Like a reanimated corpse in the final frames of a horror film, the Republican effort to repeal the Affordable Care Act lurched back to life this week, giving the American public one last jump scare. Majority Leader Mitch McConnell has promised the Senate will hold a vote on the new Graham-Cassidy bill before his window to repeal Obamacare with a simple majority closes next Friday.
If that seems fast, well, that’s because it is – so fast the Congressional Budget Office hasn’t had time to assess the impact the legislation would have on the federal budget, the health care industry (about one-sixth of the U.S. economy), or premiums and coverage. It’s so fast, McConnell hasn’t had time to make sure he even has the votes to pass it. And it’s so fast, some Republican senators who are supporting it can’t even say what it does.
Here’s what we don’t know about Graham-Cassidy.
How many people would lose coverage if it were passed
Because it won’t get a CBO score before it’s voted on, we don’t know how many people would lose health care coverage under the new bill. What we do know is that Graham-Cassidy, like previous versions of repeal legislation, revokes subsidies for the marketplace as well as federal funding for Medicaid expansion. In that past, the CBO has estimated that those actions would result in 32 million Americans losing their health care coverage over ten years. Some analysts, like the Center for Budget and Policy Priorities, USC’s Schaeffer School for Health Policy and Economics and Brookings Institute, say coverage losses could be even higher under this bill because of its other changes to Medicaid.
Whether it will cover pre-existing conditions
Trump says it will, but the bill itself offers states waivers that would allow them to charge sick people higher rates than healthy ones – a practice outlawed by Obamacare – as long as a state “intends to maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions.” That means coverage for people with pre-existing conditions would vary from state to state, and coverage could easily (and legally) cost a lot more than a patient can afford, effectively nullifying the promised coverage.
If it has enough votes to pass
As with past Republican repeal efforts in the Senate, Mitch McConnell must scrape together 50 votes to pass the legislation, with a tie-break vote from Vice President Mike Pence. And, as with past efforts, those last few votes will be crucial. Rand Paul, who voted in favor of Senate Republicans’ last health care bill – so-called “skinny repeal” – has come out strongly against Graham-Cassidy, characterizing it as “ObamaCare Lite” and vowing to vote against it.
John McCain, who famously tanked skinny repeal when the process that produced it didn’t qualify as “regular order,” has said Graham-Cassidy fails that same test. (A single hearing on the bill is scheduled for next week.) “I cannot in good conscience vote for the Graham-Cassidy proposal,” McCain said in a statement Friday.
Susan Collins and Lisa Murkowski, both of whom voted against previous iterations of repeal legislation, haven’t announced their positions. The bill’s co-sponsors are making an aggressive play for Murkowski’s support, though – reports surfaced Thursday afternoon that Lindsey Graham and Bill Cassidy were offering a special deal that would, among other deal-sweeteners, preserve Obamacare’s premium tax credits for Alaska and Hawaii while still repealing for other states.