Health care reform is like one of those ill people in a Victorian novel. They are pronounced close to death, with no possibility of a cure … and then they linger on for hundreds of pages of breathless plotting, while the reader wonders: “Is this it? Could they possibly live after all that suffering?”
The latest bedside miracle is the Graham-Cassidy-Heller proposal, which would cut spending, cap spending, and shift spending away from states that expanded Medicaid to those that haven’t. At the same time, it would give states considerable discretion to design local solutions for health care provision, something that, as I’ve noted before, is likely to be the key to getting us out of the morass in which we’re currently mired with Obamacare.
Is this the turn? Has the fever broken? Or is this just a stalling tactic, before more agonizing months and years, before the patient is finally pronounced truly and utterly dead?
Well, the political math certainly looks difficult. Republicans hold a majority in both houses, but their Senate majority is narrow enough to give them precious little wiggle room when it comes to passing a bill. Considering that Rand Paul has already been pretty negative about the bill, that wiggle will have to be more like a tremor: If Rand won’t back the proposal, they’ll need either Susan Collins or Lisa Murkowski, who have so far proven unwilling to vote for previous iterations of GOP reform ideas.
Moreover, they’re going to have to shimmy pretty quick. This bill is not, needless to say, going to garner Democratic votes. Democrats don’t want to do anything to Obamacare except pour more money into it, and this particular version is going to hurt blue and purple states that expanded their Medicaid programs.
So to get it through the Senate, the Republican sponsors will have to use a budget process called reconciliation. The reconciliation instructions expire on Sept. 30. In that time, the bill needs to get a CBO score and work its way through the torturous parliamentary procedure for bringing a bill to the floor and voting on it, as well as the lengthy arm-twisting that will probably be required to get enough senators on board. It’s not actually impossible to meet that deadline — but it doesn’t look all that possible, either.
The Medicaid changes are also going to be a problem for Republican senators from states that took Medicaid money, a group that includes Lisa Murkowski of Alaska (don’t count on that vote), and also true-red, die-hard conservatives like Tom Cotton of Arkansas. Whipping those votes would be a Herculean challenge, and it’s far from clear that leadership has any appetite for that fight.
And yet, readers caught in this interminable saga can’t quite say “It’ll be dead by page 900.” Nevada is an expansion state, but one of its senators, Dean Heller, is co-sponsoring the bill. Something about this bill is appealing to him, and maybe that something will appeal to the waverers among his colleagues.