UPDATE: McConnell to cancel vote on Graham-Cassidy; GOP moves on to tax reform

UPDATE 3 — 9/26, 3:05 pm. EDT: NPR is reporting Senate Majority Leader Mitch McConnell will cancel a previously scheduled vote on the GOP’s latest healthcare bill, legislation co-sponsored by Sens. Lindsey Graham and Bill Cassidy. 

McConnell’s decision comes following the expected announcement by Susan Collins (R-Maine) Monday that she opposes the legislation.

Both President Trump and House Speaker Ryan are looking forward to Wednesday when the GOP will roll-out its “historic tax reform” proposal.

 

UPDATE 2 — 9/24, 9:38 p.m. EDT: Speaking at the Texas Tribune festival in Austin Sunday, Ted Cruz said he opposes Graham-Cassidy in its present form, as amendments he proposed along with Utah’s Mike Lee were left out of the bill.

Cruz’s announcement, along with Maine’s Susan Collins indicating she will most likely also vote ‘no’, puts the GOP’s latest Obamacare repeal effort in serious jeopardy unless Republican leadership can convince at least a pair of Democratic senators to support it.

 

UPDATE — 9/23, 10:08 a.m. EDT: President Trump tweeted the following in response to John McCain’s Friday announcement he would not support the latest Senate Republican healthcare plan to replace the ACA.

Not giving up on the bill’s prospects, Trump also signaled confidence Sens. Paul and Murkowski could be persuaded to vote for the bill when it comes to floor as early as next week.

 

Senate Majority Leader Mitch McConnell’s office announced Wednesday the GOP’s latest effort to repeal the Affordable Care Act (ACA), the Graham-Cassidy bill, is tentatively set for a floor vote next week.

Graham-Cassidy removes the least popular provision of Obamacare, the individual mandate, which requires those between the ages of 18 and 65 to purchase health insurance either through their employer or on government-run exchanges.  Subsidies provided to those within 138–400 percent of the federal poverty level to assist in purchasing insurance through the exchanges would also be eliminated.

For low income individuals, Medicaid was expanded under the ACA for citizens within 138 percent of the federal poverty level.

A 2012 Supreme Court decision upholding the ACA made it optional for states to participate in this expansion.  The 31 states that elected to participate had 90 percent of its costs covered by the federal government until 2020 — 80 percent thereafter.  This extended funding would also be ended under Graham-Cassidy, replaced by block grants.

According to the Kaiser Family Foundation, 30 of the 31 states that have expanded will see a decrease in funding from 2020–2026 in the billions while 15 of 19 states that did not expand will see an increase.

Procedurally, the bill will be voted on under budget reconciliation so that it cannot be filibustered in the Senate, thus requiring only 51 “yes” votes.  Because the reconciliation process can only be used in the Senate once every fiscal year, which ends Sept. 30, the bill will have to be voted on before the end of the month.

Additionally, the Congressional Budget Office (CBO) will able to score the Graham–Cassidy’s financial impact — not its impact on the uninsured — before the end of FY 2017 .  The CBOs analyses of two previous Obamacare repeal bills estimated that 23 and 24 million would lose health coverage, respectively.

In response to the renewed repeal effort, a bipartisan group of 10 governors, consisting of four Republicans, five Democrats and one independent, have signed a letter addressed to Leader McConnell urging him not to pursue this legislation.

Except for Virginia, the governors endorsing a “no” vote all come from states that have expanded Medicaid. All states with the possible exception of Montana and Virginia in the above map stand to lose billions of dollars under the proposed law.

On Friday, Sen. John McCain (R-Ariz.), who represents a state that expanded Medicaid and stands to lose up to $15 billion in subsidies, has come out against the proposed legislation, joining Sen. Rand Paul (R-Ky.)

“I believe we could do better working together, Republicans and Democrats, and have not yet really tried,” McCain said. “Nor could I support it without knowing how much it will cost, how it will effect insurance premiums, and how many people will be helped or hurt by it.”

Responding later in the day, Sen. Lindsey Graham (R-S.C.) vowed to continue to try and repeal Obamacare by returning healthcare regulatory authority to the states.

The remaining Republican swing votes on the bill are Alaska’s Lisa Murkowski and Maine’s Susan Collins. One of the two’s descension would mean Democratic “yes” votes will be required for Graham–Cassidy’s passage in Congress’ upper chamber.

Other states, such as Pennsylvania, are at a budget impasse and will be harmed by the legislation. Keystone State Republican Senator Pat Toomey is still undecided about how he will vote.

 

Editor’s note: This article has been updated.

 

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