Senate Republicans Resort to Outright Bribery In Hopes of Overhauling Obamacare

A new draft of the Graham-Cassidy bill includes big handouts for the home state of a key holdout vote.


Ron Sachs/SIPA/Newscom

With less than one full week to go before a key procedural deadline, Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) have resorted to outright legislative bribery in hopes of winning enough votes to pass a bill that would overhaul Obamacare.

A new version of the legislation, which would convert Obamacare into a system of state-managed block grants, began circulating yesterday. The revision includes increased $500 million in extra funding for states that have already implemented an Obamacare waiver program—which would include Alaska. The legislation also includes additional Medicaid funding for low-density states, and for states deemed high poverty, which would boost funding for Alaska too. Alaska Sen. Lisa Murkowski, who was one of three GOP senators to vote against a previous Obamacare overhaul in July, is considered a key target for Graham and Cassidy.

These add-ons don't quite amount to the wholesale exemption for Alaska that was rumored last week. But at this point, it's hard to see them as anything but blatant legislative bribes. This is an attempt to win over Murkowski—not by making an argument for the legislation on the merits, but by topping up federal funding for her state in order to bring her on board.

Alaska isn't the only state that would receive boosted funding under the new legislation. Hawaii would also benefit from the increased federal funding to high poverty states.

There's also a somewhat curious addition in the form of an additional $750 million between 2023 and 2026 for states that were late to expand Medicaid under Obamacare. The very last state to expand Medicaid was Louisiana—home of Sen. Bill Cassidy. One of the sponsors of the legislation, in other words, appears to be padding his own state's budget. He's practically bribing himself.

There's nothing new about hiding bribes and handouts in major legislation. The version of Obamacare that passed in the Senate included hundreds of millions in funding boosts for states represented by holdout legislators, including Louisiana. Critics of Obamacare complained bitterly about these bribes. Now Graham and Cassidy are attempting to use similar tactics—arguably in even more blatant form—in order to overhaul Obamacare.

Graham and Cassidy aren't trying to win the argument. Indeed, with a legislative timeline this rushed, there is barely time to have an argument. GOP senators, when asked, do not demonstrate a strong grasp of how the bill would work, and speaking about the bill, a White House official admitted to Politico last week, "we aren't really sure what the impact will be." Early analyses have found what appear to be inconsistencies and contradictions in the revised draft. This is not exactly a sign of thoughtfully crafted, well designed legislation.

Even with the newly added bribes, however, it's unclear whether Graham and Cassidy can find the necessary votes for passage. The reconciliation rules that would allow Senate Republicans to pass the bill with a simple majority expire at the end of the month, so there isn't a lot of time. In theory, Republicans could write new reconciliation instructions allowing them to take up health care again, but that's a step they haven't taken yet, and it could complicate the tax reform push.

If anything, at this point, support for the legislation seems to be dwindling. Last week, Sen. John McCain (R-Ariz.) said he could not support the plan because it could not be debated and passed under regular order—which isn't going to happen between now and September 30. Sen. Rand Paul (R-Ky.) has been the most outspoken Republican opponent of the plan, and he signaled this morning that the revision still doesn't satisfy him.

Meanwhile, Sen. Ted Cruz (R-Tx.), who many had assumed was a yes, said this weekend that the legislation did not yet have his vote—and may not have Sen. Mike Lee's (R-Utah) vote either. In addition, Sen. Susan Collins (R-Maine), who voted against the last GOP plan in July, has consistently said she is also leaning no. It is "very difficult for me to envision a scenario" where she would vote yes, she said.

For the plan to pass, Senate Republicans can only lose two votes. It probably doesn't help that new polling shows that the plan, like previous versions of GOP health care legislation, is incredibly unpopular.

This has been the primary difficulty from the very beginning. Assuming unified Democratic opposition, Senate Republicans need 50 votes to pass an Obamacare overhaul. But each iteration of the GOP's health care legislation has had the support of somewhere between 45 and 49 Republican senators. Even with today's bribe-packed update, it's not clear that this has changed.