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As clock ticks, uncertainty surrounds latest Obamacare repeal effort

Sen. Joni Ernst, R-Iowa, speaks to KHQA from Capitol Hill on Sep. 20, 2017. (SBG)

With a little more than a week until a legislative deadline that could scuttle Republican dreams of repealing the Affordable Care Act, supporters and opponents of the latest GOP health care reform bill are making their pitches to the public and to their few undecided colleagues.

Due to Senate rules, Republicans only have until September 30 to pass a replacement for the health care law, also known as Obamacare, with a simple majority vote through the reconciliation process. After that, they will likely need 60 votes for any major reforms, and Democrats have no desire to help dismantle President Obama’s biggest legislative achievement.

The Cassidy-Graham bill, co-sponsored by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., would turn federal funds provided to states under the ACA into block grants that states would have greater flexibility in spending. With 52 Republicans in the Senate, GOP leadership can only afford to lose two votes, relying on Vice President Mike Pence to deliver a tie-breaking vote.

Though they do not have commitments from 50 senators yet, the bill’s authors insist they are very close and they are confident they will get there before the end of next week.

Sen. Joni Ernst, R-Iowa, said it is important for Republicans to follow through on their promise to repeal and replace the Affordable Care Act, pointing to the negative impact its provisions have had on some Iowa families.

“I have spoken to so many Iowans across the state that are really hurting from the effects of Obamacare,” she said.

Iowa is one of many states where there is only one insurer left offering plans on the individual marketplace in some areas, a scenario that leaves some patients priced out of the market with no other options.

“We have one statewide individual insurance carrier and those rates have increased substantially over the past number of years,” she said. “We have families that can no longer afford their insurance and once they’ve canceled their policy, there’s nowhere for them to go because there is only one provider.”

Under the Cassidy-Graham bill, many states would see a significant cut in funds over the next ten years compared to what they would receive under the ACA. Critics say having less money will lead to cuts in services and coverage.

Cassidy disputed allegations that people would lose coverage under his plan in an appearance on CNN Wednesday.

“More people will have coverage, and we protect those with pre-existing conditions,” he said.

Some independent analyses have concluded the bill would likely lead to reductions in coverage, but the non-partisan Congressional Budget Office says it will be unable to weigh in on the impact on coverage before the deadline for a vote.

Despite the urgency Ernst and others have placed on what could be their last chance to pass health care reform with a simple majority vote, lawmakers who sank the previous vote have not embraced the Cassidy-Graham plan.

Sen. Susan Collins, R-Maine, told reporters Wednesday that she is waiting for the CBO analysis before making a decision on the bill. CBO does plan to release projections of budgetary effects of the legislation Monday, but it will take weeks to produce the kind of comprehensive analysis senators have had before voting on previous health care bills.

“I’m disappointed to hear that it’s going to be only a partial analysis that will not include the impact on coverage,” Collins said. “That is very disturbing to me.”

Collins ticked off a number of other concerns keeping her from throwing support behind the latest proposal.

“They include the fact that they make fundamental changes in the Medicaid program for the first time in more than 50 years without having in-depth hearings and vetting to see exactly what the consequences would be,” she said.

She also cited an analysis estimating that Maine would receive $1 billion less in federal health care funds over the next decade than under current law.

Collins disputed the insistence of Cassidy and other proponents of the bill that it ensures coverage for patients with pre-existing conditions.

“While the bill says people are protected with pre-existing conditions,” she said, “if you look at the authority of states to waive those protections as long as they just submit a description to the Department of Health and Human Services, it indicates to me that you could end up with unaffordable rates for people with pre-existing conditions.”

Similarly, she fears states would be free to allow insurers to set lifetime and annual caps on benefits, something the ACA prohibited.

“That prevents a medical catastrophe from becoming a financial catastrophe,” she said.

A handful of other Republicans, including Sens. Lisa Murkowski and John McCain, remain noncommittal on the bill. Sen. Rand Paul, R-Ky., is still a hard no, despite pressure from leadership and an angry tweet from the president on Wednesday morning.

As with past GOP attempts to repeal Obamacare, Democrats are united in opposition and they are promising to use every tool available to prevent Cassidy-Graham from becoming law.

“This is basically Trumpcare 2.0, it’s even worse than before because it’s going to cut even more folks off from health care,” said Sen. Tammy Duckworth, D-Ill.

She noted that the American Medical Association has come out strongly against the bill. A number of other organizations representing the rights of doctors and patients have also issued statements condemning it.

“Many states are going to lose tremendous amounts of money through the Medicaid program,” Duckworth said.

The bill’s sponsors acknowledge large states that expanded Medicaid coverage through the ACA will face reduced funding, but they insist that merely puts them on a fair playing field with the states that refused to implement it.

The Cassidy-Graham bill’s future still clouded by uncertainty and the CBO score may resolve a lot of that, but in the meantime, both sides are gearing up for a tough legislative battle that could rage until the moment time runs out.

“The fight will be all through this weekend and into the early part of next week,” Duckworth said.

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