Short on Votes, GOP Health Care Push Moves Forward

WASHINGTON — The GOP’s last-ditch effort to repeal and replace Obamacare heads into an all-important week hanging by a thread and still short of the votes needed to pass it, even after a new version of the bill was released Monday that attempts to appease the concerns of a handful of uncommitted Republican senators.

Facing a Sept. 30 deadline to pass the bill with a simple Senate majority, the Republican push took on renewed urgency Monday to try and secure the 50 votes needed.

The Senate Finance committee is set to hold its first and only hearing Monday afternoon on the legislation written by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., an attempt to soften the complaints of senators upset by the lack of vetting for the legislation that will impact one-sixth of the nation’s economy. That hearing was briefly delayed as police cleared the halls of protestors that clogged the hallway outside of the hearing room.

Also on Monday the Congressional Budget Office is expected to release its analysis of Graham-Cassidy, but one that won’t tell a complete picture. Because of the expedited time frame, the CBO will release its analysis on a previous version of the bill and they still are unable to determine the impact on insurance coverage, premiums and the deficit.

After working through the weekend to shore up votes, Graham and Cassidy released a new version Monday to appeal to a handful of holdouts. It includes additional money for Alaska, Maine, Arizona and Kentucky for the four biggest critics. In particular, it carves out special funding protections for Alaska to help the state reign in the high cost of health care and it loosens the regulations on insurance coverage to help conservatives come on board.

But one GOP opponent said Monday he is still unconvinced, delivering another blow to the prospects of the legislation. Sen. Rand Paul, R-Ky., has concerns with the bill, said his spokesman, Sergio Gor, who added that the new version doesn’t address the senator’s concerns despite allowing states to loosen insurance regulations and despite Kentucky receiving more health care dollars.

Vice President Mike Pence told a local NBC affiliate in Louisville, Ky. Monday that he’s “still hopeful” that Paul will vote for the measure.

Senator John McCain, R-Ariz., said on Friday that he can’t support the legislation, pointing to the process and not the contents of the legislation.

Republicans can only afford to lose the support of two GOP senators, and if Paul’s opposition holds, then it is highly unlikely the measure will pass the Senate.

Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, have yet to say how they’d vote. Collins said that she’s waiting until the CBO report is released before she makes a decision. And Murkowski has been analyzing the impact of the legislation on her rural state with a large Medicaid population.

An analysis of state-by-state health care funding shows that under Graham-Cassidy, Alaska would get 4 percent more funding than under current heath care levels to implement a health care system. It would still lose money, however, from an end to the Medicaid expansion. The state estimates that it would lose $100 million.

Other states with critical senators receive additional funds as well. Maine would see a 43 percent increase in federal health care funds, Arizona would get an additional 14 percent and Kentucky another four percent. But critics say even those numbers are misleading because the figures don’t account for the loss of money from ending the Medicaid expansion, something that applies to all three.

The Association of Health Insurance Plans and Blue Cross Blue Shield pre-released their testimony for the hearing stating that they can’t support Graham-Cassidy.

“The bill would have negative consequences on consumers and patients by further destabilizing the individual market; cutting Medicaid; pulling back on protections for pre-existing conditions; not ending taxes on health insurance premiums and benefits; and potentially allowing government-controlled, single payer health care to grow,” a summary of their testimony states.

Activists descended on Capitol Hill Monday to protest the measure. The line outside the hearing room began forming at 6:00 a.m. and stretched more than a city block. Protestors sat-in the office of Murkowski in protest. Her chief-of-staff came out to address the activists and said that she left Anchorage at 6 a.m. on Monday and is using her flight time back to D.C. “thinking about her decision.”

Marilee Adanski-Smith traveled to D.C. from Wisconsin on Saturday to attend the hearing. She was born without arms and legs and relies on Medicaid.

“We’re here to save Medicaid. Our lives depend on Medicaid,” the small business owner said. She’s fearful that the legislation will take away Medicaid recipients ability to live at home and force people into nursing homes.

“People are going to die in nursing homes if people don’t have the community and home based services they need,” she added.

Image: Marilee Adamski-Smith from Brookfield, Wisconsin, left, and Colleen Flanagan of Boston, center, join others outside a hearing room where the Senate Finance Committee will hold a hearing to consider the Graham-Cassidy healthcare proposal Image: Marilee Adamski-Smith from Brookfield, Wisconsin, left, and Colleen Flanagan of Boston, center, join others outside a hearing room where the Senate Finance Committee will hold a hearing to consider the Graham-Cassidy healthcare proposal

Marilee Adamski-Smith from Brookfield, Wisconsin, left, and Colleen Flanagan of Boston, center, join others outside a hearing room where the Senate Finance Committee will hold a hearing to consider the Graham-Cassidy healthcare proposal, on Capitol Hill in Washington on Sept. 25, 2017. Manuel Balce Ceneta / AP

It’s still unclear, however, whether the legislation will be brought to the floor for a vote this week before the deadline of Saturday when the legislation that allows it to pass with a simple majority expires. Because no Democrats are expected to vote for the bill, Republicans need 50 of their 52 members to vote for it.

In an attempt to appeal to conservatives, including Paul, Sens. Mike Lee, R-Utah, and Ted Cruz, R-Texas, the bill would loosen insurance regulations more than the previous version. While it says insurance companies must cover people with pre-existing conditions, it wouldn’t limit the cost. It would also make it easier for states to stop ensuring that older people aren’t charged more than younger people or that essential health benefits like maternity care and hospitalization are covered.

Lee’s spokesman Conn Carroll said Lee is still addressing technical changes to the bill in order for him to support it.

Graham-Cassidy would end the Medicaid expansion in 2020 and reduce the money given to Medicaid by changing how it’s allocated. It would no longer provide it for whoever is in need — instead, it would cap the number based on population.

The bill would also end the individual mandate to buy insurance and dismantle the structure of the Affordable Care Act, widely known as Obamacare. Instead, it would give money to states to implement their own health care systems. And while it would require that people with pre-existing conditions have access to health insurance, like Obamacare, it wouldn’t prohibit insurance companies from charging people with long-term health care needs more money.

The new version of Graham-Cassidy would also provide billions of dollars more for states during the transition from Obamacare and as a contingency fund.