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McCain Holds Out as GOP Wages Last-Gasp Push to Change the ACA

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Sen. John McCain, a Republican who may hold a pivotal vote in the last-ditch GOP effort to make major changes to the Affordable Care Act, is withholding his support as leaders stare down a final deadline to act by the end of the month.

“I am not supportive of the bill yet,” the Arizona senator told reporters Monday, adding that he wants a more thorough legislative process.

A number of other Republicans are jumping on board a proposal by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana to replace the Affordable Care Act’s insurance subsidies with block grants to states, which would decide how to help people get health coverage.

(Related: 10 Medicare for All and Graham-Cassidy Highlights, for Agents)

The Congressional Budget Office said Monday it will offer a partial assessment of the measure early next week, but that it won’t have estimates of its effects on the deficit, health insurance coverage or premiums for at least several weeks. That could make it hard to win over several Republicans who opposed previous versions of repeal legislation.

On the conservative side, Sen. Rand Paul insisted Monday he is opposing the bill because it keeps too much of the Affordable Care Act.

“It’s another incarnation of replace. I won’t support it,” Paul of Kentucky told reporters, adding that it isn’t a “kidney stone” you pass to “just get rid of it.”

Asked about the likelihood that the bill would get enough GOP support to pass, Paul said, “Two weeks ago I would have said zero. But now I’m worried.”

Two months ago, Majority Leader Mitch McConnell’s effort to pass a replacement with only Republican support suffered a spectacular defeat in the Senate. When members of the Senate health committee then began working on a bipartisan plan to shore up Obamacare, Graham and Cassidy revved up a new bid to get their GOP-only bill to the Senate floor.

Democrats are warning that the proposal is a serious threat.

“This bill is worse than the last bill,” Senate Democratic leader Chuck Schumer of New York told reporters Monday. “It will slash Medicaid, get rid of pre-existing conditions. It’s very, very bad.”

Later at a news conference, Schumer said voting on the measure without a full CBO analysis would be “legislative malpractice.”

The measure would end Obamacare’s requirements that individuals obtain health insurance and most employers provide it to their workers, and give states broad flexibility to address the needs of people with pre-existing medical conditions. The proposal would end the Affordable Care Act’s tax on medical devices while keeping others intact, including taxes on the wealthy, to fund the block grants.

Shares of hospitals and health insurers that could see profits drop under the plan declined. Tenet Healthcare Corp. fell 6% to $15.72 at the close in New York while Community Health Systems Inc. slipped 4.6% to $7.26. The insurer Molina Healthcare Inc. lost 0.9% and Centene Corp. fell 1.5%.

No Democratic Support

Because the Graham-Cassidy plan has no Democratic support, Republicans have only until Sept. 30 to push it through the Senate before rules expire that allow it to be passed with 50 senators plus Vice President Mike Pence’s tiebreaking vote. Republicans control the Senate 52-48.

Graham said last week that McConnell said he was “all in” to help the two bill sponsors round up the 50 votes to pass the bill. Graham said they could have as many as 48 votes if the vote were held now. But a number of Republican senators have yet to get on board, including the three who defeated McConnell’s plan — Susan Collins of Maine, Lisa Murkowski of Alaska and McCain.

Collins “has a number of concerns” about the new proposal, including the cuts to Medicaid and the effect on people with pre-existing conditions, spokeswoman Annie Clark said Monday. She will examine the CBO analysis of the bill’s impact, Clark said.

Murkowski is getting a hard sell from Republican backers of the bill. Moments before she walked into McConnell’s office Monday, she said she’s working with Cassidy’s office to learn what the bill would mean for Alaska.

“What I’m trying to figure out is the impact to my state,” Murkowski told reporters. “There are some formulas at play with different pots of money with different allocations and different percentages so it is not clear.”

The conservative group Heritage Action, which opposed the GOP bill that failed in July, said last week the Graham-Cassidy proposal doesn’t appear to deliver on Republicans’ promise to repeal and replace Obamacare, though the group hasn’t taken a final position.

Arizona Influence

McCain had said earlier Monday on MSNBC that he would consider supporting the plan, but was waiting for input from Arizona’s GOP Gov. Doug Ducey.

President Donald Trump (Photo: White House)

President Donald Trump (Photo: White House)

On Monday, Ducey tweeted his support for the measure, calling it “the best path forward to repeal and replace Obamacare.” He added, “Congress has 12 days to say ‘yes’ to Graham-Cassidy. It’s time for them to get the job done.”

The Senate Homeland Security and Governmental Affairs Committee has scheduled a hearing for Sept. 26 about health care block grants.

Liberal Opposition

Co-sponsoring the proposal with Graham and Cassidy are Chairman Ron Johnson, a Wisconsin Republican, and Nevada Republican Dean Heller.

House Speaker Paul Ryan has spoken positively about the bill, as has Republican Rep. Mark Meadows, chairman of the conservative House Freedom Caucus. Still, it isn’t clear that the measure would have enough support to pass the chamber.

Because the measure strives to equalize Medicaid funding between states, some Republicans from Medicaid expansion states in the House could find it hard to support. That includes states like New York and California, which stand to lose federal funds under Graham-Cassidy. Those states have only Democratic senators, but have some GOP House members.

Schumer said the block grants would also slash health care funding for states with GOP senators, including Alaska, Maine, Arizona, Ohio and West Virginia.

Liberal groups including are working to defeat the plan. The liberal Center on Budget and Policy Priorities said Friday the bill would “significantly” cut federal funding for health coverage over the next decade. It said the cuts would grow more severe in 2027, when the block grants would expire and Medicaid per capita cap cuts would notch down spending. The group estimates that in 2027 alone, federal health spending would decline by $299 billion compared with current law and all states would be affected by cuts.

Credit ratings agency Fitch Ratings said Friday that because Medicaid spending represents one-third of state budgets, the bill would pose big challenges for them, particularly those that took advantage of Obamacare’s Medicaid expansion.

States ‘At Risk’

“States that expanded Medicaid access to the newly eligible population under the Affordable Care Act (ACA) are particularly at risk under this latest bill,” Fitch said. “In the short-term non-expansion states may see gains under the bill given redistribution of ACA related spending streams. But, over time even non-expansion states will face budgetary challenges given the proposed changes to Medicaid, which will likely accelerate for all states over time.”

Republican senators from Medicaid expansion states, including Rob Portman of Ohio and Shelly Moore Capito of West Virginia, are among those who say they’re still reviewing the legislation.

Still, Republicans campaigned on the promise of repealing Obamacare, and many don’t want to give up. They insist the block grants approach in the measure brings flexibility to states that Obamacare lacks. Sen. John Cornyn, the No. 2 Republican leader, said last week that he’ll gauge support for the bill, and the topic is expected to be discussed again privately by Senate Republicans on Tuesday.

Graham and Cassidy say that Pence has been telephoning Republican senators and governors. President Donald Trump let the Republican senators know he’s rooting for them, though he didn’t explicitly supporting the legislation.

“I applaud the Senate for continuing to work toward a solution to relieve the disastrous Obamacare burden on the American people,” Trump said in a statement. “Inaction is not an option, and I sincerely hope that Sens. Graham and Cassidy have found a way to address the Obamacare crisis.”

— Read ACA Waiver Proposals Are Hard to Score: CBO Chief on ThinkAdvisor.


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