Close
Date TimeSeptember 16, 2017
VoiceRepeal of the Affordable Care Act is back on the agenda, with Republicans suddenly talking about passing a bill that, until recently, few people in either party had taken all that seriously.

The prospects for the new legislation passing are murky. The proposal has generated a ton of conversation in political and health policy circles in just the past week, with multiple outlets reporting that leadership is now thinking about floor action before Sept. 30. That’s the magic date when, because of parliamentary rules, Republicans lose their ability to pass repeal with just 50 votes. But much of the chatter is hype from supporters and it’s hard to know just how difficult assembling a majority will be.

Still, even if the bill’s political fortunes are difficult to pin down, the impact it would have as a law is crystal clear. By dramatically scaling back what the federal government spends on health care and undermining rules designed to guarantee insurance for people with pre-existing conditions, this new proposal would leave millions of Americans struggling to pay their medical bills and to get coverage.

It is, in other words, another shot at full repeal, although its GOP sponsors sometimes suggest otherwise ― and that’s one reason it has escaped heavy scrutiny until now.
A New Bill With The Same Old Devastating Effects On Coverage

Those sponsors are Bill Cassidy of Louisiana and Lindsey Graham of South Carolina ― an unlikely duo, perhaps, given some of their previous statements about repeal. During the spring and summer, Graham repeatedly criticized his party’s leadership for trying to jam through legislation on a party-line vote, without trying to work with Democrats or going through the usual committee process.

Cassidy, for his part, famously urged his colleagues to pass what he dubbed “the Jimmy Kimmel test” ― a reference to the late-night television host’s impassioned public plea to make sure everybody has access to care, regardless of income or medical condition, after his newborn son was diagnosed with a genetic heart defect. Cassidy’s grandstanding on access to care seemed to make sense, given that previously he had worked with Sen. Susan Collins (R-Maine) on a skeletal proposal that he promised would let states keep their versions of “Obamacare” intact if they so chose. “California, New York — you love Obamacare, you can keep it,” Cassidy said.

But when it came time to vote repeal legislation in late July, there was Graham voting yes, even though leadership had ignored his pleas for regular order, and there was Cassidy right there alongside him, even though the bills would have violated the Kimmel test by depriving millions of coverage. Now the pair is back with a proposal that would (yet again) go straight to a floor vote and would (yet again) mean no coverage for tens of millions.

Starting in 2020, the Cassidy-Graham bill would entirely eliminate both the Affordable Care Act’s subsidies and the enhanced federal funding that underwrites the expansion of Medicaid in 31 states (plus the District of Columbia). The bill would then establish a “block grant,” handing money directly to the states for helping people to pay for health care. This would produce the best of all worlds, as Cassidy and Graham would say, because it would mean states could stop worrying about the complications of the Affordable Care Act and simply use that money in ways that will work best for them and their citizens.

In reality, the Cassidy-Graham would shrink the federal investment in health care programs dramatically, by somewhere in the neighborhood of $400 billion over the next ten years, or maybe even more, according to a preliminary and rough analysis by the Center on Budget and Policy Priorities. Starting in 2027, the money would vanish altogether. In theory, Congress could appropriate new money then, a possibility Cassidy and Graham have raised in an effort to soothe those nervous about such a dramatic drop-off in funds. In practice, it would take $200 billion each year just to keep pace. That’d be a huge ask for any Congress.    

Don’t look now, but full Obamacare repeal is back on the table


It’s true the bill would give states new flexibility ― so much flexibility, in fact, that they wouldn’t have to direct the funding to the low- and middle-income Americans who need the help most. Nor would they have to keep regulations that prohibit insurers from charging higher premiums to people with pre-existing medical conditions, or include benefits like mental health and maternity that carriers frequently excluded in the old, pre-Obamacare days and would almost surely start excluding again if they had the chance.

“This bill is far more radical [than previous repeal bills] in that it envisions going back to the pre-ACA world, where the federal government wasn’t in the business of helping low-income adults or moderate-income people without employer coverage get health insurance at all,” Aviva Aron-Dine, senior fellow at the center, told HuffPost. “Compared to pre-ACA, there would be some extra state grant money floating around – but it would have virtually no requirements attached to it at all and, since the funding wouldn’t adjust based on enrollment or costs, it would be hard for even well-intentioned states to use it to create an individual entitlement to coverage or help.”

Oh, and the bill would repeal the Affordable Care Act’s individual mandate, and do so right away ― destabilizing insurance markets and causing premiums to rise right away, according to official projections.

