The Health 202: Here’s how Cassidy and Graham rejiggered their Obamacare overhaul


Sen. Bill Cassidy (R-La.). (AP Photo/Alex Brandon)

This morning, Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) will offer adult a new chronicle of their check overhauling Obamacare, even as a whole grand bid appears headed for a meltdown. The new version still kind of looks the same as a aged one. But it apportions bigger slices of sovereign health spending to a states of pivotal senators who were disposition opposite — or undisguised against — to a strange bill, endangering a success.

If we examination a updated bill, that was leaked Sunday night to The Washington Post and other news outlets, it’s flattering transparent that senators Cassidy and Graham are personification to. A state-by-state outline claims Alaska would get 3 percent some-more funding, Arizona would get 15 percent some-more appropriation and Maine would get 43 percent some-more appropriation from 2020 and 2026 compared to stream law.

Senators from all 3 of those states – Lisa Murkowski, John McCain and Susan Collins – had corroborated divided from a check in new days. McCain indicated on Friday he’d conflict a check since it wasn’t going by unchanging order, while Collins and Murkowski pronounced they wish to improved know how it would impact their possess states.

With Sen. Rand Paul (R-Ky.) still insisting he won’t behind a bill, nabbing dual of those 3 senators is crucial. Senate Republicans have only 5 days left to pass a magnitude repealing and replacing large tools of a Affordable Care Act. Their eventuality runs out on Oct. 1, when a check settlement check around that they’d formed their whole devise expires.

Acutely wakeful of a stakes, Senate GOP caring and a White House are intent in an all-in bid to convene a votes. But it’s distant from transparent that they can get all yet dual Republicans to swallow this latest Cassidy-Graham iteration.

Senator Lisa Murkowski (R-Alaska) speaks to reporters progressing this month. REUTERS/Joshua Roberts

The devise was distributed among Republicans late Sunday. Aides to Murkowski and Collins did not immediately comment. Some Republicans tighten to a routine have prolonged counted Collins as an contingent “no,” presaging that small could be finished to a check to change her mind. On Sunday night, some were once again secretly desperate a changes would remonstrate her to opinion yes. 

McCain is unlikely to bite. Even if a Senate Finance Committee considers Cassidy-Graham 2.0 in a high-profile health-care conference this afternoon, there wouldn’t be scarcely adequate time for a Congressional Budget Office to measure it before a opinion this week. Lawmakers do design an research from a CBO today, yet it will be formed on a initial chronicle of Cassidy-Graham. And that’s a distant cry from a “regular order” McCain has called for.

But Cassidy and Graham, who have argued that Republicans contingency pass a check repealing many of a Affordable Care Act or face critical atonement from their core electorate in subsequent year’s midterms, are dire forward. They will benefaction their new check as some-more equally distributing sovereign health-care spending among a states, so that no one state faces a large appropriation cliff.

The twin is still holding a same simple proceed to revamping a ACA: The bill gathers its subsidies for private coverage and a Medicaid expansion, lumps together all of that spending, cuts it somewhat, and redistributes it to states in a form of retard grants.

Under a initial Cassidy-Graham bill, that would have resulted in a median change of 11 percent reduction appropriation for states that stretched Medicaid and 12 percent some-more for states that didn’t, according to an research by a inactive Kaiser Family Foundation. But there was a far-reaching movement in a retard extend funding; Mississippi would get 148 percent some-more relations to stream law, while New York would get 35 percent reduction from a sovereign government, Kaiser had estimated.

The new chronicle doesn’t change a sum sum of income a sovereign supervision would spend on a retard grants from 2020 to 2026. Instead, it tries to well-spoken out a law in what a sponsors wish is an effort to put states on a some-more equal footing. But a new chronicle also creates some winners and losers: South Dakota would see a largest appropriation boost (88 percent) while Oregon would remove a many sovereign appropriation (17 percent).

–Let’s demeanour during Alaska and Maine. Kaiser had estimated a initial chronicle of Cassidy-Graham would outcome in 8 percent reduction retard extend appropriation for Alaska; Republicans explain that underneath their latest check Alaska would get 3 percent more. Kaiser had also estimated that Maine would get 8 percent some-more underneath a initial measure; it would get 43 percent some-more underneath a revised chronicle of a bill, according to a GOP documents.

But let’s also chuck in an critical premonition here: The estimates that Cassidy and Graham will publicly recover currently make some assumptions that eccentric analysts contend are rather disingenuous.

For one thing, a state appropriation estimates don’t take into caring a bill’s additional cuts to unchanging Medicaid spending. If those cuts were considered, it would be transparent that states like Alaska and West Virginia would still be losing out on sovereign supports overall. And a GOP estimates also assume that states would condense their possess appropriation for coverage and afterwards cause that into a final series as “state savings.”

