WASHINGTON — Time growing short, President Donald Trump and Republican Senate leaders dove into a frantic hunt for votes Tuesday in a last-ditch effort to repeal and replace “Obamacare.” The pressure was intense, the outcome uncertain in a Capitol newly engulfed in drama over health care.
Senate Majority Leader Mitch McConnell, whose failure to pass an Obamacare repeal bill in July opened a bitter public rift with Trump, pressed hard for the newly revived effort, which had been left for dead as recently as a week or two ago. But in a sign he remained short of votes, McConnell refused to commit to bringing the legislation to the floor.
As in July, much of the focus was on Arizona Sen. John McCain. Would he step back in line with fellow Republicans now that there was a bill co-written by Lindsey Graham of South Carolina, his best friend in the Senate? McCain wasn’t saying. Lisa Murkowski of Alaska, another crucial vote, wasn’t disclosing her views either.
But a bipartisan group of governors, including Nevada Governor Brian Sandoval, sent a letter to Senate leaders on Tuesday expressing their opposition to the proposed Graham-Cassidy health care repeal plan.
Joining Sandoval in signing the letter were Governors John Hickenlooper (D) of Colorado, John Kasich (R) of Ohio, Bill Walker (I) of Alaska, Tom Wolf (D) of Pennsylvania, Steve Bullock (D) of Montana, Terry McAuliffe (D) of Virginia, John Bel Edwards (D) of Louisiana, Phil Scott (R) of Vermont, and Charlie Baker (R) of Massachusetts.
“We have spent in the state of Nevada,” said Senator Dean Heller, a sponsor of the Cassidy-Graham bill. “Paid the federal government over $18 million by individuals. About 80,000 of them, because they can’t afford the product that the government tells them they have to buy. Under this proposal, our proposal, Nevada actually receives more funding than we currently do under Obamacare. It returns power to the states, provides ultimate flexibility to governors and legislatures, regardless of whether they expanded Medicaid or not,” said Senator Heller.
Last month, Sandoval announced that silver summit will cover the health exchange in 14 Nevada counties, including Carson, keeping 8,000 people from losing coverage.
“Unfortunately, we found one carrier, which means there’s no competition and there are no choices, and you know that that’s only going to increase costs in those 14 of 17 counties,” said Heller.
“This is the way forward. This is how we’re going to move, not only health care forward but America forward, our economy forward by having a health care plan that works for everyone,” said Heller about the Cassidy-Graham bill.
Sandoval issued the following statement on the Graham-Cassidy-Heller amendment.
“I know that Senator Heller is working in the best interest of the state and I appreciate the intended flexibility created in the Graham-Cassidy-Heller amendment which would distribute healthcare funding via block grants. State experts will continue to work with our federal partners, specifically with Senator Heller’s office, on ideas to improve Nevada’s healthcare market. I continue to believe the framework authored by bipartisan Governors is the best path to improve our healthcare system but will continue to work with Senator Heller on healthcare solutions for the state of Nevada.”
Republicans must act by Sept. 30 in the Senate, or face the prospect of a Democratic filibuster. That blocking action is currently staved off by budget rules that will expire at the end of the fiscal year. The new legislation, by Graham and Sen. Bill Cassidy of Louisiana, would undo the central pillars of former President Barack Obama’s health care law, and replace them with block grants to the states so they could make their own health care coverage rules.
“Governors and state legislators of both parties would have both the opportunity and the responsibility to help make quality and affordable health care available to their citizens in a way that works for their own particular states,” McConnell said on the Senate floor. “It’s an intriguing idea and one that has a great deal of support.”
Democrats are unanimously opposed, arguing that the legislation would result in millions of Americans losing their health insurance, decrease access to affordable care and damage the Medicaid health program for the poor.
So McConnell must win the votes of 50 of the 52 Senate Republicans. That would amount to victory in the 100-member Senate, because GOP Vice President Mike Pence would then break a tie.
Pence appeared at the Capitol Tuesday and declared the Trump administration was “all-in” on the effort. The president himself was closely in touch with Graham and others.
If the bill does pass, Speaker Paul Ryan has committed to pushing it through the House as-is, and straight to the president’s desk, according to Graham. After seven years of promises to get rid of “Obamacare,” Republicans would have finally succeeded. It would be a promise kept to the GOP base, yet one with uncertain and potentially devastating political consequences for the Republican Party given that millions of people would be likely to lose their health coverage and others might have skimpier care.
The bill would let states set their own coverage requirements, allow insurers to boost prices on people with serious medical conditions, end Obama’s mandates that most Americans buy insurance and that companies offer coverage to workers, and cut and reshape Medicaid.
The bill’s full impacts are difficult to predict since the Congressional Budget Office has not had time to assess it. But senators plan to move forward without a complete CBO “score,” heightening outrage from Democrats.
By Tuesday evening the legislation remained at least one or two votes short.
The situation is nearly identical to where Republicans found themselves back in July when McConnell made one last attempt to pass a stripped-down repeal bill. It failed in a tense late-night session, with McCain, newly diagnosed with brain cancer, casting the decisive “no” vote.
McCain finds himself once again at the center of the drama this time around. But now there’s a twist: His best friend in the Senate, Graham, is an author of the bill.
McCain has been more more than willing to buck his party’s leadership over the years, and to defy Trump. Undercutting Graham might be a different issue, and McCain brusquely refused to tip his hand Tuesday.
“I don’t have anything to say,” McCain said repeatedly and snapped at a reporter who pressed for more. “I have nothing to say, do you hear me?”
Graham made clear he was arguing the case forcefully to his longtime friend, with whom he’s partnered on any number of policy initiatives over the years and rarely parted ways. A hearing on the legislation was scheduled for next week after McCain had complained there weren’t any.
“I’m not speaking for Sen McCain. I know he likes federalism, I know he wants bipartisanship, but I just don’t personally see a bipartisan proposal that’s got a snowball’s chance in hell of doing anything other than propping up Obamacare,” Graham said. “It’s either this or a march toward Bernie-care,” a reference to Sen. Bernie Sanders’ Medicare-for-all bill.
GOP Sen. Rand Paul of Kentucky has announced his opposition to the legislation, saying it doesn’t go far enough in repealing “Obamacare,” while moderate GOP Sen. Susan Collins of Maine, who opposed earlier repeal bills, also sounded like a “no” Tuesday. She said the Graham-Cassidy bill could be worse than earlier versions because of potential harm to people with pre-existing conditions.
In addition to McCain, the focus was on moderate Murkowski, who was the third “no” vote on the earlier bill along with Collins and McCain.
Murkowski kept a low profile Tuesday but in what could be a significant factor for her, Alaska’s independent governor, Bill Walker, joined a bipartisan letter with other governors in opposition to the bill, asking senators to instead focus on bipartisan approaches. A pair of potent interest groups, the American Medical Association and AARP, also declared their opposition.
But the prospect for any kind of bipartisanship appeared to die out altogether as GOP Sen. Lamar Alexander announced he had not found consensus in his attempt for a limited fix for existing health marketplaces; his Democratic partner Sen. Patty Murray accused GOP leadership of freezing their effort.