By David Thornton
The Senate, where the previous attempt to rein in Obamacare died, may vote on the last-gasp effort by the end of September.
As explained previously in The Resurgent, Republicans cannot fully repeal Obamacare without 60 votes. The previous attempt at reforming Obamacare fell apart over details of how the law’s subsidies should be treated and how to handle medical care for the uninsured. Moderate Republican support for the ACA’s expansion of Medicaid also caused serious problems in crafting a replacement bill.
The new bill, written by Senators Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), is much more modest than the failed American Healthcare Act. The proposal doesn’t completely repeal Obamacare, but does replace Obamacare’s tax subsidies with state block grants, repeals the individual mandate and scales back the Medicaid expansion.
“It’s basically federalism where you just block grant the whole thing,” Speaker Paul Ryan (R-Wisc.) told the Washington Examiner. “You block grant Obamacare back to the states. Just the whole thing.”
Majority Leader Mitch McConnell (R-Ky.) has indicated that he will bring the bill to the floor for a vote if at least 50 of the 52 Republican senators support it. At the moment, the bill is short of that mark, but Politico reports that it is gaining steam after Graham publicly lobbied President Trump and others. Estimates put Republican support for the bill at 48 or 49 senators.
The bill appears to be on a fast-track. The Washington Post reports that Republicans have already submitted it to the Congressional Budget Office for analysis. If the bill is not passed before the end of September, the Post notes that the authority to pass the legislation with a simple majority under budget reconciliation rules would expire. This would effectively kill any attempts to reform Obamacare until next year.
If the bill does pass the Senate, it faces an uncertain future in the House of Representatives. The previous bill, which originated in the House, had to be finely tuned to pass by a slim majority. Under budget reconciliation rules, the House would have to pass the Graham-Cassidy bill with no changes.
No Democrats are expected to support the bill. Sen. Elizabeth Warren (D-Mass.) tweeted, “The Graham-Cassidy @SenateGOP ‘health care’ bill IS Trumpcare, & it will rip health care away from millions of Americans.”
As with the previous Obamacare reform bill, opposition to the bill is expected to come from the right as well as the left. Senator Rand Paul (R-Ky.) has announced that he will oppose the bill, calling it “Obamacare lite.” If Paul stands firm, the defection of any other Republican will doom the bill.
Paul’s stance against “Obamacare lite” begs the question of whether he and the Freedom Caucus would prefer the full version of Obamacare to an imperfect Republican reform bill. For the foreseeable future, those are the only two options.