On Wednesday, a group of four Republican senators—South Carolina’s Lindsey Graham, Louisiana’s Bill Cassidy, Nevada’s Dean Heller, and Wisconsin’s Ron Johnson—revealed the text of their 140-page health-care reform bill.
“The idea that the Republican party has done its best to repeal and replace Obamacare is a joke,” Graham said at Tuesday’s Capitol Hill press conference. “If you believe repealing Obamacare is a good idea, this is your best and only chance to make it happen because everything else has failed.”
Known as Graham-Cassidy, the bill would repeal the employer and individual mandates but keep most of Obamacare’s spending and taxes and send that money back to the states in the form of block grants. Yuval Levin, editor of National Affairs and a leading health-care expert, said that the bill looked like the “most coherent” GOP health-care plan considered this year.
“I think it’s probably the most coherent of the proposals Republicans have looked at this year,” Levin told THE WEEKLY STANDARD in an email. “It does much less than some—keeping essentially all of Obamacare’s spending and taxes, for instance—but it does one big thing: it moves the bulk of the resources and a fair bit of the power of regulation to the hands of the states. That’s not a solution to Obamacare’s problems, but it is an improvement over the status quo. Combined with significant Medicaid reforms it makes for a bill that on net is worth voting for.”
The bill would require states to submit an application explaining how they would “maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions.” But the bill would allow states to obtain waivers exempting them from many of Obamacare’s regulations. The state waivers would allow insurers to “vary premium rates for health insurance coverage” but not “based on an individual’s sex or membership in a protected class under the Constitution of the United States.” Utah senator Mike Lee and other conservatives have (correctly) pointed to Obamacare’s regulations related to pre-existing conditions as the main reason why health insurance premiums have risen so dramatically under Obamacare. A Lee spokesman called the waiver language encouraging, but the Utah senator is still reading the bill and deciding whether or not to support it.
As an editorial in this week’s issue of TWS points out, there’s also a strong pro-life case for the bill:
Not all states would get the same amount of money as they would under Obamacare: States like California and New York would get less, but states like Virginia, Indiana, and Missouri would get more, Cassidy said. Graham and Cassidy argued the formula would fix existing inequities in Obamacare. “Four states under Obamacare get 40 percent of the money: New York, California, Massachusetts, and Maryland,” Graham said, but those four states make up about 20 percent of the U.S. population.
States would then be free to spend the money on a variety of health-care programs, including single-payer plans, plans that function just like Obamacare, plans that focus dollars on high-risk individuals, and plans that automatically provide the uninsured with catastrophic insurance. “Some will figure it out better than others, and those who do badly will copy those who do well,” Graham said.
The complex funding formula for Graham-Cassidy’s block grants is largely based on each state’s percentage of the population that is below the federal poverty line or just above it (specifically, those earning 50 percent to 138 percent of the federal-poverty line). The block grants would also be risk-adjusted to give more aid to states with older and sicker residents.
It’s unclear whether or not the bill will even get a vote on the Senate floor. The Senate parliamentarian has ruled that this fiscal year’s reconciliation bill—the Senate’s annual shot at passing legislation that can’t be filibustered—will expire by September 30. In order to even have a bill considered under reconciliation rules, it must get an official score from the Congressional Budget Office, and it could take CBO some time to perform a state-by-state analysis. “We’ve had the thing at CBO for about a week, I’m asking Mitch [McConnell] to help me get a score from CBO,” Graham said Tuesday. According to a Senate aide, Republican leadership has privately made it clear the bill is a top priority.
Graham said McConnell told him “go get 50 votes” and “we’ll bring it up.” But Graham said the Senate leadership and the president need to fully throw their weight behind the bill in order for it to pass. “I’ve been involved in a lot of things in the last 20 years,” Graham said. “This is the most important thing I believe I’ll ever be involved in as a member of the United States Senate.” The bill was greeted by a positive but less-than-enthusiastic statement from the president later that day.
“I applaud the Senate for continuing to work toward a solution to relieve the disastrous Obamacare burden on the American people,” Trump said in a statement. “As I have continued to say, inaction is not an option, and I sincerely hope that Senators Graham and Cassidy have found a way to address the Obamacare crisis.”