Of course, opponents of Cassidy-Graham remarkable these things — and kept neatly criticizing a check altogether — final night and into a early morning hours. Reporters also forked out how a Republican estimates could be misleading:

From a Wall Street Journal’s Michelle Hackman: 

From a Center on Budget and Policy Priorities’s Jason Leibenluft:

Will this latest Obamacare dissolution recipe rise – or bake again? Keep your eyes on a oven.

Sen. Ted Cruz (R-Tex.). (AP Photo/Manuel Balce Ceneta, File)

AHH: The new Cassidy-Graham check also creates a play for a votes of Sens. Ted Cruz of Texas and Mike Lee of Utah by giving states some-more ability to steep sovereign word regulations. States could potentially lift existent caps on out-of-pocket costs, permitting insurers to offer leaner word policies that interest to healthier consumers who wish reduce monthly premiums.

However, the Senate parliamentarian competence sequence that lifting ACA regulations in this demeanour isn’t closely adequate tied to sovereign health spending to go in a check settlement car Republicans are using.

Furthermore, many are doubtful that someone like Cruz, who has done repealing Obamacare a pivotal partial of his whole Senate term, would be a opinion to penetrate a whole thing. But Cruz done a hazard in that instruction yesterday, when he pronounced during a Texas Tribune Festival that Cassidy and Graham don’t have his vote, or Lee’s either.

From Houston Chronicle contributor Jeremy Wallace:

From Politico’s Seung Min Kim: 

HuffPost contributor Jonathan Cohn:

From The Post’s Dave Weigel: 

From The Daily Beast’s Sam Stein: 

OOF: In a recognition competition with Obamacare, a Cassidy-Graham health-care check would lose, large time. That’s according to a Washington Post-ABC News poll released Friday anticipating that roughly twice as many people strongly cite stream law to a GOP plan, 42 to 22 percent.

These aren’t indispensably tummy reflexes, either, because the poll described 3 aspects of Cassidy-Graham to electorate before seeking what they prefer: a rejecting of a requirement for scarcely all Americans to have health insurance, a phasing out of sovereign supports to assistance lower- and moderate-income people buy health insurance, and vouchsafing states reinstate sovereign manners on health coverage with their possess rules.

A few some-more takeaways from a poll:

–Fifty-six percent of respondents pronounced they cite a Affordable Care Act to Cassidy-Graham; 33 percent pronounced they cite Cassidy-Graham over a ACA.

–There’s a clever narrow-minded divide; 85 percent of Democrats pronounced they cite a ACA to a GOP plan; 66 percent of Republicans pronounced they cite a GOP plan.

–Among independents, 54 percent pronounced they cite a ACA while 35 percent pronounced they cite Cassidy-Graham.

OUCH: Last night, President Trump left open a probability that Cassidy-Graham competence not be successful notwithstanding expected skeleton to opinion on it this week (McConnell folks have pronounced Wednesday is a target), my co-worker Abby Phillip reports.

“Eventually we’ll win, either it’s now or later,” Trump pronounced as he prepared to residence Air Force One to lapse to Washington after spending a weekend during his golf examination in Bedminster, N.J.

Trump lamented that Republicans still have reservations on health-care even yet a check “happens to be quite good” for their states.

“I’ve been examination for 7 years as the Republicans have been observant dissolution and replace,” he said. “My primary focus, we contingency tell we — and has been from a commencement as we can suppose — is taxes…I trust we will be successful in a largest taxation cut in a country’s history.”

President Trump in Huntsville, Ala. (AP Photo/Brynn Anderson)

Trump had a lot to contend about health-care over a weekend. He’s pouring on a vigour left and right:

Sen. John McCain (R-Ariz.) was one of several Senate Republicans to demonstrate antithesis to a GOP health-care check over a weekend. (Photo by Melina Mara/The Washington Post)

–Republican senators seemed to topple like dominoes over a weekend, before sum of a revised Cassidy-Graham check leaked out. First, McCain blasted out a news recover on Friday observant he’d cruise ancillary legislation had it undergone endless hearings, discuss and amendments — yet observant that it hasn’t.

“As we have regularly stressed, health caring remodel legislation ought to be a product of unchanging sequence in a Senate…instead, a ghost of Sep 30th check settlement deadline has hung over this whole process,” McCain’s release said. “We should not be calm to pass health caring legislation on a party-line basis, as Democrats did when they rammed Obamacare by Congress in 2009.”

McCain pronounced he’d many cite a bipartisan bid that Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) (the Republican and Democratic leaders of a Health, Education, Labor and Pensions Committee, respectively) were posterior to stabilise a ACA marketplaces subsequent year. That bid seemed to tumble by a wayside final week as Republican caring attempted to emanate movement for Cassidy-Graham.

