The effort to repeal and replace Obamacare isn’t quite dead. It will officially expire on September 30 without any further congressional intervention. According to guidance handed down by the Senate parliamentarian just before Labor Day, the end of the federal fiscal year is when this year’s budget reconciliation bill—the Senate’s annual shot at passing significant legislation that can’t be filibustered—will die. If no health care bill passes before the end of the month, we can be certain that the Republican Congress will have failed to honor one of its chief promises.
As readers of this magazine will recall, numerous repeal efforts have already died—from “repeal-and-delay” to “repeal-and-replace” to the “skinny repeal.” But there is yet another effort to reform Obamacare on the table.
Sponsored by Republican senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, the plan would keep almost all of Obamacare’s taxes and spending but, starting in 2020, give the money back to the states in the form of block grants. As Graham says, if you like your Obamacare, you can keep your Obamacare. States could subsidize the purchase of health insurance just as current law does (though some states would have to kick in more money than they do now). Blue states could use the money to test single-payer plans if they wanted. Red states could spend it entirely on high-risk pools, subsidizing the sickest patients enough to effectively remove them from the individual market and bring down costs for everyone. “You’ve got to cover people who’ve been sick,” Graham tells us, “but there will be 50 different ways to do it.”
There are a few reasons to think that this last-ditch bill might pass. The biggest sign of hope came on September 6 when Arizona senator John McCain, who cast the deciding vote against the “skinny repeal” bill at the end of July, signaled his support for the Graham-Cassidy plan so long as there was enough time for a hearing, debate, and votes on amendments from both parties. Three weeks is not much time, but it is enough to debate a bill whose basic framework has been public for most of the year and which leaves the key decisions up to the states. It’s certainly better than the three hours the public was given to try to fathom the skinny option. Furthermore, Nevada Republican Dean Heller, one of the Senate moderates most skeptical of the earlier bills, is an enthusiastic supporter of Graham-Cassidy’s approach.
Liberals will complain that the funding formula is not generous enough and that by eliminating the individual mandate, the bill will destabilize insurance markets. But a state that likes the Obamacare model could pass its own individual mandate. It could try high-risk pools, auto-enrollment, or a temporary lockout period for people who choose to go without health insurance. Flexibility is the selling point of Graham-Cassidy.
Conservatives will argue that the bill does not provide enough relief from Obamacare’s burdensome requirements to cover people with preexisting conditions, and they have been right to identify those provisions as the main cause of Obamacare’s high costs. Graham and Cassidy argue that states’ ability to use the money on high-risk pools and other health care initiatives can effectively address that problem and that waivers from the secretary of Health and Human Services will help states create functional insurance markets with affordable plans that aren’t subject to many of Obamacare’s regulations.
Graham-Cassidy isn’t entirely to our taste. We have long advocated innovative free-market reforms like the plan backed in July by Ted Cruz and Mike Lee allowing insurers to be free from Obamacare’s regulations so long as they sold one Obamacare-compliant plan. This had promise for fixing the health care system nationwide. But it failed like every other option in the Senate—though Lee and Cruz are free to push for it as an amendment to Cassidy-Graham. At this point, the question for Republicans isn’t whether there is a better alternative to Graham-Cassidy, but whether this plan is an improvement on the status quo. Holding out past September 30 doesn’t create leverage for a better bill, it simply turns the bill to dust.
Two short years ago, in the wake of an undercover investigation that revealed America’s largest network of abortionists was selling the organs of aborted babies, a wide array of Republican senators—from Mike Lee to John McCain—argued that drastic measures were needed to defund Planned Parenthood. Fund Obamacare and everything else in government except Planned Parenthood, they argued. Shut down the government if necessary, they said. Graham-Cassidy defunds Planned Parenthood and redirects the money to community health centers. If the senators’ 2015 words meant anything, they will push for a vote on the bill before the end of September.
And as important as defunding Planned Parenthood is for pro-life Americans, an even greater priority is cutting off Obamacare’s funding for insurance plans that cover elective abortions. The Graham-Cassidy plan just so happens to funnel the block grants through an existing health-care law to which the Hyde amendment—a measure banning federal funding of elective abortions—is permanently attached. While Congress could pass language defunding Planned Parenthood in the next fiscal year’s tax-reform reconciliation bill, the Graham-Cassidy plan is the only realistic way to stop Obamacare’s funding of elective abortion.
There are, of course, many reasons to think the Graham-Cassidy plan will not pass: Time is running out, and as we went to press the two senators still hadn’t released the final text of the bill. Cassidy said they intend to send it off to the Congressional Budget Office for an official score no later than September 11. Even with the vote of McCain, Republicans’ 52-48 majority doesn’t leave much room for error. Majority Leader Mitch McConnell, having been burned over the failure in July, won’t lift a finger to pass it. “Senator McConnell has said get him 50 votes, and he’ll bring it to the floor,” reports Cassidy. “We feel good,” he says. “Never felt better about it,” concurs Graham.
No one else seems to think it will pass. But it absolutely should pass.
