Senate Republicans only have 13 days remaining, including today, to pass the final iteration of their regressive health care plan, and most of the stakeholders continue to act as if the GOP crusade will fail. In recent days, Senate Democrats have become far less sanguine about the possible outcome.
Senate Minority Leader Chuck Schumer (D-N.Y.) issued a "red alert" to health care advocates late Friday, and we've seen similar sentiments from Sens. Cory Booker (D-N.J.), Elizabeth Warren (D-Mass.), Kirsten Gillibrand (D-N.Y.), and Al Franken (D-Minn.). Sen. Chris Murphy (D-Conn.) told health care proponents, "Drop what you are doing to start calling, start showing up, start descending on DC." Sen. Bernie Sanders (I-Vt.) has been focused on his single-payer proposal, but he added yesterday, "Our immediate concern is to beat back yet another disastrous Republican proposal to throw millions of people off health insurance."
Among opinion leaders, progressive voices like the Washington Post's E.J. Dionne and the New York Times' Paul Krugman both devoted their columns today to warning the public that the threat to the existing health care system is quite real.
Politico reported over the weekend, "Obamacare repeal is on the brink of coming back from the dead."
Senate Majority Leader Mitch McConnell (R-Ky.) and his leadership team are seriously considering voting on a bill that would scale back the federal government's role in the health care system and instead provide block grants to states, congressional and Trump administration sources said.It would be a last-ditch attempt to repeal Obamacare before the GOP's power to pass health care legislation through a party-line vote in the Senate expires on Sept. 30.
The Washington Post reported this morning, meanwhile, that the Senate Republican leadership asked the Congressional Budget Office to "fast-track consideration" of the plan.
At this point, there are basically two broad questions to consider: (1) whether this thing might pass; and (2) just how bad a bill is it?
At issue is a proposal, unveiled last week, championed by Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.), and Ron Johnson (R-Wis.), which is generally known as Graham-Cassidy (or Cassidy-Graham, depending on whom you ask). Sponsors claim to have between 47 and 49 votes, and if they get to 50, it will pass the chamber.
Which means we're back to a familiar dynamic: looking for at least three "no" votes among the 52 Senate Republicans. Sen. Rand Paul (R-Ky.) has already said he "cannot support" the bill, though it's difficult to know whether he means it. Sen. John McCain (R-Ariz.) said yesterday he wants the chamber to follow regular order and has no use for calls to "ram through" a Republican plan. If he honors that principle, the Arizonan would be another "no" vote.
Attention would then turn to Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), both of whom opposed other GOP repeal plans, and both of whom seem unlikely to rally behind this latest far-right push.
In other words, we're still talking about a senator or two holding the fates of tens of millions of Americans in their hands. Anyone who can say with confidence they know exactly what's going to happen is kidding themselves.
All of which leads to the other question about Graham-Cassidy on the merits. While a Congressional Budget Office score is not yet available, quite a few analyses have been published over the last week, each of which paint a rather terrifying picture.
The Center on Budget and Policy Priorities, for example, explained that Graham-Cassidy would "gut" protections for Americans with pre-existing conditions. Similar reports have noted that the latest Republican plan would decimate Medicaid, kill off Medicaid expansion (while rewarding states that refused to adopt the policy), and even cut off Planned Parenthood (which, full disclosure, my wife works for), which is likely to be of interest to Collins and Murkowski.
The Huffington Post's Jonathan Cohn published an overview that's worth your time:
Starting in 2020, the Cassidy-Graham bill would eliminate both the Affordable Care Act's subsidies and the enhanced federal funding that underwrites the expansion of Medicaid in 31 states (plus the District of Columbia). The bill would then establish a "block grant," handing money directly to the states for helping people to pay for health care. This would produce the best of all worlds, as Cassidy and Graham would say, because it would mean states could stop worrying about the complications of the Affordable Care Act and simply use that money in ways that will work best for them and their citizens.In reality, the Cassidy-Graham would shrink the federal investment in health care programs dramatically, by somewhere in the neighborhood of $400 billion over the next ten years, or maybe even more, according to a preliminary and rough analysis by the Center on Budget and Policy Priorities. Starting in 2027, the money would vanish altogether. In theory, Congress could appropriate new money then, a possibility Cassidy and Graham have raised in an effort to soothe those nervous about such a dramatic drop-off in funds. In practice, it would take $200 billion each year just to keep pace. That'd be a huge ask for any Congress.
Axios published a related report this morning, meanwhile, on which states would stand to lose the most if Graham-Cassidy became law, and Kentucky, Arizona, and Alaska are projected to be hit the hardest by the Republican gambit.
That seems like a detail McCain, Murkowski, and Rand Paul might want to keep in mind.