WASHINGTON — GOP Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin released legislation Wednesday to repeal and replace major portions of Obamacare with a system of block grants, a first step towards making good on a seven-year Republican campaign promise.
“Behind me is the only thing between you and single-payer health care,” Graham said Wednesday. “If you believe repealing and replacing Obamacare is a good idea, this is your best and only chance to make that happen.”
The bill would replace Obamacare’s Medicaid expansion, subsidies for private insurance companies (cost-sharing reductions) and tax-credits for middle-income Americans with block grants. The new funding mechanism would start in 2020 and would provide states with the opportunity to apply for grants from a pool of $136 billion. That pool would grow nearly 50 percent in six years, reaching $200 billion in 2026. The legislation does not provide permanent funding for the block grant program, funding would have to be addressed again in 2026.
The legislation does include two features of previous Republican proposals to repeal Obamacare. It would repeal both the individual and employer mandates to purchase insurance, which consumers and businesses have lamented since 2014.
Effectively, what the senators described Wednesday is a bill that would put a great deal of “power” back in the hands of the states. Under the legislation, states could innovate as to how they choose to implement features of the Affordable Care Act, as long as they include protections for those with pre-existing conditions.
Obamacare already grants states some ability to choose how they implement Obamacare with 1332 waivers, which allow states to tailor Obamacare as long as they meet the basic ACA protections. The senators said Wendnesday that the flexibility provided to states through their bill would be tied to block grants. Under their plan, states would be allowed to manage their own health care programs, with less oversight from federal agencies.
Republicans seven month long effort to upend the American health care system failed in late July, after three Republican senators – John McCain of Arizona, Lisa Murkowski of Alaska and Susan Collins of Maine – voted down the party’s third and final (until now) proposal to repeal Obamacare. Some Republicans have motioned it is time for the party to move on to other legislative goals, like tax reform, but Graham thinks there is still enough support for trying one more time to repeal and replace former President Barack Obama’s landmark health care law.
“There is a lot of fight left in the Republican Party to repeal and replace Obamacare,” Graham promised. “The question is, is there any fight left in Washington to repeal and replace Obamacare.”
The South Carolina senator publicly called out Senate Majority Leader Mitch McConnell Wednesday, saying the only thing stopping this bill from getting to the floor of the Senate is lack of leadership. Graham said this bill provides voters a choice between more government interference in the market, which he repeatedly said Sen. Bernie Sanders of Vermont’s Medicare-For-All bill would bring, or more state flexibility and opportunities for competition.
“What Graham-Cassidy-Dean-Heller does is it returns that power to the states. It makes states more responsible, more responsive,” Johnson said. “For my Republican colleagues, if this isn’t quite good enought, if it doesn’t do enough repeal, this is our last shot … This is far better than Obamacare.”
Former Sen. Rick Santorum of Pennsylvania said that those who are hesitant to support the bill because it doesn’t repeal Obamacare entirely should focus on the fact that this will be one of the most historic reforms in the history of Washington.
Graham told reporters that he is working with McConnell to move the bill through Congress, but the majority leader told him he needs to get to “50 votes,” which is the threshold for passing the bill under the Senate’s budget reconciliation.
Graham said he is not ready to move on from health care, and wants the president, who repeatedly pressed senators to pass an Obamacare repeal bill during the summer, to become more involved. “Mr. President, help us because we are trying to help you,” Graham said.
The senators said they likely don’t have the votes yet, but Graham hinted multiple times that if the president can help get governors behind the proposal, senators would follow suit.
“The idea that we can do this by ourselves is unreasonable,” Graham said. “If we leave health care…it will be because Democrats said, ‘no.’”
“This is our last and best shot for the Republican Party to show that we have ideas and our ideas are better than the other side,” Graham said.
The senators face a great number of challenges in their push to get the bill through the House, the Senate and to Trump in under three weeks. The bill has yet to have a public hearing in any congressional committee, which was a chief criticism of the Republicans recent efforts to repeal and replace Obamacare, and it hasn’t been scored by the non-partisan budget agency, the Congressional Budget Office (CBO).
While these three senators toy with the idea of repealing Obamacare, more than a dozen Republican and Democratic senators are working on a solution to fix the problems with Obamacare, seemingly dropping all discussions of repealing and replacing the current system.
Senate Health Committee Chairman Lamar Alexander kicked off a series of hearings in early September that are focused on finding a way to both stabilize the Affordable Care Act and individual health insurance marketplaces and prevent premiums from soaring in 2018. Soaring premiums have been a persistent problem for individuals enrolled on the Obamacare state exchanges. Alexander hopes to have a piece of legislation crafted by Sept. 15.
While Republicans mull over these proposals, roughly a dozen Senate Democrats are rallying behind legislation that aims to expand Medicare and create a single-payer health care system in America. The bill is known as “Medicare-For-All,” and is championed by Sen. Bernie Sanders of Vermont.
While little is known about the specifics of the legislation, a number of prominent Democratic senators have jumped on board. Sens. Elizabeth Warren of Massachusetts, Kirsten Gillibrand of New York, Kamala Harris of California, Mazie Hirono of Hawaii, Richard Blumenthal of Connecticut, Cory Booker of New Jersey, Brian Schatz of Hawaii, and Tom Udall of New Mexico all plan to attend Sanders announcement Wednesday. Booker, Gillibrand, Harris and Warren have also joined Sanders as co-sponsors of the bill.