WASHINGTON ― The renewed push to pass a health care overhaul in the Senate is running into the same old problem Republicans have faced all along: They don’t have the votes, and if they can’t win over Sen. Lisa Murkowski (R-Alaska), their repeal effort looks doomed.
Even as Republicans projected optimism on Tuesday, there were signs their confidence might be less than genuine. When Senate Majority Leader Mitch McConnell (R-Ky.) was asked if he would commit to bring to the floor this latest bill ― which would hand over federal dollars to the states to manage health care ― McConnell said lawmakers were in the process of discussing that.
Republicans are trying to use the budget reconciliation process to move this legislation, meaning they need only 51 votes in the Senate ― and that includes Vice President Mike Pence’s yes vote to break a tie. But the fiscal 2017 budget resolution allowing them to use this process expires at the end of fiscal 2017.
“If we were going to go forward, we’d have to act before Sept. 30th,” McConnell said.
If Democrats and some Republicans were able to run out the clock on this latest proposal, however, GOP leadership could still come back with another health care budget resolution on which to hang another attempt to repeal Obamacare through the reconciliation process. In other words, even if the bill authored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) dies, it can come back to life again, like just about every other GOP health care plan.
For now, Republicans are using the Sept. 30 deadline to try to pressure their colleagues into voting for the Graham-Cassidy legislation before it has received a hearing, a markup or a full assessment from the Congressional Budget Office. Those procedural problems have been significant enough for Sen. John McCain (R-Ariz.) to suggest he’d vote no on the proposal, although his position could change if Republican leaders were able to win over Murkowski.
With Sens. Rand Paul (R-Ky.) and Susan Collins (R-Maine) looking largely unpersuadable, McConnell can’t afford to lose Murkowski. And if he can’t convince her to vote yes, there’s no point pressuring McCain.
All along, GOP leaders have figured that Paul and Collins would be the two Republican senators to vote against a health care proposal ― Collins because it went too far in repealing Obamacare, Paul because it didn’t go far enough.
But with Murkowski, the idea has always been to buy her off somehow. Health care is expensive in Alaska under Obamacare, and her state receives a disproportionate amount of assistance per capita under the Affordable Care Act. Relying so heavily on the law now, Alaska has more to lose from its repeal.
Knowing that, Graham and Cassidy have said they structured their bill to make sure Alaska is OK. “Alaska is about a third the size of the country with 750,000 people,” Graham said Tuesday. “It is a bedeviling problem.”
But just how much they have spared Alaska is a matter of interpretation.
Over the next 10 years, the Graham-Cassidy bill would reduce federal spending by less than some past Republican repeal bills would have. But states like Alaska would still end up losing money, relative to current law, according to an analysis by the Center on Budget and Policy Priorities.
Past 2026, things get worse. At that point, the new block grants to the states would expire, so there’d be no money at all unless Congress decided to fund the program anew. That’s dramatically harsher than any other GOP proposal to date, and it’s clear that states like Alaska ― where 25 percent of the population is on Medicaid ― would suffer severe coverage losses.
Murkowski, for her part, continues to be evasive about where she stands. On Tuesday, she came up behind a group of reporters in the Capitol and said, “Guess what? I don’t have any news!”
She insisted she’s “still looking” at the bill, although Alaska Gov. Bill Walker (I) on Tuesday signed on to a letter with nine other governors opposing the legislation.
Murkowski said she understands that the bill would give states more flexibility. She also noted that the governor had told her, “If I get half as much money, flexibility doesn’t help me.”
Graham’s claim is that almost every state, including Alaska, would make out under his bill. He acknowledges that some “big blue states,” like California and New York, would be hit with huge cuts. “I’m not out to hurt them,” Graham said Tuesday. “But I’m trying to make ― you know, create parity here.”
But even that line isn’t true. Plenty of states ― red ones, even ― would suffer cuts as a result of Graham-Cassidy, even in the first 10 years. And every state would face a substantial Medicaid reduction after that first decade.
That seems to matter very little to most Republican lawmakers. GOP senators and representatives have repeatedly promised to repeal Obamacare, and for many, fulfilling that promise appears to be more important than replacing it with a health care system that works.
When Graham was asked about his past statements that he wouldn’t vote for any new money to stabilize Obamacare ― “no matter what the impact,” as one reporter put it, mentioning rising premiums and people losing insurance ― the senator stood by his hard line.
“I’m speaking English, right?” Graham said. “I’m not going to throw another penny at a system that will never work. Why would I? Why would you continue to do what I think is insane?”
Jeffrey Young and Jonathan Cohn contributed reporting.