By ROBERT PEAR and THOMAS KAPLANSEPT. 19, 2017
WASHINGTON — Eleven
governors, including five Republicans and a pivotal Alaskan independent, urged
the Senate on Tuesday to reject a last-ditch push to dismantle the Affordable
Care Act.
But Republican leaders
pressed toward a showdown vote. And they choked off separate bipartisan efforts
to shore up health insurance markets under the Affordable Care Act, hoping to
give Republican senators no alternative but to vote for repeal.
The latest repeal bill,
drafted by Senators Lindsey Graham of South Carolina and Bill Cassidy of
Louisiana, would undo much of the Affordable Care Act and send tens of billions
of federal dollars to the states with vast discretion over how to spend the
money.
This is the choice for
America, Mr. Graham said on Tuesday: “Socialism or federalism when it comes to
your health care.”
Yet some governors, the
supposed beneficiaries of that federalism, were decidedly cool to the proposal.
New Hampshire’s Republican governor, Chris Sununu, had criticized the proposal
on Monday. But it was the opposition of Alaska’s governor, Bill Walker, that
might prove most important. He increased pressure on Senator Lisa Murkowski,
Republican of Alaska, to cast what could be a deciding vote to kill the repeal
effort, just as she voted against the last repeal bill in July.
Republican leaders appeared
determined to thwart any alternative ahead of a possible showdown vote next
week. Senator Lamar Alexander, Republican of Tennessee, announced Tuesday that
he and Senator Patty Murray, Democrat of Washington, would not come forward
with the “limited, bipartisan plan to stabilize 2018 premiums” in the
individual health insurance market that they had been working toward.
Their bipartisan efforts,
which grew out of four days of committee hearings, were overtaken by the
resumption of partisan warfare on health care.
“We have worked hard and
in good faith,” said Mr. Alexander, the chairman of the Senate health
committee, “but have not found the necessary consensus among Republicans and
Democrats.”
Ms. Murray was more
blunt: “Republican leaders have decided to freeze this bipartisan approach and
are trying to jam through a partisan Trumpcare bill.”
The Senate Democratic
leader, Chuck Schumer of New York, accused Republicans of crushing “very, very
hopeful sprouts of bipartisanship.”
But the latest repeal legislation
was facing significant opposition. The American Medical Association, the
American Hospital Association and AARP, the lobby for older Americans, all
urged the Senate to reject the bill. And 10 of the 12 governors opposing the
measure signed a letter urging Senate leaders to scrap it.
The Graham-Cassidy bill
“would result in millions of Americans losing their health insurance coverage,
destabilize health insurance markets, and decrease access to affordable
coverage and care,” Dr. James L. Madara, the chief executive of the A.M.A.,
said in a letter to Senate leaders.
The
Senate Democratic leader, Chuck Schumer of New York, said the Republican drive
to repeal the health law was crushing “very, very hopeful sprouts of
bipartisanship.”CreditAl Drago for The New York Times
Richard J. Pollack, the
president of the hospital association, said the bill “would erode key
protections for patients and consumers.”
While the two main
insurance associations remained silent on Tuesday as they pondered how they
planned to respond to the legislation, Centene, one of the few insurers that
has aggressively expanded its presence in the
individual market for next year, voiced misgivings.
“From a public policy
standpoint, it is not a good piece of legislation,” Centene’s chief executive,
Michael F. Neidorff, said in an interview. He urged lawmakers from both parties
to work together to avoid passing a law before understanding its full impact.
States may not be able to plan, given the uncertainty over their funding, he
said. “You could end up with 50 different plans,” he said.
“This is unlike anything
I have ever seen,” Mr. Neidorff said. “They have to sit back and think through
what they are doing.”
Within hours after the
bipartisan group of governors sent their letter opposing the repeal bill,
Senator Cassidy provided a letter from 15 Republican governors supporting the
concept of “adequately funded block grants to the states.”
By Tuesday evening, Ms.
Murkowski appeared to be the key vote.
At least two other
Republican senators, Rand Paul of Kentucky and Susan Collins of Maine, are
likely no votes. With Democrats united in opposition, Republican leaders cannot
afford to lose any other votes.
Vice President Mike Pence
met with Senate Republicans at lunch in the Capitol on Tuesday and told them
the Trump administration was fully behind the repeal bill, which would send
more than $1 trillion to states from 2020 to 2026.
After the lunch, Mr.
Graham said, “I’ve never felt better about where we’re at.”
