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The GOP’s New Obamacare Repeal Bill Shouldn’t Pass. It Might Anyway.

A looming Senate deadline might push holdout Republican senators over the line.

Credit - Bill Clark/CQ Roll Call/NewscomCredit - Bill Clark/CQ Roll Call/NewscomAfter nine months of political failure, Senate Republicans, you may have heard, are closer than ever to passing a bill that would repeal, or at least rewrite, Obamacare. Legislation introduced last week by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-LA) that would repeal Obamacare's individual mandate and convert it into a system of state-administered block grants appears to be gaining momentum, with some reports suggesting that it may be just a few votes short.

This is true, but then, Senate Republicans have been just a few votes shy of a majority to repeal Obamacare all year long. A number of high-profile holdouts remain, and passing the bill would require a handful of GOP lawmakers to break their word.

In some sense, little has changed. On the merits, and on the politics, this bill shouldn't pass. And yet it still could.

There is one important factor that is different: Thanks to Senate rules, Republicans know they have a strict deadline. After September 30, the procedural vehicle that allows Senate Republicans to pass a health care bill with a simple majority vote expires. This means they have less than two weeks to make good on their promise to repeal and replace the health care law. In other words, it's their last chance. They might take it.

The list of holdouts will, at this point, be mostly familiar to anyone who has followed the saga of Obamacare repeal this year. Sens. Collins (Maine) and Murkowski (Alaska) have always had concerns about the way the bills treat Medicaid and Planned Parenthood funding. The new legislation, which would convert Medicaid into a block grant over time and defund Planned Parenthood, wouldn't address those concerns.

Sen. John McCain (R-Ariz.) who cast a deciding vote against the last repeal bill, in July, citing the rushed and secretive way in which it was handled, still has process concerns: He wants regular order, with the opportunity for debate and amendments, which would not seem to be possible given the compressed timeline required under Senate rules. The Congressional Budget Office has already indicated it will not have a complete score ready until sometime next month. McCain remains undecided.

Other objections are somewhat more novel. Sen. John Kennedy, (R-La.), for example, said yesterday that he worries that in its current form the bill would let liberal states erect government-run single payer systems. Somehow we have arrived at the point in this debate in which a Republican legislator is worried that passing a bill dubbed Obamacare repeal would actually pave the way for fully government run systems.

His concern is not entirely unfounded, however. The legislation would give states far more flexibility to regulate and manage how Obamacare dollars are spent, meaning that liberal states could plausibly put the block grant money they received toward funding single payer, although it probably wouldn't be enough on its own to make the budget math work.

States that hoped to innovate in a more market oriented direction, meanwhile, would have more flexibility than under current law, but would face more restrictions than their liberal counterparts. The bill would allow all states to experiment, but it is tilted towards experiments in increased government intervention.

The block grant design, meanwhile, has led to criticisms that the bill would not really repeal Obamacare, but would merely kick its administration down to the states while retaining most of its spending. This is the chief objection raised by Sen. Rand Paul (R-Ky.), who has consistently opposed Republican health care legislation this year and has emerged as the chief Republican opponent of the new plan.

In a series of tweets and an op-ed for Fox News, Paul has argued that Graham-Cassidy cannot be legitimately described as Obamacare repeal, because it keeps most of its funding in place, and would retain its requirement that insurers cover all applicants regardless of preexisting conditions.

The bill's block grant formula, Paul says, would redistribute federal money from blue states to red states, because it spreads out the money that is now used to fund Obamacare's Medicaid expansion—which only 31 states participate in—to every state. Essentially, it would take money away from states that expanded Medicaid under Obamacare and give more to states that didn't.

Is it relevant that Paul's home state of Kentucky was one of the states to expand Medicaid? Perhaps. But Paul's description of the underlying political dynamic isn't too far off.

"It just looks like the Republicans are taking the money from the Democrat states and giving it to the Republican states," Paul said Monday. And his worries about the arcane future policy battles the system would set up are worth considering: "So we're going to go through year after year of Republicans fighting Democrats over the formula?" It's hardly clear that Graham-Cassidy would result in a stable policy or political equilibrium.

