The future of the American health care system may rest of Sen. Lisa Murkowski's shoulders -- and with only a week remaining, no one can say with confidence what the Alaska Republican is going to do.
On paper, the question seems fairly easy to answer: not only did Murkowski oppose previous GOP repeal efforts, but her home state of Alaska would be one of the nation's biggest losers if the Republican plan were approved and implemented. Common sense suggests she's a likely "no" vote.
But what if Republicans changed their plan to shield Alaska from GOP-imposed punishments? Politico had this report late yesterday, which rattled the political world quite a bit.
The Senate's Obamacare repeal bill may protect Alaska and up to four other sparsely populated states from major cuts to Medicaid through 2026, a potential boon to the home of pivotal GOP swing vote Sen. Lisa Murkowski.The plan from Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) allows a limited number of states to opt out of its new Medicaid financing system, which would give states set sums to run their programs and do away with the open-ended entitlement that exists today.
The scheme has already received quite a few unflattering nicknames: "Alaska Purchase," "Klondike Kickback," and my personal favorite, "Polar Payoff." Whatever you're inclined to call it, the underlying idea appears to be a straightforward pitch to Murkowski: if she'll vote with her party to repeal Obamacare, Republicans will let Alaska keep Obamacare. The irony of such a move, of course, appears to be lost on the idea's proponents.
There's a lot to this development, so let's take the various elements one at a time:
1. Though the reports about this attempted pay-off have not yet been confirmed, Sen. Bill Cassidy (R-La.), the lead architect of the Graham-Cassidy plan, didn't exactly deny the reports' accuracy. His spokesperson only said that "no changes of any kind have been finalized."
2. As recently as June, Sen. Lindsey Graham (R-S.C.), the other half of Graham-Cassidy, said that efforts to buy senators' votes with side deals are "crap," and if his party started going down this road, "they're going to lose me." Perhaps he's changed his mind?
3. In July, there was related chatter about Republicans trying to effectively bribe Murkowski with a special side deal for Alaska, and at the time, she said she wasn't interested. "Let's just say that they do something that's so Alaska-specific just to, quote, 'get me,'" Murkowski said at the time. "Then you have a nationwide system that doesn't work. That then comes crashing down and Alaska's not able to kind of keep it together on its own." If she hasn't changed her mind, this new gambit will fail.
4. Creating a new, national law that exempts a handful of states may not be constitutional.
5. If Republicans are prepared to shield Alaska from the brutality of their own legislation, won't other senators ask for similar deals for their own states?
I imagine there will be some observers, especially on the right, who argue that Democrats, when crafting the Affordable Care Act, considered side deals for individual senators -- most notably the so-called "Cornhusker Kickback" for then-Sen. Ben Nelson (D) of Nebraska. If Dems did it in 2009, the argument goes, why shouldn't Republicans do it now?
The answer isn't complicated: after GOP officials condemned the move, and the media turned it into a major controversy, the "Cornhusker Kickback" was dropped from the ACA. In other words, Democrats considered this, before changing their minds and taking a more responsible route.
If Republicans create a special pay-off for Alaska, they won't be following in Dems' footsteps.