“I fear that a awaiting of one final try during a particularly Republican check has left a sense that their efforts can't succeed,” McCain said. “I wish they will resume their work should this final try during a narrow-minded resolution fail.”

Sen. Susan Collins (R-Maine) (AP Photo/Robert F. Bukaty, File)

A desertion by McCain makes passing Cassidy-Graham fundamentally impossible without assistance from either Collins or Paul. And both those senators corroborated divided during a Sunday morning speak shows. Collins told CNN she’s disturbed about how a GOP check would impact Medicaid recipients and people with preexisting medical conditions.

“It is really formidable for me to prognosticate a unfolding where we would finish adult voting for this bill,” Collins said. “I have a series of critical reservations about it.”

Collins pronounced she had a extensive discussion with Vice President Pence on Saturday, but wants to see an analysis of a legislation from a inactive Congressional Budget Office this week before she creates a final preference — nonetheless it won’t embody an comment of how many people would be lonesome underneath a bill.

“Even over a weekend, we was receiving emails suggesting that a sponsors of a check are still changing a formula,” Collins said. “So it competence be formidable for a CBO to do a kind of in-depth research that it customarily does, yet that’s what we would like to see before creation a grave decision.”

As for Paul, he showed no pointer he’s prepared to retreat his position on Cassidy-Graham because, he believes, it leaves in place too many of a ACA’s spending (albeit bend it over to states). “I’m only not for this block-granting concept,” Paul pronounced on NBC’s “Meet a Press.”

A video mashup of a Sunday shows:

Health and Human Services Secretary Tom Price. (AP Photo/Jacqueline Larma, File)

–Hey, maybe you’ll mark Tom Price on your subsequent aeroplane flight. The secretary of Health and Human Services will be drifting commercially some-more often, observant yesterday that he’ll skip taxpayer-funded trips on private jets until his agency’s examiner ubiquitous completes a review.

“I cruise that’s suitable since of a concerns that we’ve heard,” Price said during an coming Saturday on Fox News.

Reports about Price and his use of franchised jets during slightest dual dozen times were damning adequate to prompt an central examination by a agency’s examiner general, The Post’s Aaron C. Davis reports. The IG’s spokeswoman told The Post on Friday that a group will ask annals of Price’s transport and examination a justification done by Price and his staff for a trips, that reportedly cost taxpayers a total $300,000. House Democrats had requested the investigation, arguing the flights seemed to violate sovereign law designed to make certain executive bend officials use a many careful transport available.

“OIG is conducting a examination of Secretary Price’s Federal transport regulating franchised aircraft. The examination focuses on either a transport complied with Federal Travel Regulations, yet competence ring other issues associated to a travel,” Tesia Williams, a mouthpiece for Levinson. “We take this matter really seriously, and when questions arose about potentially inapt travel, we immediately began assessing a issue. we can endorse that work is underway and will be finished as shortly as possible.”

President Trump after removing off Air Force One on Sep 15. / AFP PHOTO / MANDEL NGANMANDEL NGAN/AFP/Getty Images

President Trump pronounced yesterday that his administration is looking into a matter. “As distant as Secretary Price is concerned, that’s different. We’re looking into it,” Trump told reporters in Washington, according to a pool report.

A few some-more good reads from The Post and beyond:


  • The National Press Club will reason an event on “Mental Health The Opioid Crisis.”

  • Various groups, including a American Cancer Society Cancer Action Network (ACS CAN), American Diabetes Association, American Heart Association, American Lung Association, Consumers Union, and a National Multiple Sclerosis Society, reason a press event.

  • The Senate Finance Committee binds a hearing to cruise a Graham-Cassidy plan.

Coming Up

  • The Brookings Institution will reason an event on “The Medicare Physician Fee Schedule and Alternative Payment Models” on Tuesday.

  • The House Financial Services Subcommittee on Housing and Insurance will reason a hearing on “examining word for nonprofit” on Thursday.

  • The American Enterprise Institute binds an eventuality on “Innovative rethinking of health caring smoothness and competition” on Friday.

  • The National Press Club will have a headliners luncheon with FDA Commissioner Dr. Scott Gottlieb on Friday.

Sen. John McCain (R-Ariz.) speaks about his opinion to kill Obamacare repeal:

Sens. Susan Collins (R-Maine) and Rand Paul (R-Ky.) list concerns about a Cassidy-Graham bill:

At a Jun city hall, Sen. Bill Cassidy (R-La.) touts coverage for preexisting conditions: 

Melania Trump hosts a initial eventuality in a White House garden:

From Late Night with Seth Meyers: Kim Jong Un calls Trump demented and Sen. John McCain won’t opinion for Obamacare repeal: 

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