Mr. Graham said he had
spoken to President Trump about the bill five times in the last two days, and
said Mr. Trump was “focused like a laser” on it. Mr. Graham quoted Speaker Paul
D. Ryan as saying that the House would pass the bill if the Senate approved it.
The Graham-Cassidy bill
would blow up the architecture of the Affordable Care Act, a striking departure
from the Alexander-Murray effort to draft a modest bipartisan bill to provide
federal funds to insurance companies to reimburse them for reducing out-of-pocket
costs for low-income consumers.
Some conservatives argued
that the bipartisan bill would just prop up the health law.
It “doesn’t have a chance
in the House,” said Senator Ron Johnson, Republican of Wisconsin, who helped
write the Graham-Cassidy bill.
Mr. Alexander said the
resistance to his bill was formidable. “I know how to get bipartisan results,
but I’m not a magician,” he said.
The battle over the
Affordable Care Act — adopted in 2010 without any Republican votes — has once
again become an all-consuming political drama on Capitol Hill.
The chairman of the
Senate Finance Committee and the top Democrat on the panel announced last week
that they had reached agreement on a plan to prevent the imminent exhaustion of
federal funds for the Children’s Health Insurance Program. But efforts to
translate that agreement into legislation have been at least temporarily derailed
by the Republican push for repeal of the Affordable Care Act.
Republicans were trying
desperately to round up votes for the Graham-Cassidy bill before the end of
next week, when the measure will lose the procedural protection that allows it
to pass with a simple majority, rather than the 60 votes that would otherwise
be required.
While Republicans like
the idea of federalism and block grants, many wanted to know how their states
would be affected. Under the legislation, states with high health care costs —
especially if they expanded Medicaid under the Affordable Care Act — would
generally lose money, while low-cost states that did not expand Medicaid would
gain.
“The idea of giving the
states more flexibility and authority is a good idea,” said Senator Rob Portman
of Ohio. “As a Republican, I join my colleagues in thinking that states are the
place where many health care decisions are already being made, and can be made
more efficiently to cover more people and to lower costs.”
But he added, “I want to
see what the impact is on Ohio.’’
Ohio did expand Medicaid,
and roughly 700,000 people have gained coverage as a result.
The Republican governors
who signed the letter opposing the latest Republican repeal plan were John R.
Kasich of Ohio, Brian Sandoval of Nevada, Charlie Baker of Massachusetts and
Phil Scott of Vermont.
Two other Republican
governors, Mr. Sununu and Larry Hogan of Maryland, expressed similar concerns
in separate statements.
“The Graham-Cassidy bill
is not a solution that works for Maryland,” Mr. Hogan said. “It will cost our
state over $2 billion annually while directly jeopardizing the health care of
our citizens.”
Mr. Graham and Mr.
Cassidy have cited Maryland as a state that, in their view, has been receiving
more than its fair share of money under the Affordable Care Act.
Mr. Sununu said he could
not support the Graham-Cassidy proposal because “New Hampshire could possibly
lose over $1 billion in Medicaid funding between 2020 and 2026.” He said such a
cost shift would be a particular problem for his state because “New Hampshire
is proud of its tradition of not having an income tax or sales tax.”
Members of the Senate
health committee, who celebrated its bipartisan efforts to stabilize insurance
markets in the past two weeks, said they were disappointed.
Senator Collins said she
hoped the panel would continue its work on a bipartisan measure, which she said
had gone “extremely well” under the leadership of Mr. Alexander and Ms. Murray.
Senator Bob Casey,
Democrat of Pennsylvania, said the Graham-Cassidy bill had been moving quietly
through Washington, “like a snake in the grass,” while senators on the health
committee were trying to work together across party lines.
“If we allow that snake in the grass to inject
its venom into people — my analogy for losing your health care coverage — then
we’re not the Senate we should be,” Mr. Casey said. “We’re not the government
that we should be.”
Besides creating block
grants, the Graham-Cassidy bill would make deep cuts in Medicaid. It would end
the expansion of eligibility under the Affordable Care Act, which has provided
Medicaid coverage to 13 million people. And it would put the entire program,
which serves more than 70 million people, on a budget, ending the open-ended
entitlement that exists. States would instead receive a per-beneficiary
allotment of federal money.
Reed Abelson contributed reporting
from New York.
https://www.nytimes.com/2017/09/19/us/politics/obamacare-act-fix-collapses-repeal-trump.html?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=56513358&_hsenc=p2ANqtz-9KshleRd8o6wnETS44Do3LZtAcYh5ME2mXOi1Bq3xI1XnYrZqaJ2loIDcHJd_kj9_UwYX-6ZuPIIaUQI3tfkDmrGzT1A&_hsmi=56513358
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