Collins’ care bill ‘no’ dims hopes of GOP
WASHINGTON — The latest Republican attempt to end President Barack Obama’s health care law was in jeopardy Monday as Maine Sen. Susan Collins announced her opposition to the proposal.
Collins said in a statement that the legislation would make “devastating” cuts in the Medicaid program for poor and disabled people, drive up premiums for millions and weaken protections that the Patient Protection and Affordable Care Act gives people with pre-existing medical conditions. She said the legislation is “deeply flawed,” despite eleventh-hour changes its sponsors have made in search of support.
Collins told reporters that she made her decision despite a phone call from President Donald Trump, who’s been trying to press GOP senators to back the measure.
“Today, we find out that there is now a fourth version of the Graham-Cassidy proposal, which is as deeply flawed as the previous iterations,” Collins said in her
statement, referring to the proposal by GOP Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. “The fact that a new version of this bill was released the very week we are supposed to vote compounds the problem.”
She added: “This is simply not the way that we should be approaching an important and complex issue that must be handled thoughtfully and fairly for all Americans.”
The Senate must vote this week for Republicans to have any chance of prevailing with their narrow margin. On Sunday, protections expire against a Democratic filibuster, bill-killing delays that Republicans lack the votes to overcome.
Sen. John Thune, R-S.D., told reporters that a “lot of conversations are going on.” But he conceded that a revival would be “a heavy lift” and the prospects were “bleak.”
Arizona Sen. John McCain, who killed a repeal effort in July with a dramatic late-night vote, faulted Republicans for trying to pass sweeping health care legislation without the participation of Democrats or fulsome public deliberations about the undertaking.
The Senate in July rejected three attempts to pass legislation erasing Obama’s 2010 statute. The GOP has for years made promises to scrap the law, and its struggles to deliver despite controlling the White House and Congress has infuriated conservatives whose votes Republican candidates need.
Republicans had pinned their latest hopes on the Graham-Cassidy measure. It would end the Affordable Care Act’s Medicaid expansion and subsidies for consumers and would ship the money — $1.2 trillion through 2026 — to states to use on health services with few constraints.
With their narrow 52-48 majority and solid Democratic opposition, three GOP “no” votes would doom the bill. GOP Sens. Rand Paul of Kentucky and Texas’ Ted Cruz have said they oppose the measure, though Cruz aides said he was seeking changes that would let him vote in favor.
Sen. Lisa Murkowski, R-Alaska, remains undecided. Murkowski, who voted against the failed GOP bills in July, has said she’s analyzing the measure’s effect on her state, where medical costs are high.
It was unclear if Senate Majority Leader Mitch McConnell, R-Ky., would hold a roll call. Thune said he believed McConnell would hold a vote if Republicans “have at least some hope that we would pass it.”
Collins announced her decision shortly after the nonpartisan Congressional Budget Office said “millions” of Americans would lose coverage under the bill and projected it would impose $1 trillion in Medicaid cuts through 2026.
“Enrollment in Medicaid would be substantially lower because of large reductions in federal funding for that program,” the budget office said. In addition, it said, the number of people buying insurance on their own would be lower because of reductions in federal subsidies for such coverage.
Moreover, “funding would shift away from states that expanded eligibility for Medicaid under the Affordable Care Act,” the budget office said, “and toward states that did not.” Thirty-one states — including California, Massachusetts, New York and Pennsylvania — and the District of Columbia have expanded eligibility.
Arkansas also expanded Medicaid, and former Gov. Mike Beebe said in a statement that the Graham-Cassidy bill would hurt Arkansas by ending Medicaid expansion. Beebe credited the expansion for giving health coverage to more than 300,000 Arkansans, helping the state’s economy and reducing the cost to hospitals of providing unreimbursed care to the uninsured.
The expansion was authorized under legislation passed by the state’s Republican-controlled Legislature and signed by Beebe, a Democrat, in 2013.
The expansion extended Medicaid eligibility to Arkansas adults with incomes of up to 138 percent of the poverty level: $16,643 for an individual, for instance, or $33,948 for a family of four.
BILL REVISIONS
Desperate to win over reluctant senators, GOP leaders revised the measure several times, adding money late Sunday for Alaska, Arizona, Kentucky, Maine and Texas in a clear pitch for Republican holdouts. They also gave states the ability — without federal permission — to permit insurers to charge people with serious illnesses higher premiums and to sell low-premium policies with big coverage gaps and high deductibles.
Collins said the eleventh-hour revision of the Graham-Cassidy bill “epitomizes the problems” with the GOP-only process.
Collins’ decision drew a shout-out from late night talkshow host Jimmy Kimmel, who tweeted: “Thank you @SenatorCollins for putting people ahead of party. We are all in your debt.” Kimmel had been an outspoken critic of the bill.
Cassidy acknowledged the new version would provide
more funding to Alaska and Maine compared with the first iteration of his bill, stressing that it would include $1 billion more in block grants for Maine. And he expressed hope that might put Collins in the measure’s favor.
“If there’s a billion more going to Maine … that’s a heck of a lot,” Cassidy said. “It’s not for Susan, it’s for the Mainers. But she cares so passionately about those Mainers, I’m hoping those extra dollars going to her state … would make a difference to her.”
Kentucky’s Paul said the bill costs too much and said Republicans were motivated by fear of punishment by conservative voters if they failed.
“It’s like a kidney stone. Pass it, pass it, pass it,” Paul told reporters.
Loud protesters forced the Senate Finance Committee to briefly delay the chamber’s first and only hearing on the issue. Police lugged some demonstrators out of the hearing room and trundled out others in wheelchairs as scores chanted, “No cuts to Medicaid, save our liberty.”
Cassidy and Graham defended their bill before the Finance committee.
“I don’t need a lecture from anybody about health care,” Graham told the panel’s Democrats. Referring to Obama’s overhaul, he added, “What you have created isn’t working.”
Also on Monday, Trump took on McCain, who’d returned to the Senate after a brain cancer diagnosis in July to cast the key vote that wrecked this summer’s effort. Trump called that “a tremendous slap in the face of the Republican Party” in a call to the Rick & Bubba Show, an Alabama-based talk radio program.
Trump added Monday night on Twitter: “A few of the many clips of John McCain talking about Repealing & Replacing O’Care. My oh my has he changed - complete turn from years of talk!”
Trump’s tweet accompanied six minutes and 24 seconds of clips of McCain promising to repeal and replace the Affordable Care Act over the years.
Asked during a CNN debate Monday night about Trump’s tweets, Graham said McCain was willing to die for his country and that he can vote any way he wants. McCain was a Navy pilot whose plane was shot down over Vietnam. He spent more than five years as a prisoner of war.