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Graham and Cassidy go into overdrive to win Murkowski vote
Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) are going into overdrive to win over Alaska Sen. Lisa Murkowski (R), a pivotal vote for their bill to dismantle ObamaCare and give states more authority over healthcare.
The two have seen Murkowski, one of three Republicans to sink the GOP’s last repeal bill, as a critical vote for some time.
Graham told a meeting of conservative activists last week that special accommodations would have to be made in the bill for Alaska to win over Murkowski. The senator asked the groups to understand, and to not make a stink if concessions were made.
The Graham-Cassidy proposal would convert ObamaCare’s subsidies and funds for Medicaid expansion into block grants that would be given to states to design their own programs.
Right now it looks like an uphill battle to change Murkowski’s mind.
“I’d say the chances are less than 30 percent. Alaska doesn’t do very well in this bill. Her governor is lukewarm on it and her insurance commissioner is not for it,” one Senate GOP aide added.
Graham and Cassidy met with Murkowski on Wednesday in the office of fellow Alaska Sen. Dan Sullivan (R).
The face-to-face negotiations took a break Thursday as Graham traveled back to South Carolina and Murkowski flew back to Alaska, according to their offices.
Karina Petersen, a spokeswoman for Murkowski, said her boss is still vetting the bill and studying data from the Centers on Medicare and Medicaid Services and Department of Health and Human Services.
Alaska has higher health-care costs than other states because of its vast size and isolated geography.
Lori Wing-Heier, the director of Alaska’s Division of Insurance, testified before the Senate earlier this month that the state has some of the highest health-care costs in the nation because of its low population.
Under Graham-Cassidy, Alaska would see a $1 billion reduction in funding compared to current law for years 2020 through 2026, or about $1,350 per resident, according to a new study by Avalere, an independent consulting firm.
A study by the Center on Budget and Policy Priorities, a left-leaning think tank, projected a $255 million reduction in federal funding for Alaska in 2026 alone, a number made more daunting by the state’s small population of 742,000.
The Independent Journal Review reported Thursday that a new draft of Graham-Cassidy would allow Alaska as well as Hawaii to keep ObamaCare’s premium tax credits in addition to receiving block grants.
But Murkowski’s spokeswoman said she was not aware of any revised bill language being shared with her office.
Graham on Wednesday downplayed the notion that Alaska would fare better than other states in the bill but nevertheless acknowledged that something would have to be done to accommodate the state’s high costs.
“What we’re going to do is not deny Alaska the uniqueness of Alaska, but that’s it,” he said, according to The Washington Post.
The strategy could prove risky, however, as conservatives may balk at any language that might be seen as a special giveaway to Alaska.
One conservative Republican aide said extra funding for the state “possibly” could be a problem.
Graham’s office did to respond Thursday to a question about special aid for Alaska.
With Sen. Rand Paul (R-Ky.) opposed to the bill and Sen. Susan Collins (R-Maine) seen as a likely no, Republicans can’t afford to lose another GOP vote.
Yet winning Murkowski won’t guarantee passage either.
Cassidy’s office is also working with Sen. Mike Lee (R-Utah), another conservative who has raised concern about waivers for states.
Lee was encouraged earlier this week by the progress of the talks.
Other Republicans have raised concerns or said they need more time to study the bill.
Sen. John McCain (R-Ariz.) has repeatedly told reporters that legislation as complicated as healthcare reform should go through the regular order of committee hearings and markups.
The Senate Finance Committee is scheduled to hold a last-minute hearing of the legislation on Monday, but it’s doing so on a rushed schedule as lawmakers are racing to vote before Sept. 30, when special budgetary rules that will allow it to pass with a simple majority instead of 60 votes expire.
Conservative Sen. Ted Cruz (R-Texas) has raised concerns over whether the bill goes far enough to exempt states from ObamaCare’s insurance market regulations, which he believes have sent premiums soaring.
