Epic Monster Battle

Sigh. You know, I was all over this 12 days ago.

Cassidy/Graham is the worst bill yet. It drops Federal funding sooner, removes more protections for pre-existing conditions (basically the moment you’re diagnosed your insurance premium gets jacked to bankruptcy), more Millions lose coverage, it explicitly steals money from Blue States to give to Red ones, Planned Parenthood is cut, etc. etc..

It’s just horrible.

Republicans Demand Another Vote to Repeal the Affordable Care Act
By ROBERT PEAR, The New York Times
SEPT. 18, 2017

Just when the effort to repeal the Affordable Care Act appeared to be dead, a last-ditch push to obliterate the law could be nearing a showdown vote in the Senate, and a handful of Republicans insist they are closing in on the votes.

The leaders of the latest repeal effort, Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, say their drive is gaining momentum. But it is still a long shot. Under their bill, millions could lose coverage, Medicaid would see the same magnitude of cuts that earlier repeal bills extracted, and insurers in some states could charge higher premiums to people with pre-existing conditions.

Already, Senator Rand Paul, Republican of Kentucky, has said he will not vote for the measure because it leaves too much of the Affordable Care Act in place.

And Senator John McCain, Republican of Arizona, who cast the deciding vote that killed the repeal effort in July, expressed misgivings that the Senate would try again to pass a bill that had not been examined by committees with expertise — and with no Democratic support.

“Why did Obamacare fail? Obamacare was rammed through with Democrats’ votes only,” he said on CBS’s “Face the Nation” on Sunday. “That’s not the way to do it. We’ve got to go back. If I could just say again, the way to do this is have a bill, put it through committee.”

Senators Susan Collins of Maine and Lisa Murkowski of Alaska, Republicans who steadfastly opposed previous repeal efforts, have not said where they stand. But the new bill holds the same provisions that they opposed this summer: deep cuts to Medicaid and a temporary elimination of federal funding to Planned Parenthood.

The Graham-Cassidy bill has two major elements, one that is new and one that was found in many other Republican repeal bills this year.

The new element is a block grant. Mr. Graham and Mr. Cassidy would give each state a fixed amount of federal money for health care and health insurance each year from 2020 to 2026. The allotments total $1.2 trillion over the seven years. That is slightly less than what the federal government is expected to spend under the Affordable Care Act on the expansion of Medicaid, on premium tax credits and on subsidies to reimburse insurers for reducing the out-of-pocket costs of low-income consumers.

States would have sweeping new discretion over how to use the money, and they could receive federal block grant funds without putting up state money.

In addition, the Graham-Cassidy bill would make deep cuts in Medicaid. It would end the expansion of eligibility under the Affordable Care Act, which has extended coverage to 13 million people. And it would put the entire program, which serves more than 70 million people, on a budget, ending the open-ended entitlement that now exists. States would receive a per-beneficiary allotment of federal money.

The Congressional Budget Office has estimated that 15 million fewer people would have Medicaid as a result of similar proposals in other Republican bills. It is not clear when the budget office will issue a report on the Graham-Cassidy bill, showing its effects on federal spending and the number of people without insurance.

Mr. Graham and Mr. Cassidy would distribute federal block grant funds to the states using a complex formula that, like any such formula, creates winners and losers. It is difficult for any state to be sure how much it would receive. The authors of the bill say they intend to reduce expected federal payments to high-cost states like Massachusetts and increase federal payments to states that have not expanded Medicaid.

With the proposed block grant, Mr. Cassidy said, “we equalize how much each American receives toward her care, irrespective of where she lives.” By 2026, the per-beneficiary amount for each state would be within 10 percent of the national average.

Mr. Graham and Mr. Cassidy boast that their bill would also enhance the ability of states to waive “Obamacare regulations.” Insurers would still have to offer insurance to anyone who applied, but states could obtain federal waivers allowing insurers to charge higher premiums to sick people or to omit some of the benefits they are now required to provide, like maternity care, mental health care or treatment for drug addiction.

Coverage, while theoretically available, could become unaffordable for some people with costly conditions like cancer or AIDS, health policy experts say. “Less-healthy people would face extremely high premiums” in states that obtained waivers involving both benefits and premiums, the Congressional Budget Office said in analyzing a similar provision of the bill passed by the House.

