WASHINGTON ― There’s nothing like a deadline to get things moving on Capitol Hill, and with a Sept. 30 expiration date for the bill that Republicans want to use for an Affordable Care Act repeal, Senate Republicans who once seemed resolutely opposed to even the most modest Obamacare repeal suddenly sounded less resolute Monday.
The proposal ― authored by Sens. Lindsey Graham (S.C.), Bill Cassidy (La.) and other Republican colleagues ― would still likely result in millions losing coverage. The bill would still cut Medicaid, albeit over a longer timeline, and states could still choose to undermine protections for people with pre-existing conditions. But the measure, attached to a “reconciliation” bill that allows a simple majority vote, would give states more flexibility in deciding those cuts and coverage decisions.
That flexibility has inspired Sen. Rand Paul (R-Ky.) to come out strongly against the legislation, castigating the bill as a rebranding of Obamacare. “Conservatives should say no,” Paul tweeted Monday.
The proposal, however, is seemingly less repellent to Sen. Lisa Murkowski (R-Alaska), one of the three Senate Republicans who voted against the “skinny repeal” in July, along with Susan Collins (Maine) and John McCain (Ariz.). Murkowski told HuffPost on Monday that she’s undecided on Graham-Cassidy, as the measure is known, and that she and her staff were “still looking” to see how Alaska would make out under the bill.
Pressed that it seemed as if her state would at least face less severe cuts than previous repeals ― an analysis from the Center on Budget and Policy Priorities says the bill would cut Alaska funding by only $149 million over 10 years, while states like California and New York would suffer cuts of $35 billion and $22 billion, respectively ― Murkowski said the depth of those cuts was what she and her staff were trying to determine.
A Congressional Budget Office score would be helpful in making those determinations, but the CBO said it would have only a “preliminary” assessment next week and that a more detailed analysis on the effects of the legislation on deficits, health coverage and premiums would take “at least several weeks.”
Still, Republicans are trying to pass this bill now. Lawmakers and the administration have stepped up their lobbying of Murkowski and Alaska Gov. Bill Walker, an independent, in recent days. Neither Murkowski nor Walker is coming out in opposition at this point. When HuffPost asked about those conversations Monday, Murkowski suggested Walker was, like her, still trying to gather information.
House Freedom Caucus Chairman Mark Meadows (R-N.C.), who’s been instrumental in the health care negotiations in both chambers, told HuffPost on Monday that the bill’s authors and Trump administration officials realize that “making sure the needs of Alaska are addressed is a top priority.”
“Whether we repeal and replace Obamacare comes down to a few key senators,” Meadows said.
While Meadows wouldn’t answer if that meant buying off those individual senators, that certainly could be a strategy in the coming days ― even coming hours.
The entire repeal effort could come down to a small amount of money for Alaska, with Republicans perhaps arguing that, over the next 10 years at least, Alaska would be better off. (The trick with Graham-Cassidy is that it pushes back most of its cuts to years that may be outside of a CBO budget window.)
Ultimately, if Republicans are going to deliver on their promised repeal and replacement of Obamacare, they will have to vote for a bill with unknown effects, and House Republicans from states like California and New York would have to back huge health care assistance cuts to their states.
In that sense, the condensed timeline may help Republicans. Lawmakers may not have enough time to learn about the effects of their bill before they vote on it ― something that didn’t apparently bother House Republicans when they voted on their health care proposal without a revised CBO score. Just like in the House, Meadows noted that the tight timeline had made for a “better negotiating mood” for the majority of senators.
Collins is considered less likely to vote for this measure, but she didn’t completely rule it out Monday afternoon. She said backing the bill would be “problematic” without a CBO score, and she has “grave concerns” about certain cuts that Maine could suffer.
Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah) both seem to be on board with the legislation, and other senators, including Rob Portman (R-Ohio) and Lamar Alexander (R-Tenn.), seemed likely to fall in line if GOP leadership could win over Murkowski.
Republicans can lose only two GOP votes if they’re to even advance this bill to the House. That means they have to pick up some combination of Collins, Murkowski and McCain.
On Monday, Senate Majority Leader Mitch McConnell (R-Ky.) met with Murkowski and McCain in his office, one after the other.
McCain, who was diagnosed in July with an aggressive form of brain cancer, said he wanted regular order on this bill, a process that would normally subject the legislation to hearings and committee markups, as well as the opportunity for lawmakers to get votes on amendments. And McCain didn’t sound sympathetic to arguments that there wasn’t now enough time for that regular order.
“I’m not the one that waited nine months to bring up an issue,” McCain said. “And we just went through that last fiasco. It’s not my problem that we only have those few days left. What were we doing the last nine months?”
Still, McCain said he was still considering voting for the legislation. His governor, Doug Ducey (R), came out in support of the Graham-Cassidy proposal on Monday, and McCain said it would be difficult to vote against legislation authored by Graham, his closest friend in the Senate.
That doesn’t mean, however, that he will just fall in line. “I don’t want to have to just vote aye or no on what’s one-fifth of the gross national product,” McCain said.
There’s still plenty for Murkowski to object to ― defunding Planned Parenthood, long-term Medicaid cuts, provisions letting states undermine protections for people with pre-existing conditions. Overcoming those issues may just be too challenging for Republicans, at least with only a 12-day timeline.
A more likely scenario is for the GOP to push this Graham-Cassidy bill as hard as it can in the coming days, see how far it can get and then wait until next year when a new majority-vote reconciliation vehicle is available to them.
It may not be easier to actually pass the legislation, especially considering how close Republicans will be to the 2018 elections. But the GOP health care proposals have died numerous times and come back to life. Even if this Graham-Cassidy proposal dies, there’s no reason to believe it’s the last possible chance for Republicans to repeal Obamacare.
Jennifer Bendery, Jonathan Cohn and Jeffrey Young contributed reporting.