Repeal, Replace, Redux
Republicans Rush Toward an Obamacare Replacement With Little Time and Information
A Sept. 30 deadline has the chamber moving at high speed. Not everyone is entirely comfortable with it.
The purpose was, ostensibly, to discuss the legislative business before the chamber. But the main goal was to gauge collective interest in one particular bill: a last-ditch effort to repeal and replace Obamacare, which has crept back up from its burial ground like the political zombie that it is.
The bill Congress is now frantically considering was, as of a week ago, seemingly such a long shot that one Democratic lawmaker put it at a two on a scale of one to ten for passage—ten being a certainty—and a top Republican senator said he didn’t even think it would get a floor vote.
But on Capitol Hill, deadlines have a way of stiffening backs and speeding up processes. And a proposal authored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-LA) is the last vehicle that can be considered before budget reconciliation rules that allow the Senate to pass a health care bill with just 50 votes are set to expire. The legislation would effectively turn the federal health care system into a massive block grant, with states given more flexibility to dictate looser or more stringent coverage standards and Medicaid funding being re-distributed and, in some cases, limited throughout the country.
And so they met with McConnell, in his office and on the Senate floor. They spoke over the phone and one-on-one—all to discuss whether it was worth it, both politically and intellectually. Not all Republicans support the concepts that underpin the bill. After all, some GOP-heavy states would see dramatic drops in Medicaid funding under the proposal. The bill would also force lawmakers to essentially disavow past, publicly expressed concerns about the process by which a bill should be considered.
The Senate will not use regular order—an open process whereby amendments are offered—and will only hold rushed hearings. There won’t be a score from the Congressional Budget Office, either—at least not one that will measure how many people could lose coverage under the bill. The nonpartisan legislative scorekeeper said on Monday it would need several weeks to make such a determination, and the Senate GOP needs to get this done by the end of the month.
And yet, for all that, the bill remains on the doorstep of passage, with the White House now lobbying for support of Graham-Cassidy in the Senate, a congressional aide with knowledge of the matter told The Daily Beast.
“It takes 50 votes plus the vice president sitting in the chair, and I think right now most people would agree the count is probably either 48 or 49,” Sen. Mike Rounds (R-S.D.) told reporters. “So I think we’re probably pretty close.”
The remaining hurdles include a group of skeptical senators who might just be too wary of acting too quickly with too little information on legislation affecting one-fifth of the economy.
McCain has been adamant that the Senate consider amendments and hold actual hearings. He left open the door to supporting Graham-Cassidy on Tuesday. And that door opened a bit further after Arizona Gov. Doug Ducey announced he supports the legislation. But after his meeting with McConnell, he restated his desire to see a new process take place.
“The governor came out in favor, which obviously has some impact. The fact is we have also not gone through the regular order,” McCain said. “I want to know what amendments are in order. I want to know why it is that we haven’t had a product in the last nine months. I want to know a lot of things.”
Sen. Rand Paul (R-KY) attacked the legislation from a philosophical, not procedural, vantage point. On Monday, he called the bill a “game of Republicans sticking it to Democrats” whereby states that decided to expand Medicaid under Obamacare would lose funding, while Republican states that did not expand Medicaid would stand to benefit.
“It keeps 90 percent of Obamacare and redistributes the proceeds,” Paul told reporters at a meeting in his Senate office. “It just looks like the Republicans are taking the money from the Democrat states and giving it to Republican states. … This is keeping Obamacare, redoing the formula to give Republican states more money.”
Sen. Susan Collins (R-ME), one of two consistent moderate GOP holdouts on previous iterations of repeal-and-replace, would not commit to voting against Graham-Cassidy. But she had major concerns about the legislation and the Senate’s process. The other of those two, Murkowski, kept her cards close to the vest, as is her custom.
And, in a surprise, one other Republican senator said he feared that Democratic states might use the Graham-Cassidy federalism formula to enact single-payer health care.
“I don’t think states should have the authority to take money from the American taxpayer and set up a single-payer system. Now, some people think that’s inconsistent with the idea of flexibility, but that’s what the United States Congress is for,” Sen. John Kennedy (R-LA) told The Daily Beast. “I’m impressed by the fact that so many governors have signed onto this idea. On the other hand, I’ve worked for two governors and you can generally get governors to sign onto things when you give them gobs of money.”
Democrats watched it all unfold with a mix of horror and helplessness. The party scrambled on Monday to put a critical spotlight on the bill, taking to the floor and social media with red-siren warnings. A top Senate aide put the universe of Republicans the party could persuade as “bigger than just three”—Paul, Murkowski, and Collins—but not much bigger. The assumption was that the White House would sign anything that Congress produces, even if it would completely upend the bipartisan fever that President Donald Trump seems to be enjoying.
“He has been resistant up to this point to being productive on health care,” said the aide. “Health care has been outside the realm of issues he’s been interested in working on a bipartisan basis on. It is the one he has resisted the most.”
Even if the Senate can pass the legislation before the end of the month, the repeal-and-replace package has hurdles to clear before being signed into law. After September 30, the House would need to vote on the exact Senate bill. If the lower chamber changes any parts of it, the bill would be sent back to the Senate, where it would then need 60 votes for passage.
The chairman of the House Freedom Caucus, Rep. Mark Meadows (R-N.C.) told Politico that he’s “very optimistic” Graham-Cassidy would pass in the House. But that might be overstating the case. Republican House members from Medicaid-expansion states could recoil at the funding cuts their constituents would endure. Already, Rep. Tom Reed (R-N.Y.), told CNN that some aspects of Graham-Cassidy are “concerning,” while Rep. Peter King (R-N.Y.) said he couldn’t see how he could vote for it.
It’s not just the New Yorkers who have concerns. As written, the measure will face resistance from conservative hardliners, too. Rep. Dave Brat (R-VA), a member of the House Freedom Caucus, applauded the concept of Graham-Cassidy, but indicated he can’t support it because it doesn’t go far enough to repeal Obamacare.
“It absolutely depends on how much latitude the states are given along with the block grants and so the block grant idea is great and federalism is great but it would be a mistake and intellectually dishonest to call it a repeal of Obamacare if it keeps all of the taxes and all the regulations and the high cost of Obamacare in place,” Brat wrote in a text message to The Daily Beast.