WASHINGTON — With less than two weeks to go before a key deadline, Senate Republicans are again ramping up efforts to repeal and replace an Obama-era health care law.
After the dramatic early morning defeat of a proposal to repeal the Affordable Care Act in July, the trademark GOP initiative has been on the back burner.
But momentum began to swell around a renewed effort last week when a group of conservative senators, led by Bill Cassidy, R-La., and Lindsey Graham, R-N.C., unveiled a new proposal and called on President Donald Trump and Senate party leaders to back them up.
Senate Republicans leading the latest proposal paint the debate as a choice between their proposal, which would attempt to give more decision-making power to states, versus a “Medicare-for-all” universal health care model, spearheaded by Sen. Bernie Sanders, I-Vt.
Sanders and other top Vermont officials have already voiced strong opposition to the latest Republican proposal.
Republicans have an 11-day window to pass the health care bill on a simple majority because of a procedural deadline. After Sept. 30, the bill would need 60 votes to pass — a virtual impossibility in the chamber where Republicans hold a 52-seat majority.
Still, whether Senate Republicans will be able to drum up support within their own party to get the 50 votes they need to pass the bill by the end of the month remains to be seen. In July, the repeal effort was derailed when three GOP members voted to oppose.
The bill would scrap key parts of the Affordable Care Act, including the individual insurance mandate. The proposal would eliminate subsidies for private insurance and would abolish the expansion of the Medicaid program that many states opted into under the Obama-era law.
Under the proposed system, states would receive funds from the federal government in a lump sum grant, which they could then direct at their discretion to health care-related purposes.
The formula would result in a decrease in funding for some states, particularly those that expanded Medicaid, including Vermont.
According to estimates from Cassidy’s office, Vermont is projected to see a decrease of nearly $2 million in the federal block grant over the first six years the program is implemented. Vermont would get about $334.8 million in 2020, which would decrease to $333 million in 2026.
California would lose $2 billion over that time period, and Massachusetts would see a $5 billion reduction. Meanwhile, some states will see the amount they receive from the federal government grow considerably. Wyoming’s block grant, for example, would double from 2020 to 2026.
A full independent analysis of the bill is not yet available, and may not be before the Republicans’ Sept. 30 deadline. The Congressional Budget Office announced Monday that they aimed to produce a partial analysis of bill by next week, but would not be able to provide information about the impacts the proposal would have on the deficit, rates of health care coverage, or premium costs for “at least several weeks.”
Cassidy, Graham and other backers say the proposal will give states more control over health care.
As lawmakers returned to Congress Monday, interest in moving forward with the proposal seemed to be on the rise. The chair of the Senate Finance Committee announced that the panel would hold a hearing on the bill next week, signaling that the majority is taking the bill seriously. Republican leaders also announced Tuesday that an attempt to find a bipartisan agreement to stabilize Obamacare insurance markets had collapsed.
However, the GOP can afford to lose only two votes — and even as party leaders threw their full weight behind the new proposal, it is not yet clear where a handful of key senators will come down.
Senate Republicans have made a target of the single-payer system proposal that Sanders unveiled last week as they lobby for the Graham-Cassidy model. Graham, touting the merits of the bill at the caucus’ weekly press conference, painted a stark dichotomy between his proposal — which would, he said, increase state-level control — and the left’s vision for universal health care.
“So here’s the choice for America: socialism or federalism, when it comes to your health care,” he said.
Later, Graham said to reporters that the timing of the release of Sanders’ proposal on the same day he introduced his Obamacare repeal bill was “a gift from the political gods.”
Asked if it helped with selling his bill, Graham responded, “totally.”
After making the rounds last week to champion his proposal, Sanders this week has focused on urging defeat of the Graham/Cassidy proposal.
Sanders addressed a cheering crowd of demonstrators on the Capitol lawn Tuesday midday. “Thousands of people a year will die if that legislation becomes law, “ Sanders said, “and I have a hard time understanding how any member of the Senate could vote for legislation which takes insurance and support away from disabled children who are now on the Medicaid program.”
Republicans have until Oct. 1 to pass their new Obamacare repeal. We cannot let them destroy our health care. We need to fight back.
— Bernie Sanders (@SenSanders) September 18, 2017
Sen. Patrick Leahy, D-Vt., has also come down against the GOP-led proposal.
“It basically is step one in doing away with Medicaid,” Leahy said as he made his way to the Senate floor Tuesday afternoon.
The Republican proposal would add considerable expense to states like Vermont and decrease the number of people covered by health insurance, he said.
“What’s not to like?” Leahy said, joking, before adding, “I certainly am not going to support it.”
Back in Vermont, as state officials attempted to grasp the implications of the proposal, Gov. Phil Scott once again broke ranks with members of his party in Congress.
Scott was one of 10 governors from both parties to sign a letter asking Senate leaders not to take up the latest amendment and instead focus on negotiations to improve the current health care law.
“Only open, bipartisan approaches can achieve true, lasting reforms,” they wrote.
Democratic leaders touted the letter at their press conference Tuesday to demonstrate bipartisan opposition to the latest repeal effort.
On Monday, officials in Vermont were trying to understand how the proposal would impact the state’s health care system.
“We’re still working through this and figuring out what the impact would be,” Vermont Director of Health Care Reform Mary Kate Mohlman said.
Changing to the block grant system outlined in the bill would be a “very significant shift” from the current system, Mohlman said. Officials are trying to understand how the Graham-Cassidy bill would impact changes the state already has in the works, such as the shift to the all-payer model.
“I think the fundamental bottom line is, there’s a lot of questions around this,” Mohlman said.