Revised Graham-Cassidy Bill Appears Short of Votes

The Graham-Cassidy Senate plan to repeal and replace the Affordable Care Act (ACA) appeared to have few paths to passage before the deadline to use a budget maneuver that needs only 50 votes, after Senator Susan Collins, R-Maine, said late Monday she would not support it.

In a prepared statement, she said, “Expert projections show that more than $1 trillion would be taken out of the Medicaid program between the years 2020 and 2036. This would have a devastating impact to a program that has been on the books for 50 years and provides healthcare to our most vulnerable citizens, including disabled children and low-income seniors.”

Collins’ announcement came after a day in which Capitol Hill police hauled people with disabilities out of a hearing on the bill and an analysis from Avalere Health on the latest version of the bill found it would reduce federal funding to states by $4 trillion over 20 years. The plan's leading sponsors are Senators Lindsey Graham, R-South Carolina, and Bill Cassidy, R-Louisiana. Cassidy is a medical doctor who previously worked with Collins on a plan that would let states keep the ACA if they wished.

The Avalere analysis came hours after the Congressional Budget Office scrambled to offer a statement on the updated version of Graham-Cassidy, giving this assessment: “Funding would shift away from states that expanded eligibility for Medicaid under the ACA and toward states that did not.” An analysis of the earlier version of Graham-Cassidy found that New York and California would lose a combined $123 billion through 2026 while Texas would gain $35 billion.

Since President Donald Trump took office in January, Republicans in Congress have tried to use the budget resolution process to replace the ACA with just 50 Senate votes, plus a tiebreaker from Vice President Mike Pence. This would avoid the need for 60 votes to break a Senate filibuster. But a budget resolution to fund the government is needed by this weekend, before the new fiscal year begins October 1, 2017.

Collins joins Republicans Rand Paul of Kentucky and John McCain of Arizona in opposing the bill; as of noon, when the Senate Republicans were set to have their weekly Tuesday lunch, there was no word whether Alaska Senator Lisa Murkowski would oppose the bill as she had a previous version. Paul had offered a list of demands to change his vote, but these would be unlikely to win back support from Murkowski. Reports indicated Senate leaders had attempted to include provisions in the bill that would aid Maine and Alaska in an effort to woo Collins and Murkowksi.

In her statement, Collins, a long-time advocate for people living with diabetes, said both versions of Graham-Cassidy would “open the door for states to weaken provisions for people with pre-existing conditions, such as asthma, cancer, heart disease, arthritis, and diabetes. Some states could also allow higher premiums for individuals with pre-existing conditions, potentially making their insurance unaffordable.” She also warned against eliminating coverage for categories such as mental health or substance abuse.

McCain, meanwhile, has opposed the bill because he wants the Senate to follow “regular order” by having committee hearings and seeking a bipartisan fix to the problems with the ACA. Senators Lamar Alexander, R-Tennessee, and Patty Murray, D-Washington, have been doing this through the Senate Health, Education, Labor, and Pensions Committee, but that process was suspended when leaders pressed for passage of the Graham-Cassidy plan before the September 30 deadline.