One of the reasons that the effort to repeal the Affordable Care Act met a dramatic late-night demise in July was the criticism that GOP lawmakers held no actual hearings on this matter that could directly impact many millions of Americans. As Republican senators look to make one last try at repeal before their clock runs out, legislators are finally holding their first, but ultimately pointless, public hearing on healthcare.
I’m just a bill…
Ordinarily a bill goes through an iterative process before it becomes law. The path goes something like this:
- One or more Senators introduce it
- The bill is then referred to relevant committee(s)
- The committee(s) hold one or more hearings and markup sessions on bill, debating its merits and adding or subtracting language (amendments)
- The final, amended bill passes committee by majority vote
- The full Senate then votes on the bill after committees are done
That’s regular procedure. But when you go through the regular procedure, in the regular way, for a regular bill, you run the procedural risk of needing to have at least 60 Senators on your side in order to move forward.
That’s clearly not going to happen with ACA repeal proposals, which are universally unpopular with the Senate’s 48 Democrats (and Democratic-caucusing independents). So all of the the ACA repeal efforts have been moving through a process called budget reconciliation.
To put it briefly, budget reconciliation allows certain types of bills to be fast-tracked through the Senate with only a simple majority. Since Vice President Mike Pence holds the tie-breaker, the GOP need only get to 50 “yea” votes in order to pass the bill.
At the same time, this all has to happen by Sept. 30, which is the end of the federal government’s fiscal year. Any bill passed after that would have to go through the normal channels and would need the 60 votes to end debate in the Senate.
Out of the ordinary
The failed July bill did not go through any committee hearings, which was one of Sen. John McCain’s (AZ) key objections when he voted it down.
“We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people,” McCain said at the time. Other Senators also called for a return to “regular order” in the wake of the July mess.
And so, a hearing.
Sen. Ron Johnson (WI), one of the co-sponsors of the Graham-Cassidy bill, personally promised that the bill would get at least one proper committee hearing. He could bring it before his committee, he said: Homeland Security.
“I’m chairman of Homeland Security,” Johnson said. “If either the Finance Committee or [Health, Education, Labor and Pensions] Committee won’t hold a hearing, I’ll notice one this afternoon. We’ll hold a hearing on this prior to September 30th.” And he did indeed put a hearing on the Homeland Security calendar for Sept. 26.
If that sounds ridiculous to you, you’re right: The Homeland Security and Governmental Affairs Committee has nothing at all to do with healthcare or health insurance legislation. There’s no real overlap.
But Johnson’s political dare paid off: Sen. Orrin Hatch (UT), chair of the Senate Finance Committee, agreed to hold a hearing on the proposal on Monday, Sept. 25. The relevant testimony and witness list are yet to be determined.
“Senators have expressed a strong desire to examine the details of the Graham-Cassidy proposal through a public hearing,” Hatch said in a statement. “A hearing will allow members on both sides of the aisle to delve deeper into its policy and gain a better understanding of what the authors hope to achieve.”
The hearing, however, is largely for show — to tick a box and say they did it. Aside from a few wild cards, Senators’ minds are already made up along partisan and ideological lines.
And what do they hope to achieve?
The one leg up that the Graham-Cassidy bill has over McConnell’s summer attempts is that it’s not being hidden or kept secret. But other than that, it’s a very similar pile of cuts, likely to have consequences every inch as dire… if not worse.
The Congressional Budget Office, tasked with analyzing potential legislation to run the numbers on it likeliest outcomes, won’t have time to churn out a full, deep-diving report on the Graham-Cassidy proposal. However, it is expected to release a high-level, preliminary sketch early next week.
Anyone with a pre-existing condition would be at risk for incessantly skyrocketing premiums under Graham-Cassidy, Vox reports. The non-partisan Center on Budget and Policy Priorities also finds that federal healthcare funding — to programs like Medicaid and individual subsidies — would be slashed by hundreds of billions of dollars over the next ten years.
The American Medical Association sent a letter [PDF] to the offices of McConnell and Senate Minority Leader Chuck Schumer (NY) asking the Senate to reject Graham-Cassidy because it “would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care.”
Other organizations voicing opposition include the AARP, the American Cancer Society, Cancer Action Network, the American Diabetes Association, the American Heart Association, the American Lung Association, the Arthritis Foundation, the National Health Council, and the March of Dimes, among others.
How’s that math?
There are 52 Republican Senators and one Vice President — so to get to 51 votes, McConnell can only afford to lose three.
An analysis by the numbers-minded folks at FiveThirtyEight concludes that 46 votes are a sure thing or a nearly sure thing right out of the gate. That leaves a couple of likely “no” votes and four “wild cards” to contend with.
Sen. Rand Paul (KY) has already gone on the record in opposition, both in various Tweets and in an op-ed for Fox News. Paul’s opposition comes from the far conservative side: He believes that Graham-Cassidy does not go far enough to remove all traces of the ACA from the world. However, Paul also originally had stringent objections to the July bill at first, before changing his mind and voting for it anyway — so it’s anyone’s guess where his vote would actually fall.
The same is true of Utah Sen. Mike Lee, who also initially opposed the July bill for being insufficiently conservative before then voting for it anyway.
Sen. McCain has indicated that he might be amenable to voting “reluctantly” in favor, but said his approval was contingent on whether the governor of Arizona felt the Graham-Cassidy would help or hate the people of that state. Gov. Doug Ducey put out a statement endorsing Graham-Cassidy on Monday, and so now McCain is considered more likely to go for it.
The other two holdouts in July were Sens. Susan Collins (ME) and Lisa Murkowski (AK). Both objected to deep cuts to Medicaid and other healthcare spending that would negatively affect the populations of their states — and since the new bill provides for cuts that are either equally as bad or worse, all eyes are on Collins and Murkowski to renew their objections once again.
Neither, however, has yet gone on the record with either full opposition or support. The Portland Press-Herald reports that Collins has “concerns” with the Graham-Cassidy proposal, particularly with regards to Medicaid.
Murkowski is also a long shot to bring on board, CNN reports, because the Graham-Cassidy proposal, as written, would likely be a losing proposition for Alaska overall. Alaska’s governor has come out against the bill.
But as Axios reports, the Trump Administration has gone all-in on trying to sway every single Republican Senator to support the proposal — and so we are once again, as a nation, on tenterhooks, waiting to see which way the breeze blows up on Capitol Hill in the coming days.