Exactly how many people would lose insurance, and what kind of benefits would be left for the people who hold onto coverage, is not clear. The Congressional Budget Office hasn’t had a chance to evaluate the plan yet, although Cassidy, like most Republicans these days, has already said he’s willing to ignore CBO altogether because he thinks their analysis is unreliable. (Actually, the CBO predictions of the Affordable Care Act’s ultimate coverage impact were quite good, even though some specific projections of the type of coverage people would have were way off.)
Why Cassidy-Graham Bill Might Not Pass, And Why It Might

The substantive impact of the bill, and the rushed process Republicans are using to push it, makes the Cassidy-Graham bill looks a lot like the bills that failed to get majority votes back in July, when the Senate took them up.

And the politics of repeal would seem to be no more favorable for Republicans than they did then. The 2010 health care law, which has led to a historic decline in the number of people without insurance, has grown steadily, if incrementally, more popular during the repeal debate, according to polling. Clear majorities now prefer either keeping or improving the law, flaws and all, rather than getting rid of it outright.

As it happens, in just the past few weeks, a handful of Republican and Democratic senators have taken that instruction to heart. They have been working diligently on a different piece of legislation ― a narrowly tailored bill designed to shore up the program in the states where it is struggling and, in the process, find some common ground between the parties.

This was just the kind of effort that one Republican in particular, Sen. John McCain of Arizona, had insisted he wanted when he cast a dramatic and decisive vote against the final GOP repeal proposal to come up in late July ― and it would seem like he would be loathe to short-circuit this new bipartisan effort, now that it is underway. But McCain is also very close to Graham and at this point nobody knows how he’ll reconcile personal loyalty and political principle. (So far, McCain has sent out conflicting signals over how he feels about the Cassidy-Graham bill.)

Another factor in the bill’s eventual success or demise will be the way it shifts money among the states. Because of its complex funding formula, states like Alabama and Texas would initially see more funding, while states like California and Connecticut would see dramatic cuts, according to the same Center on Budget and Public Priorities analysis. The partisan tinge to the transformation is presumably intentional, since it’s mostly a transfer of money from Democratic states to Republican ones ― and, perversely, from those states that have tried hardest to expand coverage, by expanding their Medicaid programs and promoting enrollment, to those that have done as little as possible to help their citizens and in some cases worked actively to undermine the Affordable Care Act.

But the formula doesn’t work out perfectly for Republican states, according to the same analysis. By year ten, for example, Alaska, Ohio and West Virginia would all be losing money, and that’s politically critical since Alaska’s Lisa Murkowski was one of three Republican senators who voted no on the final repeal bill while the votes of Ohio’s Rob Portman and West Virginia’s Shelley Moore Capito were in play until the end, although they both voted yes.

Neither Capito, Murkowski, nor Portman have said much about the new bill, nor has Collins, who was the third member of the triumvirate to kill repeal last time. The only Republican senator to indicate a clear position on Cassidy-Graham so far has been Rand Paul, of Kentucky, who has said he’s a firm no ― ironically, if predictably, because it leaves too much of the Affordable Care Act’s edifice in place.

He might stick to that position and vote no, making the GOP vote math impossible unless leaders can somehow flip Murkowski (thought to be highly difficult) or Collins (thought to be impossible). Or he might change his mind. Or other Republicans could come out against the proposal.

