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.
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.
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.
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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