Asked this week if the bill’s insurance waivers go far enough, Cruz responded, “Not at the moment.”
Cruz, however, added that he is working with colleagues to “expand the regulatory freedom and lower premiums so that families who are struggling will be able to afford health insurance.”
Other Republicans say they need more time to make up their minds.
Sullivan, who shares some of Murkowski’s concerns about the potential impact on Alaska’s pricey insurance market, and Sen. Shelley Moore Capito (R), whose home state of West Virginia has benefited ObamaCare’s Medicaid expansion, say they are still reviewing the bill.
Senate Republican aides say McConnell has gotten fully behind Graham-Cassidy over the past week.
He told Republican senators at a lunch meeting Tuesday that this is their last chance to repeal ObamaCare in the current Congress as the legislative vehicle they need to circumvent a Democratic filibuster expires on Sept. 30.
But while McConnell and his leadership team are engaged, they are not as fully in control of the negotiations as in July, when McConnell worked with Senate Finance Committee Chairman Orrin Hatch (R-Utah), Senate Budget Committee Chairman Mike Enzi (R-Wyo.) and Senate Health Committee Chairman Lamar Alexander (R-Tenn.) to draft the healthcare bill Senate Republicans were pushing at the time.
In July McConnell’s office was in control of almost every decision and he handled much of the negotiation with wavering senators.
Now, Graham, Cassidy and their partner, former Pennsylvania Sen. Rick Santorum (R) are taking the point.
“It’s their bill, they’re the best ones to sell it,” said a senior GOP aide.
McConnell met with Murkowski and McCain on Monday to feel them out.
The GOP leader also met with Graham and Cassidy prior to their meeting with Murkowski on Wednesday.
Graham and Cassidy are after Murkowski’s vote
https://www.axios.com/graham-and-cassidy-are-after-murkowskis-vote-2488018309.html
Sens. Lindsey Graham and Bill Cassidy are considering three new Alaska-specific changes to their health care proposal to gain the backing of Sen. Lisa Murkowski, according to the Independent Journal Review.
What they’re offering:
- Alaska and Hawaii would “continue to receive Obamacare’s premium tax credits” despite them getting repealed in the rest of the country.
- Medicaid per capita caps are delayed for both Alaska and Hawaii.
- Both states get “an increased federal Medicaid matching rate”
Why it matters: Murkowski was one 3 GOP no-votes on health care earlier this year.
What every major health group has said about Graham-Cassidy
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Senate Republicans are teeing up what appears to be one final vote on Obamacare repeal next week.
Notably, health care groups — from the American Medical Association to health insurance companies like Blue Cross Blue Shield — are beginning to release statements about the bill sponsored by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-SC). Avalere Health, a health care consulting firm, predicted Wednesday that the bill would reduce federal funding to states by $215 billion through 2026 and by more than $4 trillion over a 20-year period.
Put simply, the bill would redistribute money allotted for Obamacare and Medicaid expansion to states that have resisted Obamacare implementation. Thirty-four states would lose funding they previously received from the federal government for health care, according to Avalere.
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Republicans are rushing to pass this bill before the September 30 expiration of its special budget reconciliation status, and the Congressional Budget Office will not have time to give a full report on how many Americans would lose coverage under the bill.
But several health groups have reviews of the bill anyway — and so far, none of them are positive.
Here’s a roundup of what leading health organizations have said about the Graham-Cassidy Bill:
“…the Graham-Cassidy Amendment fails to match this vision and violates the precept of “first do no harm.” Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care.”
American Academy of Pediatrics
“I [Fernando Stein, president, American Academy of Pediatrics] must speak out against this dangerous, ill-conceived policy on behalf of our 66,000 pediatrician, pediatric surgical specialist and pediatric medical sub-specialist members, and stop it from advancing.
“This bill may be disguised under a different name, but it contains the same dangerous policies as the legislation that failed to advance out of the Senate earlier this summer. In fact, Graham-Cassidy goes even further in its attacks on Medicaid.”
