The desperate Republican effort to cobble together the votes necessary to pass legislation that would rewrite Obamacare has now descended into low farce.
For backers of Graham-Cassidy, which supporters have described as a repeal of Obamacare, the number one target is Alaska Senator Lisa Murkowski, who was one of three Senate Republicans who voted against a previous repeal plan in July. The way they are trying to win her over is by offering legislative kickbacks that are explicitly designed to help Murkowski's home state.
One funding boost was already included in the initial draft of the legislation. A report this afternoon indicates that the chief backers of the bill, Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) are looking to add several more carve outs that would specifically target Alaska. If added to the legislation, these carve outs would let Alaska escape the core features of Graham-Cassidy.
In essence, they would be attempting to bribe Murkowski to vote to repeal Obamacare by letting her state keep Obamacare.
The core idea behind the Graham-Cassidy legislation is to convert Obamacare into a system of block grants. Medicaid would be transformed into a per-capita grant, meaning that funding would be capped per individual. Obamacare's premium tax credits for people buying insurance through state health insurance exchanges would be eliminated. Instead, that money would be given to states, which would have more leeway to determine how it is spent.
But according to a report by IJR's Haley Byrd, based on information provided by a GOP Senate aide, Sens. Graham and Cassidy are working on a new draft that would keep Obamacare's premium tax credits in place in Alaska and Hawaii, delay the implementation of the per-capita grants the legislation envisions for Medicaid for both states, and provide both with an additional boost to federal Medicaid funding.
It is possible that these changes will not be inserted into the legislation. But if they were, Alaska would effectively be exempt from the fundamental policy changes that Graham-Cassidy seeks to enact. Adding these provisions to the legislation would constitute an implicit admission that its most prominent reforms are not necessary.
Indeed, the attempted bribe appears to be even more brazen than that. These exemptions would reportedly come in addition to the block grant that Alaska was already scheduled to receive under the proposed legislation.
In other words, Alaska would not merely be allowed to keep Obamacare in its current form. It would also be given a large infusion of new money from the block grant. It would be a bribe on top of a bribe.
This would not be the first attempt to buy Murkowski's vote with bonus funding targeted at Alaska. The initial draft of the legislation included additional Medicaid money for "low-density states" that have unusually high per-capita health care spending—which curiously seems to apply only to Alaska and possibly North Dakota.
There is real merit to the idea that states should be allowed more flexibility to regulate their health care systems. But there are serious questions about whether this legislation would provide the sort of flexibility its supporters claim.
Yet what the effort to woo Murkowski shows is that Republicans who support Graham-Cassidy are not attempting to win votes for the bill by making the case for its substantive merits. Indeed, few even seem to understand the mechanics of how it would work.
Instead, they are attempting to buy off wavering lawmakers with transparent bribery that not only adds to the cost of the law, but undermines the chief argument for its necessity. If this indicates the general quality of the arguments in favor of the bill, then it does not deserve to pass.