The bill, then, doesn't really solve any of the problems that have kept previous iterations of Obamacare repeal from passing. Yet Senate Republicans, looking through the prism of months of frustration and failure, might pass it anyway for one reason: This is their final shot, and they promised they would.

It's true that few if any Republicans imagined that repeal and replace would look like this. But few if any Republicans ever imagined what, precisely, repeal and replace would look like at all. With the Senate deadline looming, Republican legislators may see this as imperfect but better than the alternative, which is to do nothing, or to find ways to address the instability of Obamacare's exchanges by propping them up.

It doesn't hurt that in addition to allowing Republicans to say they voted to repeal and replace Obamacare, it would also shift responsibility—and blame—to the states. Although federal formula and funding cliff fights would still loom in the distance, Republicans might convince themselves that in voting for Graham-Cassidy, they would be voting to not have to deal with Obamacare ever again. And after this year's bruising, embarrassing legislative efforts, that might be enough.

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  • Crusty Juggler - Lawbertarian||

    "It just looks like the Republicans are taking the money from the Democrat states and giving it to the Republican states," Paul said Monday. And his worries about the arcane future policy battles the system would set up are worth considering: "So we're going to go through year after year of Republicans fighting Democrats over the formula?"

    You libs just hate it because we're winning! Now it's our turn!

  • buybuydandavis||

    If Republicans actually took *their turn*, playing tit for tat, they'd take *every penny* now going to Blue States for medicare expansion and give it to Red States.

    They would be *justified* in doing so on tit for tat grounds.

    Yet Rand Paul wrings his hands over Republicans proposing to spread that money to Red and Blue States alike as some corrupt Republican plot.

    Cuck.

  • Crusty Juggler - Lawbertarian||

    "It just looks like the Republicans are taking the money from the Democrat states and giving it to the Republican states," Paul said Monday. And his worries about the arcane future policy battles the system would set up are worth considering: "So we're going to go through year after year of Republicans fighting Democrats over the formula?"

    You libs just hate it because we're winning! Now it's our turn!

  • Ra's al Gore||

    Maybe Paul can get a concession or two for his vote.

  • Calidissident||

    Ken Shultz rant incoming in 3, 2, 1 ...

  • chemjeff||

    All this winning! I can't take any more of this winning!

  • Ra's al Gore||

    BTW, there is a new Gruber video out talking about how Bush bailed out RomneyCare.

  • kyleh||

    GOP's healthcare solution is to let health actuaries once again include any risk factor they want in calculating your premium. Next they'll let insurance companies take look at your DNA to help set your premium (see H.R. 1313).

    I'm still waiting for a Republican plan to contain the cost of health care to all Americans. It's not going to happen without price transparency. Republicans could be talking about improving markets for prescription drugs and healthcare services with state-by-state all-payer rate setting or a nationwide surprise-bill law to protect from out-of-network providers who show up at an in-network hospital.

  • Tony||

    Remember when Republicans spent almost an entire decade mocking Nancy Pelosi for saying "You have to read it to find out what's in it," deliberately taking her words out of context, and and are now trying to pass their own healthcare bill without either reading it or having the CBO score it?

    Is John still around? I need someone to explain to me how Republicans can be so fucking monumentally hypocritical, cynical, and stupid and still get out of bed in the morning.

  • Crusty Juggler - Lawbertarian||

    I need someone to explain to me how Republicans can be so fucking monumentally hypocritical, cynical, and stupid and still get out of bed in the morning.

    They're politicians?

  • Tony||

    Oh, so just like Canadian or Japanese MPs. All politicians, all bad hypocrites, no need to look into any specific pathologies of a particular political movement, because they're all just crooks! Ah, being a Republican. It's like getting an A in class because you're the most retarded.

  • Crusty Juggler - Lawbertarian||

    Good take.

  • Unlabelable MJGreen||

    What kind of school did you attend?

  • Hank Phillips||

    Tony is the guy Orwell referred to--the one who believes that communist altruism and fascist altruism are opposites. He therefore has to side with one or the other. He'll eventually realize they're the same thing, and that avoiding initiation of force is the way to go even if it means abandoning altruism and death worship. Besides, there are dozens of fascist sockpuppets in here cross-dressing as LP sympathisers. What's the harm?