Mr. Cassidy played down that concern. Under the Graham-Cassidy bill, he noted, a state seeking a waiver would have to describe how it intends to “maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions.”

But critics have taken notice. Sixteen groups representing patients and heath care providers came out Monday in opposition to the bill. Among those who issued a joint statement opposing it were the American Heart Association, the American Diabetes Association, the March of Dimes and the lobbying arm of the American Cancer Society.

“Much of the proposal just repackages the problematic provisions of the Better Care Reconciliation Act,” which the Senate rejected in July, the groups said.

Aides to Senator Collins said she was concerned about cuts to Medicaid and protections for people with pre-existing conditions under the Graham-Cassidy bill.

The Cassidy-Graham bill would eliminate the requirement for most Americans to have health insurance and for larger employers to offer it to employees. Like prior Republicans bills, it would also cut off federal funds for Planned Parenthood for a year.

Now Rand Paul doesn’t like it because it’s not quite horrible enough, bless his pointy little head. John McCain is harumphing “Regular Order!” and Collins and Murkowski have not been heard from yet.

Old Yertle the Turtle McConnell will only bring the bill to the floor of the Senate if he has 50 votes in the bag. There’s a meeting tomorrow to test the waters.

Senate GOP tries one last time to repeal Obamacare

Some Republicans believe that if the bill were put on the floor Monday, it would have the support of 49 senators.

“All we need is one more,” Sen. Pat Roberts (R-Kan.) said of the repeal effort, which failed in July after GOP Sens. John McCain of Arizona, Susan Collins of Maine and Lisa Murkowski of Alaska voted no on a slimmed-down repeal bill.

Graham and Cassidy’s bill amounts to a new approach and was introduced just last week, but Senate Republicans have already sent it to the Congressional Budget Office for analysis and have demanded the agency expedite the score, a Republican aide said. The Senate is in session only three days this week, so any Obamacare repeal vote would occur the last week of September, giving the CBO another week or so to evaluate the proposal. A bipartisan fiscal funding deal passed earlier than usual this month, leaving the Senate GOP with an opening at the end of a month usually filled with brinkmanship.

McConnell is expected to discuss the matter with his leadership team on Monday, then weigh support for the bill with his full caucus on Tuesday. At lunch last Thursday, most of the caucus pushed for another try on health care, and McConnell was favorably inclined, as long as it won’t fail again.

“McConnell is behind it,” Graham said in an interview late last week. Republicans are “not going to tolerate us just sitting around saying we did the best we could. One and done is not going to do it.”

It’s an incredibly steep task. Sen. Rand Paul (R-Ky.) said he is a “no,” panning the bill as “Obamacare lite.” And Republicans believe Collins also won’t vote for it, though she has not made a final decision. Graham-Cassidy backers can’t afford to lose another vote.

McCain has been cautiously open to the approach, but some more conservative senators could scuttle it since the bill keeps many of Obamacare’s taxes. Some senators are expected to wait until the CBO score arrives until making a final decision.

The White House is aware the votes aren’t yet there, the administration official said: “It’s still a long ways to go.”

Republicans say McConnell won’t bring up the bill if there is any chance of failure, given the dramatic collapse in the summer.

“McConnell would like something to pass. But he also knows that getting 50 to vote for that is a challenge,” said a Republican aide tracking the bill. “They show him it has 50, he’ll schedule a vote.”

Even if the bill passes the Senate, there is no guarantee the House would take it up — and if it did, Speaker Paul Ryan and his caucus would have to pass the bill with no changes due to the Senate’s deadline to use “reconciliation.” The House passed a dramatically different Obamacare bill this spring.

Despite the long odds, Senate Republicans are hesitant to give up given the beating they have taken from the president, his staff and the GOP base. If the Senate GOP could revive Obamacare repeal, it would help lift a cloud of conservative angst hanging over the Senate majority after July’s failure.

The collapse of that effort is hurting incumbent senators up for reelection and could fuel primary challenges next year, senators said.

So don’t think this couldn’t pass. Politicians need to keep their phony baloney jobs!