“Overall, the Graham/Cassidy/Heller/Johnson bill would increase health care costs for older Americans with an age tax, decrease coverage, and undermine preexisting condition protections. In addition, this bill would jeopardize the ability of older Americans and people with disabilities to stay in their own homes as they age and threaten coverage for individuals in nursing homes.”
Blue Cross Blue Shield Association
“The [Graham-Cassidy] bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions. The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans. Legislation must also ensure adequate funding for Medicaid to protect the most vulnerable.”
“The Graham-Cassidy bill is a serious threat to the health care of millions of Americans. This bill is the worst Obamacare repeal bill yet: Millions of Planned Parenthood patients could lose their health care if the Graham-Cassidy bill were to pass — millions more would lose their coverage through Medicaid, and could lose essentials like maternity care and coverage for prescription drugs. Policy on women’s health care should not be written by a small group of male politicians behind closed doors. Enough is enough. With this latest version of Trumpcare, Americans will pay more and get less, but women will pay the biggest price of all.”
“At Kaiser Permanente, we believe that changes to our nation’s health care laws should increase access to high-quality, affordable care and coverage for as many people as possible. The Graham-Cassidy bill does not meet any of those tests.
“The block grant proposal in the bill would erode coverage of needed medical services and pose major issues for state budgets. Repealing the individual mandate without alternative incentives for enrollment will lead to fewer people enrolled and higher premiums.”
America’s Health Insurance Plans
“[The Graham-Cassidy-Heller-Johnson proposal] would have real consequences on consumers and patients by further destabilizing the individual market; cutting Medicaid; pulling back on protections for pre-existing conditions; not ending taxes on health insurance premiums and benefits; and potentially allowing government-controlled, single payer health care to grow.”
American Heart Association and 16 other patient and provider groups
“Affordable, adequate care is vital to the patients we represent. This legislation fails to provide Americans with what they need to maintain their health. In fact, much of the proposal just repackages the problematic provisions of the Better Care Reconciliation Act (BCRA), which we opposed. Fortunately, the BCRA was voted down by Congress earlier this year.”
Association of American Medical Colleges
“During the long debate regarding health care reform, the nation’s medical schools and teaching hospitals have continually advocated for a number of key principles as fundamental cornerstones of any successful health care system. These principles include offering high-quality, affordable health insurance to all; preserving and fortifying the safety net through Medicaid and other policies; and encouraging innovation in the delivery system, among others.
“The current proposal does not meet these principles and will almost surely lead to dramatic increases in the number of uninsured patients nationwide and put important existing patient protections at risk. Additionally, a proposal like this—a complete overhaul of the health care system—should be fully and adequately examined by the Congressional Budget Office before it is brought to a vote.”
Senators Cassidy and Graham’s proposal, like the ACA repeal proposals before it, would put the health and lives of tens of thousands of persons living with HIV at risk. We appeal once more to our senators to stop once and for all efforts to repeal the ACA and turn to improving rather than dismantling critical health coverage reforms.
The Alzheimer’s Association and Alzheimer’s Impact Movement
“The proposed changes to Medicaid outlined in the Graham-Cassidy Amendment could have a drastic impact on this vulnerable population given that more than 1 in 4 seniors with Alzheimer’s and other dementias are currently on Medicaid. The Alzheimer’s Association and AIM are also alarmed by the potential impact of this legislation on Americans living with pre-existing conditions, including the 200,000 Americans living with younger-onset Alzheimer’s.”
“Our analysis indicates the bill could allow insurers to:
- Charge cancer patients and survivors far higher rates to make coverage unaffordable
- Eliminate coverage for cancer care in their health plans
- Re-institute arbitrary caps on annual and lifetime coverage”
Analysis: Senate’s health care cuts could top $4 trillion
Change in federal funding under Graham-Cassidy compared to current law, 2020-2026
The Senate’s health-care overhaul would quickly pull $215 billion in federal funding out of the health care system, and those cuts could later grow as high as $4 trillion, according to a new analysis from the consulting firm Avalere Health.
