Republicans in the Senate have just nine days left before a crucial deadline to pass their plan to repeal and replace the Affordable Care Act. Here are three key takeaways:
– GOP leaders still don’t have the votes to pass a bill sponsored by Sens. Lindsey Graham and Bill Cassidy.
– Those Republican leaders are doing everything they can behind closed doors to get those votes
– The next few days are likely to be quiet in terms of news and information. The Senate is out of session and lawmakers themselves are back home. Key vote Lisa Murkowski even told CNN how excited she was to get back to Alaska and go for a long bike ride in this, the “perfect time of year” for the state (FWIW, she defined “perfect time of year” as around 50 degrees and sunny).
McConnell’s ‘intention’ to vote:
Graham sent everyone scurrying Wednesday when he said explicitly the Senate would vote next week on the Graham-Cassidy bill. Graham isn’t the Senate’s majority leader, so it’s not really up to him.
Shortly thereafter Senate Majority Leader Mitch McConnell’s team released a statement saying it was his “intention” to vote next week. Those are two different things.
What it all means: McConnell is ready to green light this — he’s made that very clear. His floor and health care teams are fully engaged and he’s doing everything in his power to get this across the finish line.
BUT: CNN reports the Kentucky Republican is taking this day-by-day. There’s not going to be a scheduled vote until they have the votes or are on the cusp of having them. They aren’t there yet. An enormously public floor failure is not something anyone wants again.
At least for now.
Reminder: Next week is supposed to be the rollout of the GOP push on tax reform.
Today’s required reading:
– CNN’s Tami Luhby with a cold reality: literally zero health industry/advocacy groups support Graham-Cassidy
– CNN’s Lauren Fox on the most amazing thing Senators are saying out loud: the policy may be bad, but we promised we’d do this.
The real Kimmel effect:
Ask Republican aides about whether late-night TV host Jimmy Kimmel’s public war with Cassidy is going to have a major affect on this debate, and mostly you’ll get some iteration of “Bad PR problem for the senator, inconsequential to the bill itself.”
Or as one lobbyist put it more bluntly. “Oh Hollywood is against this? That means our guys should love it.”
This isn’t wrong — a lot of aides scoffed at this exchange Wednesday. Another texted Wednesday night during Kimmel’s monologue simply: “Rolling my damn eyes.”
But here’s where this is potentially problematic for Republicans:
1. The debate helps re-engage the base/grassroots/opposition groups that played such an important role in the bill’s first defeat.
2. Pre-existing conditions: This is potentially a sleeping giant issue in this bill. Remember when Senators made abundantly clear they would NOT do what the House did on pre-existing conditions. Simply wouldn’t. No chance. Not acceptable. Guess what? This bill has a similar, if perhaps more incentivized mechanism for states to waive price protections for those with pre-existing conditions. Kimmel is making that a key piece of his attacks. And it’s starting to come back to the forefront of the debate. That’s not good news for senators. One of the people who made clear the House bill went to far on pre-existing conditions? Murkowski.
On pre-existing conditions:
Cassidy and President Donald Trump say individuals with pre-existing conditions are guaranteed protection in this bill. Outside analysts, insurers, advocacy group say they aren’t. Who’s right? CNN has been explaining this for days, but here’s my take: The nuance here is important:
– Yes, the bill maintains the Obamacare ban on insurers denying someone a plan because of a pre-existing condition
– No, it doesn’t explicitly get rid of the price protections for those with pre-existing conditions (community rating)
Here’s what it does: The bill allows individual states to obtain waivers to drop the mandate for price protections. It incentivizes them to do so, actually. In exchange, a state must show it can provide “adequate and affordable” coverage to those with pre-existing conditions. Here’s the problem: “adequate and affordable” aren’t defined. The waiver process appears hardly rigorous on its face. Outside analysts say unequivocally this opens the door to a loosening of the regulations.
Why are they doing this: There’s a reason, politically toxic as it is, this keeps coming up — Republicans say the mandates, this one in particular, are responsible for premium increases on younger and healthier individuals and that’s not fair. Republicans also say states, either via risk pools or other mechanisms, will have alternative methods to address price and coverage issues for those with pre-existing conditions — the same argument made in the House. Here’s a problem with that: the costs are very high. And this bill reduces health care spending.
Bottom line: Graham-Cassidy puts an end to the guarantee that those with pre-existing conditions won’t face price increases because of their health problems.