It’s difficult to say. After all, the idea that repeal could come back now, despite repeal’s unpopularity, in the form of a proposal that in some respects is more radical than its predecessors, is difficult to fathom. And yet here we are.
Hurricane Jose looms off the US East Coast
Manitoba's NDP chooses Wab Kinew as new leader - CBC.ca
Casey Affleck's divorce from Summer Phoenix finalized
BREAKING: London Bridge EVACUATED - armed police rush to scene amid terror fears
Toronto to Montreal in 39 minutes? Futuristic people mover zips to next stage
Late-Night Lately: Colbert Prepares for the Emmys, Corden Becomes 'It,' Jennifer Lawrence and Fallon Compete
Barcelona News: Real Madrid star Isco snubbed transfer because of Lionel Messi
‘Dress-wearing’ students must submit photos before dances, Wisconsin high school says
FEMA’s Hurricane Response Is Making Trump Look Good. Thanks, Obama
Parsons Green terror: Teenager arrested in Dover in connection with bomb attack
Beyoncé And Jay-Z Enjoy A Kid-Free Evening At Rihanna's Diamond Ball
Sanders Rips Trump: ‘Let Me Tell You What A Curse On The American People Is’
Theresa May ‘has already set aside £27bn to pay EU for a three-year transition deal’
Facebook hands over Russia-linked ads
Emmys 2017: How to Stream the Show Online
Toronto police find two missing brothers
Parsons Green terror: Theresa May warns attack is IMMINENT - threat level now CRITICAL
Cassini: Probe incinerates on entry to Saturn
LONDON TERROR ATTACK: Police identify key suspect behind Parsons Green Tube explosion
Universal Kids to Release Russian Series 'Masha and the Bear' In U.S
Mother of 6-year-old boy connected to Amber Alert found dead, Quebec police say
What we know so far about the London Underground explosion
Trump again seizes on terror incident to call for travel ban
BREAKING: London terror attack - second bomb at Parsons Green, reports
Witnesses say they heard announcements from officials that 'some kind of explosion' had occurred on a train
Candice Bergen Wore A Message For Melania On Her Sweater
North Korea fires missile
Couples Sex Tapes Reality Series in the Works at eOne, Armoza Formats
Chelsea Manning, Sean Spicer named fellows at Harvard
Trump: There will be a wall, no amnesty
Selena Gomez has kidney transplant after best friend donates organ 'The ultimate gift'
The U.S. wants to negotiate a NAFTA deal that automatically expires after 5 years, commerce secretary says
Martin Shkreli Is Jailed for Seeking a Hair From Hillary Clinton
TV Ratings: 'Talent' Approaches Finale With Wednesday Win
Real Madrid opens Champions League defence on high note
Paris officially named host city for the 2024 Olympic Games
In a series of tweets, Trump denied he made a deal with Dems on immigration
Halle Berry, 51, exposes NIPPLES as she flaunts extreme cleavage in boob-baring top
Japan is building the fastest supercomputer in the world
ESPN's Jemele Hill Responds After White House Criticism of 'Trump is A White Supremacist' Comments
‘Strange things happen every day:’ Merkel sings at election event (VIDEO)
Theresa May to deliver Brexit speech in Florence
Schumer and Pelosi say Trump agreed to fix DACA and tackle border security, minus his border wall. The WH disagrees
Royal wedding on the way? Prince Harry 'introduces Meghan Markle to the Queen at Balmoral'
Clinton Torches Ivanka For ‘Lip Service,’ Says She Should Be ‘Held Accountable’
Hear the White House response to Jemele Hill's tweets
End of the World on September 23, 2017: Shock Bible prophecy warns The Rapture is COMING
Bye-bye, bikini: Kate Upton made her modestly-dressed NYFW debut at Michael Kors
Russia says it proposed full normalization with US under Trump
Feds call July 2018 timeline for marijuana legalization ‘reasonable’
FOOD SHORTAGE: Caribbean running out of supplies
Emmys: Colbert Calls Trump 'Biggest' TV Star, Jokes About Host 'Manual Labor'
Trudeau's Bahamas vacation cost over $215K — far more than initially disclosed
Millions in Florida could be without electricity for weeks with temperatures in the 90s
How 'Black Mirror' Predicted New Apple Technology
The Disaster Artist review – James Franco's ode to bad film-making is a riot
ESPN’s Jemele Hill: Trump Is A ‘White Supremacist’ And Unfit For Office
Niall Horan parties on a luxury yacht with friends in Sydney
Aussie tradie attempts to rescue great white shark by dragging it into the sea off Manly Beach - Daily Telegraph
Edith Windsor, Plaintiff In Landmark Same-Sex Marriage Case, Dies
iPhone 8, iPhone X will have wireless charging with Qi, AirPower
Under fire for storm response, Macron arrives in hurricane-hit French islands
Hope Hicks Named White House Communications Director
All The Possible Excuses For Ted Cruz ‘Liking’ A Porn Video
Theresa May asked Trump to step into dispute between Boeing and Bombardier
Exclusive: Hillary Clinton says Trump associates helped Russia meddle in the 2016 election
Electricity is out for almost 8 million, including nearly 60% of Florida
Canadians return home after harrowing encounter with Irma
Some areas can't be reached to really find out the extent of the damage
