The Corner

Health Care

Obamacare Repeal: One More Time, with Feeling

A sign on an insurance store advertises Obamacare in San Ysidro, San Diego, California, October 26, 2017. (Mike Blake/Reuters)

[Update: I’ve been reliably informed that the document Spiro shared is not the current version of the plan. In addition, The Hill  has a new story about the effort, including a link to an (also outdated) bill draft. A Cassidy spokesman is quoted saying that “no legislation is imminent.”]

A tweet from a health-care fellow at the liberal Center for American Progress:

This would appear to be Republicans’ last-ditch attempt (well, their latest last-ditch attempt) to repeal Obamacare. It seems broadly similar to the bill from late last year, Graham-Cassidy, but drops the attempt to reform traditional Medicaid.

Hill-watchers are skeptical this effort will go anywhere before the elections later this year. It would require the GOP to pass a budget resolution, craft a bill that meets the requirements of the Senate’s “reconciliation” process (meaning, among other things, that all provisions must affect the budget), bring together the support of 50 of the Senate’s 51 Republicans, and push the legislation through the House as well.

I’m eager, though, to see the full details on how the proposal handles the states that expanded Medicaid, which today get more federal funding than those that didn’t, as well as the specific states represented by holdout senators.

Regarding the expansion, the fair thing to do is to gradually even out funding, which is what a previous incarnation of Graham-Cassidy did — and, according to the above summary, what the new proposal does too. But this implies a funding cut for expansion states, which are disproportionately blue but not entirely so. One of Rand Paul’s criticisms of the old bill, for instance, was that it took from “Democrat” states and gave to “Republican” states. (Coincidentally, his own Republican-leaning state expanded and would have seen its funds cut.)

And the summary above might hide some key nuances. A report last month by Quin Hillyer claimed the new version “phases in the grants in a way that ensures those particular states will not see what amounts to short-term cuts in federal funding” — implying the finer details could be important. Frankly, if the ten-year end point is equal funding, I’m not sure there’s any way the period in between can make expansion states happy. But I’m curious what the plan is.

Regarding perks for holdout senators, Spiro suggests the new legislation will “bribe” Senators Lisa Murkowski and Susan Collins. (Murkowski’s Alaska expanded Medicaid; voters in Collins’s Maine approved expansion in a referendum, but the governor is refusing to implement it.)

Remember, if the GOP loses more than one senator, the bill goes down in flames. And beyond Paul, Murkowski, and Collins, that includes John McCain, who sank the previous effort, and whose health problems have been keeping him home from D.C. So a lot rides on whether all these folks find the new formula (A) acceptable in terms of how it treats their own states and (B) something they’re willing to defend in public.

After the flop in July of last year, I wrote that I thought serious health-care reform might be impossible, given the GOP’s slim margins, the divisions within the party, and the procedural obstacles in play. The attempt to pass Graham-Cassidy in September, which didn’t even result in a vote, hardly proved me wrong. I still suspect that to be the case — and a repeat performance of last year’s humiliations, in an election year, would be spectacularly bad for the GOP.

But never say never, I guess.

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