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WASHINGTON — A group of Republican senators are making a late push to repeal and replace Obamacare this month even as some colleagues seem ready to move on or even work with Democrats to patch up the law.
The bill, backed by Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin, would combine funding for Medicaid and Obamacare’s subsidies into a block grant that states could use to craft their own health care plans. Some states would receive less money compared with the current law, others potentially more, and the funding would only extend to 2026, leaving beyond that uncertain.
The bill faces a high barrier to passage. Heller and Graham conceded that getting their own Republican governors to support their bill was a “work in progress” and called on President Donald Trump to rally support and on Senate GOP leaders to fast track their legislation.
“Mr. President, help us, because we’re trying to help you,” Graham said on Wednesday.
While Trump offered the bill's sponsors some encouragement later in the afternoon, he stopped short of endorsing their plan. "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,” the president said in a statement.
The senators debuted their legislation hours before a scheduled news conference by Sen. Bernie Sanders, I-Vt. and various Democrats to unveil a new single-payer bill that would cover all Americans under a more comprehensive version of Medicare.
Graham explicitly contrasted his bill with what he called “Berniecare,” casting it as the GOP’s last, best chance to prevent Democrats from eventually replacing private insurance with a public program.
“Bernie, this ends your dream of a single-payer health care system,” he said.
But Republicans seem torn between taking another crack at replacing Obamacare and declaring a truce with Democrats in order to focus on other issues like tax reform.
In a separate effort, the Senate Committee on Health, Education, Labor and Pensions has been holding hearings this month to craft a bipartisan bill aimed at lowering premiums and attracting more insurers to Obamacare’s exchanges. So far there seems to be broad support across party lines for funding cost-sharing reduction payments that the president has threatened to end while making it easier for states to tweak their health care programs.
The Graham-Cassidy-Heller-Johnson bill is, in many ways, as sweeping as past Obamacare replacement legislation. Like the Better Care Reconciliation Act, which failed despite backing from Republican leaders, it would reduce and then end additional Medicaid funding that states receive through Obamacare and eliminate requirements that individuals buy insurance and that employers provide it. The bill would block federal funding to Planned Parenthood, which is reimbursed by Medicaid for nonabortion services.
The goal, according to Cassidy, is to “equalize” federal spending per patient between states that receive extra Medicaid dollars through Obamacare and those that do not. States would also have more flexibility to spend money on care, including raising benefits for higher-earning residents rather than lower-income customers who receive the bulk of aid under Obamacare.
Republicans will have to act fast: The bill that Graham and Cassidy are sponsoring needs to pass, with a simple majority, by Sept. 30. In a matter of weeks, they’d have to score the bill with the Congressional Budget Office, wrangle the necessary votes, and then convince the House to quickly follow suit.
“I know it may appear last minute — well, it is last minute — but it is the right approach at the right time,” former Senator Rick Santorum, R-Penn., who helped craft the bill, said at the news conference with its sponsors.
As for the health committee’s efforts, insurers are finalizing their rates and participation next month for 2018, meaning Congress would need to pass legislation almost immediately to have an impact. The committee's chairman, Sen. Lamar Alexander, R-Tenn., has set a self-imposed deadline at the end of the week to reach a consensus.
Without dismissing their efforts, Senate Republican leaders sounded skeptical this week.
“I think the way forward, at least of today, is not clear, but those discussions are underway and we'll see where they go,” Majority Leader Mitch McConnell, R-Ky. said at a news conference on Tuesday.
Still, some Democrats and progressive activists are nervous that the GOP’s long quest to repeal Obamacare may have one last push left.
“The risk is getting distracted by the longer-term health care policy discussions when these guys are still rabid to get the ACA,” Senator Chris Murphy, D-Conn., told reporters on Tuesday, referring to the Affordable Care Act.