'Bachelor in Paradise' Stars on Why the ABC Dating Show Can Work
‘Independencia!’ Hundreds of thousands rally in Barcelona as tensions rise over vote to separate from Spain
SEE THE DAMAGE: Irma slams Florida
'Transparent': Jill Gordon Replaces Jill Soloway as Showrunner for Season 5
Volkswagen, Mercedes-Benz launch electric cars: 'anything Tesla can do, we can do better'
GAS SHORTAGE: Many gas stations have no fuel, drivers say
'Survivor' Season 35 Player Profile: Meet Jessica Johnston
Jury selection begins in Lac-Mégantic train derailment trial
Winds and heavy rain from Irma move across the northern half of Florida's peninsula
Here's What's Happening in TV This Week
Angelina Jolie brings her kids (and her flowy pants) to Toronto Film Festival
New phones, Apple Watches, and more: What to expect at Apple's iPhone 10th-anniversary event - Quartz
Equifax Hack Proves Strong Passwords Aren't Enough
Bannon: Trump firing of Comey was the 'biggest mistake in modern political history' - Washington Post
Hurricane downgraded as it climbs through the center of Florida and into Georgia
'Outlander' Cast, Producers Break Down That Shockingly Emotional Premiere Death
'Five Foot Two' explores Lady Gaga's vulnerable side
Amazon's two-day shipping is more like 13, thanks to Hurricane Irma
HILLARY ‘GOBSMACKED’ Talks on book launch eve about ‘painful’ election loss
Here Are All The Records Irma Has Broken So Far
Toronto: Can Netflix Doc 'Gaga: Five Foot Two' Go Where 'Madonna: Truth or Dare' Did Not?
The top iPhone 8 rumors, ranked from most to least plausible - The Verge
Privacy Policy
How to find a celebrity at the Toronto International Film Festival
'We've got them on the ropes!' Why EU will NEVER get its £90bn Brexit divorce bill
North Korea's Kim Jong-un hosts huge celebration after nuclear test
Egypt announces discovery of 3,500-year-old tomb in Luxor
WORLD WAR 3: Angela Merkel offers to fix North Korea crisis amid nuclear missile threat
Irma upgraded to powerful Category 4 storm as it pounds the Florida Keys, and the rest of the state awaits the worst
Facebook tests Tinder-like ‘meet up’ feature
Should dating apps have HIV filters?
Most stations in Miami-Fort Lauderdale out of gas
Bride Always Dreamed About Making Fiancé’s Friends Sweat Asses Off In Fucking Sun
Emergency operations in Florida Keys relocating
'Game of Thrones' Guide: The Definitive Resource for Season 7
Why Virtual Reality Is Getting More Important at the Emmys
Reporter in Cuba: This is tragic
See the difference between Irma and Andrew
Survival Comedy Series Produced by Matt Damon Ordered at Netflix
Football Is A Thriving Business, But For How Long?
Hillary Clinton Adds 'Daily Show' to New Press Tour
'Big Brother 19': Fifth Juror Reveals How Eviction Will Impact His Finale Vote
Operation Sanctuary: Woman jailed for trafficking girls
Nato chief: world is at its most dangerous point in a generation
Floridians flee: Exodus could be one of largest in US history
New York Today: New York Today: Rafael Nadal’s New York
The hurricane, now with maximum sustained winds of 150 mph, leaves catastrophic damage on islands
Universal Kids Acquires Bear Grylls Series Ahead of Relaunch (Exclusive)
Mexican authorities report an 8.4 earthquake off southern coast, raising tsunami fears - Los Angeles Times
Alleged Russian political meddling documented in 27 countries since 2004
Hillary Clinton Sets 'Late Show With Stephen Colbert' Return
USA TODAY Sports: Week 1 NFL picks
Senator: Trump Jr. interview not easing concerns over Russia
Photos: Hurricane Irma tears through Caribbean
Nancy Pelosi Says Trump Promised Her He’d Sign The Dream Act
Hurricane watches have been issued for parts of Florida as governor warns all of state's residents to prepare
Facebook finds Russian ads that sought to sow division during U.S. election
Economic Adviser Appears To Have Fallen Out Of Trump’s Favor
The 'extremely dangerous' storm is swirling over Puerto Rico as it makes its way toward a possible Florida hit
Brexit: Businesses warn over 'UK workers first' proposal
Hurricane Irma, Packing 185-M.P.H. Winds, Makes Landfall in Caribbean
'Game of Thrones': The 15 Best Quotes From Season 7
Hillary Clinton Wasn’t The Only Democrat Whose Campaign Got Hacked In 2016
Hurricane Irma is packing 185 mph winds, making it one of the most powerful Atlantic storms ever recorded
Late-Night Hosts Blast Trump on DACA Decision
South Korea's Moon discusses "unpredictable" North Korea situation with Putin - Reuters
Track the storm
Jimmy Fallon Unveils $1 Million Donation to J.J. Watt's Hurricane Harvey Relief Fund
Putin: Military hysteria over N. Korea may lead to planetary catastrophe, heavy loss of life
'Game of Thrones': The Final Images From Westeros, for Now
North Korea nuclear crisis: Kim Jong-un 'begging for war'
Seoul steps up military response to North Korea's nuclear test
Will North Korea's hydrogen bomb test force China to rethink its policy?
The Houston Texans Are Donating $1 Million To Harvey Disaster Relief
Read the letter Obama left for Trump
What happens if Kim attacks? 5 things to know
Close