Senate Majority Leader Mitch McConnell refused to promise a vote on Republicans’ last-ditch proposal to overhaul the Affordable Care Act as Democrats and other opponents started ramping up a new campaign Tuesday to block it.
“If we were going to go forward, we would have to act before Sept. 30,” McConnell told reporters when asked if the GOP-only bill will come to the Senate floor before next week’s procedural deadline. “We are in the process of discussing all of this.”
Sen. Lindsey Graham, co-sponsor of the proposal to replace federal insurance subsidies with block grants to states, insisted the GOP will get 50 votes for the latest effort. The Trump administration is starting to throw its weight behind the bill, as Vice President Mike Pence joined Senate Republicans in a private meeting to urge them on.
But Republican Sen. John McCain of Arizona — who provided the decisive vote to block GOP leaders’ Obamacare repeal plan in July — cast doubt on the current effort, saying the rushed process wasn’t enough to satisfy his insistence on regular legislative procedure.
McCain said he would rather see a bipartisan bill, though Health Chairman Lamar Alexander said he and the panel’s top Democrat, Patty Murray of Washington, were unable to work out a consensus on a bipartisan plan to shore up Obamacare’s insurance exchanges. Murray said in a statement she is disappointed GOP leaders “decided to freeze this bipartisan approach” and that she still believes a deal can be reached.
The Senate needs to act on Graham’s bill by Sept. 30 to use a fast-track procedure that prevents Democrats from blocking the proposal, but the deadline doesn’t leave enough time to get a full analysis of the bill’s effects from the Congressional Budget Office. Several Republicans are withholding their support or rejecting the proposal outright.
Democrats and interest groups began mobilizing opposition. House Minority Leader Nancy Pelosi of California called for “all hands on deck” among her members to schedule public events to speak against the proposal. The American Medical Association and senior citizens’ lobby AARP asked the Senate to defeat the bill, and 10 governors — including four Republicans and an independent — wrote a letter asking the Senate not to take up the proposal.
“A week ago this hadn’t even raised its ugly head,” said Senate Democratic leader Chuck Schumer of New York. “But now the groups are really mobilized. You will find the hospitals, the AARP, the nurses, cancer care, and all the societies, they are all mobilized. They realize this bill is even worse that the last one. “
Sen. Lisa Murkowski, R-Alaska (Photo: Murkowski)
While McConnell of Kentucky wouldn’t commit to hold a vote — and risk another embarrassing floor defeat like the last Obamacare-repeal bill in July — he said, “It’s better than the status quo by far, and that’s an argument we’re all comfortable making.”
Most Senate Republicans are still trying to figure out what it’s in the bill, authored by Graham of South Carolina and fellow Republican and Bill Cassidy of Louisiana. It would let states decide how to use federal money to help people get health coverage. The measure would end Obamacare’s requirements that individuals obtain health insurance and that most employers provide it to workers, and give states flexibility to address the needs of people with pre-existing medical conditions.
“There’s still some people undecided and they’re encouraging people to make decisions, but time is running out,” Sen. Ron Johnson of Wisconsin, a co-sponsor of the proposal, said after Senate Republicans discussed the bill at a closed-door lunch.
‘Working Very Hard’
“We’re working very hard to see if we have consensus,” said second-ranking Senate Republican John Cornyn, who added that leaders haven’t decided whether they would hold a vote on the proposal even if it doesn’t get enough support.
McCain told reporters that a regular legislative process could yield 80 votes for a bill.
“Regular order is about having legislation, having hearings, having debate, having amendments, turning out a product,” McCain said.
Even if Republicans manage to get a bill through the Senate by Sept. 30, the House would have to accept it with no changes. Graham said House Speaker Paul Ryan told him, “you send it to the House and it’ll pass.”
The Graham-Cassidy measure strives to equalize Medicaid funding between states, which means that some House Republicans from Medicaid expansion states 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.
Lawmakers won’t have much more information about the legislation by the time the Senate would have to vote. The CBO 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.
McConnell has told senators he would bring up the bill if it had 50 votes, and under fast-track rules he could do so at any time before Sept. 30. That’s the end of the government’s fiscal year, when the rules expire and the GOP would have to start over.
Republicans can only lose two votes in the 52-48 Senate and still pass the measure, with Pence’s tie-breaker.
Republican Rand Paul of Kentucky said Monday he’s opposed to the Graham-Cassidy bill, saying it doesn’t go far enough.
Two other Republicans — Susan Collins of Maine and Lisa Murkowski of Alaska — have voted against every repeal bill considered this year in the Senate, citing cuts to Medicaid and Planned Parenthood as well as provisions that would erode protections for those with pre-existing conditions. The Graham-Cassidy bill contains similar provisions on those three areas.
Collins said Monday the proposal’s effects on Medicaid were “of great concern to me,” and after Tuesday’s meeting she said she hadn’t gotten any new information to make a decision.
Murkowski has also declined to state a position while she assesses the measure’s impact on her state.
“It’s not that I’m being evasive, it’s that I’m trying to be diligent,” Murkowski said Tuesday.
Alaska Governor Bill Walker, an independent, was among the 10 governors who wrote to McConnell and Schumer asking the Senate not to consider the bill. Among the four GOP governors who signed the letter was Nevada’s Brian Sandoval, in a split with Nevada’s Republican Sen. Dean Heller, who is co-sponsoring the bill.
“Only open, bipartisan approaches can achieve true, lasting reforms,” the governors said.
—With assistance from Sahil Kapur, Arit John and Steven T. Dennis.
— Read 10 Medicare for All and Graham-Cassidy Highlights, for Agents on ThinkAdvisor.
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