Why it matters: Avalere is a respected and independent voice, and because the Congressional Budget Office won’t have time to completely evaluate the bill’s effects before a vote, this will likely be one of the best estimates we have available.
What Avalere found: The bill, sponsored by Sens. Lindsey Graham and Bill Cassidy, would redistribute federal health care dollars while also shrinking the overall pot. Avalere’s analysis looks at how the cuts would grow over time:
- 2020-2026: Total federal spending would shrink by $215 billion; 34 states and Washington, D.C. would lose money, compared with the status quo, while seven states would get more.
- By 2027, the total national cut would climb to $489 billion.
- 2027-2036: Federal spending would shrink by more than $4 trillion, and every state would be getting less than they’re on track to get under current law.
Key caveat: The Graham-Cassidy bill would roll federal funding for the Affordable Care Act’s premium subsidies and Medicaid expansion into a single pool, then convert it into block grants to the states. Those grants are set to expire in 2026. Avalere analyzed the bill as written — with that money disappearing completely — but the bill’s supporters say Congress would obviously step in to authorize a new round of grants.
What Graham-Cassidy means for pre-existing conditions
https://www.axios.com/what-graham-cassidy-really-means-for-pre-existing-conditions-2487720743.html
Jimmy Kimmel’s takedown of Sen. Bill Cassidy, and Cassidy’s response, ripped open the question of whether the GOP’s latest health reform bill protects people with pre-existing conditions. Cassidy and co-sponsor Sen. Lindsey Graham insist it does — as did President Trump in a tweet last night — but experts say that’s not really the case.
The bottom line: The bill’s funding cuts could pressure states — even blue states — to waive protections for sick people, as a way to keep premium increases in check. Older, sicker people in every state could end up paying more as states try to make up for a funding shortfall.
What the bill does: The bill wouldn’t repeal the Affordable Care Act’s rules about pre-existing conditions. But they might end up only existing on paper, the Kaiser Family Foundation’s Larry Levitt said.
Graham-Cassidy doesn’t let states waive the part of the Affordable Care Act that says insurers have to cover sick people. But it does allow states to opt out of several other ACA rules that can cause people with pre-existing conditions to pay more for their health care. Those provisions include:
- The ban on charging sick people higher premiums than healthy people.
- The requirement that insurers cover “essential health benefits,” including prescription drugs. People who need expensive drugs might not have access to a plan that covers those drugs, requiring them to pay out of pocket.
- Services that aren’t “essential” benefits aren’t subject to the ACA’s ban on annual and lifetime limits.
- The bill also would also loosen rules about how much insurers can raise their premiums because of a customer’s age. (Older people are more likely to have pre-existing conditions.)
What supporters will argue: The bill requires states to say how their waivers would provide affordable and accessible coverage for people with pre-existing conditions. But there’s no definition of what that means, and there’s also no enforcement mechanism.
- “The bottom line is these protections are much more at risk under this bill than they are now,” said Cori Uccello, a senior health fellow with the American Academy of Actuaries.
Another level: At least theoretically, because the bill gives states so much control, a more liberal state like California might choose to preserve more of the ACA’s regulations than, say, Alabama. But this bill would radically redistribute federal health care funding — generally away from blue and purple states and toward red states. Those cuts could back blue states into seeking more expansive waivers.
- Caroline Pearson of Avalere told me: “if you have less money, you either cover fewer people, or you cover the same amount of people with less generous coverage. People with pre existing conditions are very reliant on having access to affordable insurance and need insurance that is comprehensive. So if a bill reduces the availability of comprehensive insurance, people with chronic conditions are going to be disproportionately harmed.”
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HENRY KOTULA 