Opponents of the
proposal seized on its plan to overhaul Obamacare’s subsidized insurance and
Medicaid expansion and replace those with block grants.
By ADAM CANCRYN
09/19/2017
07:02 PM EDT
Updated 09/19/2017 08:37 PM EDT
Republicans hoping to jam a last-minute Obamacare repeal
plan through the Senate are confronting a rising tide of opposition as health
care groups, patient advocates and even some red-state governors join forces
against a bill they worry would upend the nation’s health care system.
The wide-ranging backlash threw the GOP’s repeal push into
fresh doubt on Tuesday, even as White House officials and Senate Republican
leaders insist they are on the verge of winning the 50 votes needed to
dismantle Obamacare under a reconciliation bill that expires in two weeks.
Opponents of the proposal co-authored by Sens. Bill Cassidy
of Louisiana and Lindsey Graham of South Carolina seized on its plan to
overhaul Obamacare’s subsidized insurance and Medicaid expansion and replace
those with block grants to the states — a mass restructuring they warned would
sow chaos in insurance markets. They panned its new regulatory flexibilities as
a backdoor route to undermining key patient protections — including safeguards
for those with pre-existing conditions.
And in the biggest blow, several Republican governors urged
the GOP to abandon a plan that would force states to swallow potentially
billions in funding cuts — and instead to focus on stabilizing Obamacare.
“The Graham-Cassidy bill is not a solution that works for
Maryland,” said Maryland Gov. Larry Hogan, one of the half-dozen GOP governors
to come out against the bill so far. “We need common-sense, bipartisan
solutions that will stabilize markets and actually expand affordable coverage.”
The criticism from Republican governors adds another
complication to an already fraught process for Senate Republicans facing a
tight deadline to repeal Obamacare. GOP leaders — once skeptical of the
Graham-Cassidy plan’s chances — are now all in on a bid to speed it through the
Senate.
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In a clear bid to boost the bill’s prospects Tuesday, House
Speaker Paul Ryan and the White House came out in opposition to a bipartisan
plan to stabilize Obamacare being written by Sens. Lamar Alexander (R-Tenn.)
and Patty Murray (D-Wash). The intention was to put pressure on Republican
senators to back the last-ditch effort to gut Obamacare.
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Alexander later announced he’d abandoned work on that effort
after failing to find consensus. He has said he’d “like to” be able to support
Graham-Cassidy and is still reviewing the bill.
Senate Majority Leader Mitch McConnell also backed the
approach Tuesday, although he declined to commit to bring it to the floor.
“We’re in the process of discussing all of this,” McConnell
said. “Everybody knows that the opportunity expires at the end of the month.”
All of which has amped up the pressure on GOP lawmakers who
are eager to fulfill their seven-year repeal vow but who remain puzzled about
what the bill would actually mean for their home states — especially since the
Congressional Budget Office said it will not have details about the practical
implications of the bill, including how many people could lose coverage and the
impact on insurance premiums, "for at least several weeks."
“The kind of status quo on money, or more money to states
and more control to states — that’s very appealing, very simple,” said Alaska
Sen. Dan Sullivan, who added that he’s still poring over the bill’s effects.
“What I’m very focused on as we speak is figuring out the dollar amounts,
frankly, and the formula and how it impacts my state.”
Cassidy — the chief architect of the bill’s proposal to take
Obamacare’s federal funding and redistribute it to states in equal amounts —
has spent the past several days reassuring senators that their states wouldn’t
see major funding cuts under the block grant plan.
But that rosy view has met with increasingly harsh pushback
from policy analysts, industry groups and state officials — including some in
the Louisiana Republican’s own state.
“The legislation you’ve introduced this past week gravely
threatens health care access and coverage for our state and its people,”
Louisiana Health Secretary Rebekah Gee wrote in a letter to Cassidy, estimating
that the bill’s block grant system would slash $3.2 billion in health funding
for the state over a decade.
That figure tracks with early estimates published by the
left-leaning Center on Budget and Policy Priorities, showing that only 15
states would end up better off financially under Graham-Cassidy compared with
the current law — while those that have been most successful at enrolling
residents in coverage would face tens of billions in cuts.
Another state-by-state analysis, set to be released
Wednesday by health care consultancy Avalere, will similarly show most states
losing federal funds through the bill.
“That is definitely the case,” Avalere Vice President for
Policy and Strategy Caroline Pearson said. “The vast majority of states will
get less money.”
The projected financial hit to states has pitted some
Republican governors against their own Senate delegation. Nevada Gov. Brian
Sandoval — in a break with bill co-sponsor Dean
Heller — and Ohio Gov. John Kasich both signed onto a
10-governor letter urging the GOP to abandon Graham-Cassidy in favor of
propping up Obamacare. Louisiana Gov. John Bel Edwards, a Democrat, opposed the
bill too.
The state-level objections echoed the message from across
the health community — a diverse group of industry, patient and public health
advocates that have nevertheless remained largely united against the GOP’s
repeated repeal efforts.
Sixteen patient and provider groups, from the American Heart
Association to the March of Dimes, slammed the bill in a joint letter over
worries it would gut Medicaid and undermine protections for those with
pre-existing conditions. A raft of other powerful health lobbies, including the
American Medical Association and American Academy of Family Physicians, piled
on throughout the day on Tuesday, each urging the GOP to abandon repeal in
favor of bipartisan fixes.
By BURGESS EVERETT, JOSH DAWSEY and RACHAEL BADE
Hospitals and insurers — until this week largely convinced
the repeal fight was over — sprang back into action as well, criticizing the
prospect of creating 50 wildly different state health care systems as
unworkable and irresponsible, with minimal vetting of the bill’s merits ahead
of time.
“Could you have imagined any other Senate in our modern
history that would even consider this process?” one health care lobbyist
vented, calling it the worst GOP proposal yet. “We’re talking about such a
tremendous portion of the United States economy. Real people’s lives. The
reverberations are just so huge.”
To date, not one major health care industry or advocacy
group has expressed support for the Graham-Cassidy plan.
The hits are going to keep coming. Activist groups that
Democrats credited for helping derail the last repeal bill are ramping up their
efforts, targeting holdouts like Sens. John
McCain of Arizona and Susan
Collins of Maine.
And comedian Jimmy Kimmel, who lauded Cassidy in May for his
promise to vote against any bill that undermined protections for people with
pre-existing conditions, is expected to go after the senator Tuesday night for
breaking his promise. Graham-Cassidy would let states obtain waivers that allow
plans to charge higher premiums based on individuals’ health status.
Cassidy has defended the provision by noting that states
would be required to ensure “affordable and adequate” coverage options for sick
enrollees.
The sudden scrutiny has heightened tensions in a Senate that
last week seemed resigned to simply shoring up Obamacare for the short term.
“I have nothing to say,” McCain, a key swing vote, retorted
Tuesday when asked about his position on the bill. “I have nothing to say, OK?
Did you hear me?”
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