Washington • Senate Republicans’ latest attempt to overhaul Obamacare — after multiple failures this year to fulfill campaign promises to gut the health care law — might be headed for a quick derailment.
If that’s the case (so far two GOP senators have said they’ll oppose it), it would mean a swift end to an idea Utah Gov. Gary Herbert and some of his fellow governors have long been calling for: more state control and (at least for a few years) extra money.
The legislation would provide “a fiscally viable path forward while harnessing the capacity of states to innovate in ways that can improve health outcomes at lower cost,” Herbert said in a statement Friday. “It is not perfect. But it is a far more equitable way of providing for the most vulnerable among us.”
Democrats, health care groups and other critics have panned the bill that could leave millions of Americans without coverage, and even Sen. John McCain, an Arizona Republican whose “no” vote toppled the last GOP effort to gut Obamacare, said he couldn’t back the new push. With Sen. Rand Paul, R-Ky., also opposed, Republicans are scrambling to find enough “ayes” to pass it.
“We should not be content to pass health care legislation on a party-line basis,” as Democrats did with Obamacare, McCain said in a statement Friday. “If we do so, our success could be as short-lived as theirs when the political winds shift, as they regularly do. The issue is too important, and too many lives are at risk, for us to leave the American people guessing from one election to the next whether and how they will acquire health insurance.”
Sen. Orrin Hatch is leaning toward supporting the bill, but Sen. Mike Lee is undecided so far.
Herbert and fellow GOP governors have argued since the passage of Obamacare, formally known as the Affordable Care Act, that the law gave Washington too much control of the health care system rather than letting states devise their own.
The latest bill, known as Graham-Cassidy after its sponsors, Sens. Lindsey Graham and Bill Cassidy, would eliminate Obamacare’s mandate that individuals buy insurance coverage and give states block grants to set up their own systems to insure their residents.
Some states would be big monetary winners under the plan, including Utah, while others, like California, would lose billions over the next decade.
Utah did not expand its Medicaid program and lost out on hundreds of millions in federal funding under Obamacare. But it would see a 2 percent bump in funding under Graham-Cassidy through 2026, according to a study by the health care policy group Avalere. The Center on Budget and Policy Priorities estimates Utah could gain $313 million more in federal money through 2026.
Those grants, though, would expire that year under the legislation and Utah could see a loss of 23 percent of federal funding through 2036, Avalere reports.
Caroline Pearson, Avalere’s senior vice president, said the bill would “significantly reduce” funding for states over the long term and “states would have broad flexibility to shape their markets but would have less funding to subsidize coverage for low- and middle-income individuals.”
Senate leaders — should they be able to muster enough votes — plan to push through the legislation this week because of a parliamentary rule that would allow passage with only 51 votes. Come October, legislation to change Obamacare would require 60 votes to get to final passage because of Senate rules — an unreachable mark without big concessions to Democrats.
Hatch, who heads the Senate Finance Committee, has slated a hearing on the Graham-Cassidy bill for Monday afternoon.
The Utah Republican told reporters this week he’s still deciding whether to back the bill, but he has a “tendency to want to support” it.
“Sen. Hatch has spoken in support of the ideas behind Graham-Cassidy, namely giving states more control over their health systems, putting Medicaid on a strong fiscal path going forward and repealing large parts of Obamacare,” Hatch spokesman Matt Whitlock said. He noted that the hearing Monday will allow senators on both sides of the aisle to delve into policy impacts of the legislation and what the sponsors are trying to achieve.
Lee, who voted for the last GOP effort to dismantle Obamacare, also is weighing his options on this version, his spokesman, Conn Carroll, said last week.
“Sen. Lee is very encouraged by the waiver provisions in the bill, and we are working with Cassidy’s office on some technical changes,” Carroll said.
Herbert, who was chairman of the National Governors Association last year, has argued for years that states — the laboratories of democracy, as he calls them — are best suited to deal with health care rather than a top-down federal law.
“Please allow each of the states, in their various hues of blue, red and purple, to take on the primary role of regulating their health insurance markets,” Herbert recently testified before the Senate Health, Education, Labor and Pensions Committee.
“Instead of foisting huge social and economic experiments on the entire country — too often along narrow party-line votes — Congress has an opportunity to diversify the social, economic and political risk associated with major policy change by letting the portfolio of states experiment with what works and what doesn’t,” Herbert said.
While not endorsing a specific plan, Colorado Gov. John Hickenlooper, a Democrat, also told that same committee that states should get more flexibility.
“It’s time for the federal government to work with us, not against us,” he said.
Governors of more populous states, though, have come out against the Graham-Cassidy measure. They stand to take huge hits because they expanded Medicaid under Obamacare and have more residents who would lose affordable coverage under the new bill.
New Jersey Gov. Chris Christie, a Republican, said last week the bill would hurt his state.
“I oppose Graham-Cassidy because it is too injurious to the people of New Jersey,” Christie told reporters, according to Politico. “I’m certainly not going to support a bill that takes nearly $4 billion from people in the state.”