Tuesday, September 19, 2017

UPDATE on Senate's ACA death threat: How will AZ Sen. John McCain vote?

In my earlier post today I noted that AZ Gov. Ducey has now said he will support the latest attempt in the U. S. Senate to repeal and replace the ACA (“Obamacare”) - and that might be a tipping point in the vote count because Sen. John McCain has signaled that his vote would be influenced by what Ducey supports. Here are two more looks at the threat to ACA in the Senate.

AZBlueMeanie at Blog for Arizona hits the panic button over the Cassidy-Graham bill - which is the latest version of Trumpcare that would throw millions off of health insurance: (Update) Action Alert: you have until September 30 to kill this zombie ‘Trumpcare’ bill.

Yesterday I posted an Action Alert: you have until September 30 to kill this zombie ‘Trumpcare’ bill.

Steve Benen doubles down on this action alert today. Senate Dems issue a ‘red alert’ on Republican repeal efforts:

Senate Minority Leader Chuck Schumer (D-N.Y.) issued a “red alert” to health care advocates late Friday, and we’ve seen similar sentiments from Sens. Cory Booker (D-N.J.), Elizabeth Warren (D-Mass.), Kirsten Gillibrand‏ (D-N.Y.), and Al Franken (D-Minn.). Sen. Chris Murphy (D-Conn.) told health care proponents, “Drop what you are doing to start calling, start showing up, start descending on DC.” Sen. Bernie Sanders (I-Vt.) has been focused on his single-payer proposal, but he added yesterday, “Our immediate concern is to beat back yet another disastrous Republican proposal to throw millions of people off health insurance.”

Among opinion leaders, progressive voices like the Washington Post’s E.J. Dionne and the New York Times’ Paul Krugman both devoted their columns today to warning the public that the threat to the existing health care system is quite real.

See the Blue Meanie’s post for the citations and lots more.

McCain after his"no" vote on skinny repeal.
But what will he do this time?

FiveThirtyEight.com, in this morning’s Significant Digits email, runs the numbers and concludes that Republicans Really Could Repeal Obamacare This Time.

But then they add: Of course, that’s been true every time.

Republicans are only a handful of votes short in the party’s latest attempt to repeal the Affordable Care Act. And one of the key “no” votes from July, Sen. John McCain of Arizona, could flip to “yes,” since Arizona Gov. Doug Ducey has endorsed this latest repeal legislation. (McCain has suggested he would be more likely to vote for a Ducey-backed bill.)

But there are not yet 50 Republicans publicly backing the newest Obamacare repeal bill, known as Graham-Cassidy. And the GOP has always been a handful of votes short. Those final few votes are the hardest, and it’s not clear Republicans can get them before Sept. 30, the day of an important deadline that will limit GOP options to repeal Obamacare afterward.

What’s surprising about the potential passage of this legislation is that it is in some ways more conservative than the bill that almost passed in July. Written by Sens. Bill Cassidy (Louisiana), Lindsey Graham (South Carolina), Dean Heller (Nevada) and Ron Johnson (Wisconsin), the legislation — unlike previous Obamacare repeal proposals — gives a lot of power to states to set their own health care policies. Before we get to how likely it is to pass, here are some of its policy highlights (I borrowed from analyses from the website Health Affairs by Washington and Lee University’s Timothy Jost and George Washington University’s Sara Rosenbaum):

  • Obamacare’s tax revenue — instead of paying for subsidies and tax credits to individuals and extra Medicaid funding — would go toward block grants for each state.
  • The total amount of money going to states will likely be less than if Obamacare stayed in place, according to an analysis by the left-leaning Center on Budget and Policy Priorities.
  • In effect, this legislation would take the money that goes to the 31 states that expanded Medicaid under Obamacare and spread it to 50.1 So California would likely end up with tens of billions of dollars less, but Texas (which did not expand Medicaid) much more.
  • A state could require everyone to have health insurance and subsidize private insurance targeted at low-income people, like Obamacare. But a conservative state could create a system with few regulations, even allowing insurance companies to set higher prices for people with pre-existing conditions. (Graham-Cassidy only explicitly bars setting higher rates based on gender or race.)
  • There would be a cap on national spending on Medicaid outside of Obamacare, likely leading to the kind of cuts to the program that were estimated under previous GOP efforts at Obamacare repeal.

Here’s 538’s tally of Senate Republicans. 41 certain to vote for it, five likely to vote for it, one certain to vote no, one likely to vote no, and four wild cards. McCain is one of those wild cards.

What could switch McCain to a “yes”? Graham and McCain are extremely close friends, perhaps the tightest relationship of any two members of the Senate. I have some doubt that McCain would vote down a bill that Graham has advocated so strongly for. And the Ducey endorsement of this legislation could also move the Arizona senator towards supporting it.

So, yes, the Republicans are close to having the votes to repeal Obamacare. But, as Politico’s Jennifer Haberkorn wrote recently, “Any Obamacare repeal bill has 45–46–47 votes in the Senate. The issue for the GOP has always been the last few to get to 50.”

By the time this legislation gets a CBO score (which is likely to predict that it would leave millions of additional people uninsured), Democrats and activists whip up opposition to it, and the press writes a bunch of stories about who will not be covered under its provisions — three things that have happened each time Republicans have neared Obamacare repeal this year — a “yes” vote will be harder for wavering GOP senators than it seems today.

Also, this bill — even if it passes the Senate — must still be approved by the House. So Republicans seem close to repealing Obamacare. But that’s what everyone has been saying for months. Will they finally do it? Stay tuned.

It bears repeating. America’s health care system is in the balance. Our own Sen. John McCain could be the deciding factor by voting along with his BFF Lindsey Graham for the arguably worst repeal/replace bill yet. Should he do so his action - against his own self-declared “regular order” principles - would be the worst vote of his career. Call him and tell him.

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