  • Leo Kovalensky||

    A particular movement?? You just compared what the Republicans are doing to what the Democrats did on Obamacare, and you're calling the Republicans out specifically? What will you say when Schumer comes out and (hypocritically) says that this bill is being passed without anyone knowing what's in it?

  • mortiscrum||

    Yes, because what the Republicans are doing is not on the same planet compared to what Democrats did. As I listed in another comment, there was actually a great deal of transparency and process in creating and passing the ACA. Now it might be fair to say there should have been even more since the bill was so huge and influential, but it's false to say the bill was crafted in an entirely partisan manner with no public oversight or input. But this is exactly what Republicans have been claiming since 2009.

    Now, they try to pass a bill using a process that entirely fits the accusations they've been making against the ACA. They actually are being entirely partisan and avoiding public oversight as much as they possibly can. The two situations are not the same, at all, and the fact that Republicans were chastising Democrats for something Democrats never actually did and Republicans are now doing is....horrendous? Disgusting? Abominable?

  • Hank Phillips||

    It's like convincing a cigarette smoker to throw the thing in the gutter. Democrats and communists believe there is a huge difference between them and identical (save for a plank or two) Republicans and nationalsocialists. But they haven't a clue as to the dimensions of the units that distinguish these variants of looter altruism. It suffices that they expect truth from looters. One might as well expect health from cigarettes.

  • loveconstitution1789||

    Does the CBO need to score things to repeal them? Didn't think so.

    Republicans and Democrats are equally bad at screwing us taxpayers, most Republicans are just trying to repeal one of the biggest blunders of the 21st Century- ObamaCare.

  • mortiscrum||

    Yeah, but the Republicans are also claiming a "replace" portion to their plan. It's extremely helpful, as well as established tradition, to get a score for new legislation.

    A closer to optimal option would be to have multiple CBO reports, 3 public House committees, 2 Senate committees, have the Senate Health Committee mark it up for 60 hours and 13 days, the Senate Finance Committee do the same for another 8 days (with 130 amendments considered and 79 roll-call votes), and then finally have the full Senate debate for another 25 days. But that's neither here nor there.

  • sweettea71||

    "It's extremely helpful, as well as established tradition, to get a score for new legislation."

    What with the CBO's long track record of getting everything right?

  • loveconstitution1789||

    Cut spending and repeal ObamaCare.

    Repealing ObamaCare would definitely send lefties into a violent rampage. It would be great!

  • Hank Phillips||

    This whole debate is over prohibition, birth control and abortion. Nationalsocialist republicans (like Randal Paul) want 1920s prohibitions on condoms, diaphragms, pills and abortion because Gott Mitt Uns. Internationalsocialist Democrat infiltators push back with laws forcing republicans to pay medical cartel prices for someone else's birth control because altruism. In effect, this is selling reproductive privilege instead of abolishing laws that infringe individual rights of pregnant women. Canada repealed all such laws. Why subject us to looter-press meanderings about the way angst-ridden electees react to their comrades' coercive proposals?

  • Johnimo||

    I think I might want to agree with old Hank? Help me out here, what's "Gott Mitt Uns"? Who are "Internationalsocialist Democrat infiltators"? LOL

    This paragraph is way too much fun!

  • colorblindkid||

    I believe it is the Democrats who are now blocking OTC birth control.

  • Uncle Jay||

    RE: The GOP's New Obamacare Repeal Bill Shouldn't Pass. It Might Anyway.
    A looming Senate deadline might push holdout Republican senators over the line.

    I guess the GOP's promise to repeal Obamacare was bullshit.
    Gee, what a surprise from the party of the gutless.

  • BYODB||


    In a series of tweets and an op-ed for Fox News, Paul has argued that Graham-Cassidy cannot be legitimately described as Obamacare repeal, because it keeps most of its funding in place, and would retain its requirement that insurers cover all applicants regardless of preexisting conditions.


    So, it would fail then. It does indeed appear that Paul is taking the fewest crazy pills on this issue.

