 through 2026. The good news is that for all the twists and turns in this ongoing process, the fate of Obamacare repeal should be sealed by mid-week.