Senator Susan Collins (R-ME) told CNN’s Jake Tapper on State of The Union on Sunday that “it’s very difficult” to envision a scenario where she would vote for the latest Obamacare repeal bill, dubbed “Graham-Cassidy.” She said she will definitively decide Monday, after the Congressional Budget Office (CBO) releases its preliminary estimates on the bill.
But Senator Bill Cassidy (R-LA) — one of the bill’s drafters — said on ABC’s This Week that parts of tomorrow’s CBO score will no longer be relevant because he’s introducing another bill, which the agency has not scored yet. He said that score — like the vote — will come later in the week. During the previous repeal attempt, senators had to vote on a bill for which the CBO score was released just hours beforehand.
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Among Collins’ concerns about the bill are its cuts to Medicaid, potential premium spikes, and lack of consumer protections, specifically for patients with pre-existing conditions.
The bill, first proposed by Sens. Lindsey Graham (R-SC) and Cassidy, would repeal the Affordable Care Act (ACA) marketplace subsidies and Medicaid expansion in 2020. The federal government would replace the previous funding stream and instead allow states to create their own block grant program. The formula is written in such a way that money is transferred from states that saw higher coverage gains under the ACA, which were predominately blue states, to those who saw lower gains, which were predominately red states.
States — through waiver authority — can also roll back essential health benefits and allow insurers to raise premiums for sick patients or those with pre-existing conditions. Concurrently, starting in 2020, the proposal converts Medicaid — for low-income adults, children, elderly, and disabled — from a program that has an open-ended federal financing to one that is limited to a set amount per enrollee.
The CBO will release its preliminary score Monday morning, according to Collins, but its analysis will be without estimates on health insurance coverage or premiums until after lawmakers are scheduled to vote. Senators are expected to vote this week — before September 30, the last day Republicans can pass their health bill with just 51 votes under current budget rules.
Already, two senators announced they were voting against the Graham-Cassidy bill. On Friday, Sen. John McCain (R-AZ) — a close friend of Graham’s — released a statement saying he could not, in good conscience, vote for the bill, making him the second public no. Sen. Rand Paul (R-KY) has taken to Twitter nearly every day, saying he will vote no for the bill, though he indicated on Sunday that he could change his mind if the block grants are removed from the proposal.
Despite the opposition from these senators and virtually every major medical organization in the country, the White House remains confident they’ll get the votes needed — at least publicly. On Fox News Sunday, White House Director of Legislative Affairs Marc Short insisted that the effort to repeal and replace the Affordable Health Care Act is not dead and said the White House is still working to win the support of a handful of senators, including Paul.
“This administration has stood for life and this bill protects the sanctity of life by denying taxpayer dollars going to fund abortions,” said Short. “If Rand Paul is the final vote here, it’s hard to see how he can go to his pro-life supporters and say: I had the chance to protect life and instead I went the other way.”
McCain, Collins, and Sen. Lisa Murkowski (R-AK) voted against the Republican’s last GOP health bill, seemingly killing the ACA repeal effort in July. But Graham and Cassidy resurrected ACA repeal-and-replace with their proposal, effectively killing bipartisan health talks.
The process has been more rushed, as the bill’s legislative text was introduced less than two weeks ago. There will only be one hearing before the Senate Finance Committee on Monday. Additionally, there will be a limited analysis by the CBO given the agency’s short timeframe to thoroughly assess the bill. Given the lack of comprehensive analysis, think tanks and health organizations have tried to fulfill the role. Bipartisan health care consulting firm Avalere estimates that between 2020 and 2027, federal funding under the new block grants would be $489 billion less than under current health financing. The non-partisan Brookings Institution estimated that 21 million fewer people will have insurance by 2026.
Collins said that she’s been in talks with Vice President Mike Pence about the GOP health bill, and he’s been showing her numbers on what it would mean for Maine residents. According to White House numbers obtained by Axios, Maine would see a 44 percent increase in federal funds in 2026. The numbers do not account for all the cuts proposed in the health bill.
When pressed by Tapper on whether her criticisms to the bill and process means she will vote no, Collins said “I’m going to know tomorrow morning whether or not CBO reinforces the concerns and reservations that I already have, based on the studies that you’ve cited or whether CBO is going to say that they can’t come up with the kind of in depth analysis that the agency usually does.” And added, “or maybe there’ll be a surprise in there. I don’t anticipate that, but I want to wait.”