  • Johnimo||

    He's smart, because there is NOTHING good going to come of Obamacare and/or its succeeding iterations. It's real simple folks: There's just not enough money to go around. For a less complicated explanation, see Maggie Thatcher's famous opine on "the trouble with socialism."

  • D.Polemiker||

    The creativity of the private sector was once the life-blood of our world-class health care. Now we are witnessing a Republican(?) Senate rushing to exsanguinate a nearly comatose health care system.

  • Rockabilly||

    GOP - The party of limited government

    Oh - it's the part of unlimited government ?

    Republican Platform

    A Rebirth of Constitutional Government

    https://gop.com/platform/we-the-people/

    Whatever man

  • Red Twilight||

    Only total morons believed that.

    There is NOTHING more the Republicans love to do than borrow and spend. And blame the Democrats for taxing and spending

  • ||

    Still seems slightly less bad than Obamacare and will still ultimately fail so whatever. I don't care. Eventually it will come crashing down and then we will either become a single payer system (please no), or actual market base reforms will have to be enacted. Should be a dramatic build up of screaming and hypocritical politicians make lazy talking points. It will be really lame, but I will follow it because I am a weird-o.

  • And you believe that why?||

    Since few people are willing to even acknowledge that we need to control costs by increasing supply, I fully expect we'll have a single-payer boondoggle. Perhaps once this fails, enough people will be open to options that will actually work.

  • swampwiz||

    Let's see ... if this bill passes, the Blue states will set up MediSomething-For-All, and when they take over the federal government in 2021, they will simply up the funding.

  • Leo Kovalensky||

    Worse... this will continue the spiral that Obamacare is in. When the Democrats take over in 2021, they'll pass single payer because only the government can solve the problems that the government creates.

  • The Last American Hero||

    There's a lot of assumptions baked into a 2021 takeover, and while things can change quickly (see 2004 to 2008 to 2016), they are not currently on course to change much.

  • buybuydandavis||

    The bill's block grant formula, Paul says, would redistribute federal money from blue states to red states, because it spreads out the money that is now used to fund Obamacare's Medicaid expansion—which only 31 states participate in—to every state. Essentially, it would take money away from states that expanded Medicaid under Obamacare and give more to states that didn't.

    Is it relevant that Paul's home state of Kentucky was one of the states to expand Medicaid? Perhaps. But Paul's description of the underlying political dynamic isn't too far off.

    "It just looks like the Republicans are taking the money from the Democrat states and giving it to the Republican states,"

    Right now, Blue States get money that Red States don't. Spreading that money to all states seems more in keeping with a Republic than the current "Blue States get money, and Red States suck it".

    To be equivalent to the Obama Banana Republic, Red States would take *all* the money formerly given to Blue States and leave *none* for the Blue States.

    But Rand goes Cuckservative. Sad.

    Not only unwilling to go full tit for tat against the Dems, he even characterizes an even distribution of the funds formerly hoarded by Dems for themselves as some heinous political corruption by Republicans.

  • And you believe that why?||

    I'm not going to bother looking up the dozens of citations that prove, in general, red states get more federal money, compared to what they pay in, than blue states. I've spent enough time trying to debunk this rumor that I don't expect you will bother to read the links anyway.

    What I want to know is who started this rumor and what data they used to justify it. Even a time-frame for when it started would be useful.

  • buybuydandavis||

    The GOP's New Obamacare Repeal Bill Shouldn't Pass. It Might Anyway.

    "Obamacare Now and Forever!"

  • Red Twilight||

    I hope it does.

  • Glen 69||

    Ok people. I am a very dedicated libertarian but we have to take something into consideration. The progressives basically pumped a huge dose of heroin into the American system with the ACA. The best we can hope for is to create a methadone alternative at this point. The block grant is closer to a libertarian model than anything else that has been considered.
    "50 laboratories of innovation" is was what we called for over the last eight years. Well it is being given a chance which is better than being stuck with the ACA for the next century. So please, Rand, pull your head out of the freaking ideological clouds and see this as a chance to do work towards something actually libertarian.

  • sweettea71||

    If it isn't repeal only don't bother. Obamacare will crater shortly. All you need to pass is a single sentence bill...There shall be free-market based healthcare and health insurance.

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