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Obamacare Repeal Effort Nears Another Vote

Analysis  |  By Christopher Cheney  
   September 25, 2017

This week's anticipated Senate vote on a repeal-and-replace plan for the Affordable Care Act is likely the GOP's last chance to enact healthcare reform this year.

This week marks a major milestone in congressional efforts to repeal the Patient Protection and Affordable Care Act (PPACA), a pair of beltway watchers says.

Majority Leader Mitch McConnell, (R-KY), is maneuvering for a vote on repeal-and-replace legislation sponsored by Sen. Bill Cassidy, (R-LA), and Sen. Lindsey Graham, (R-SC). The Senate Finance Committee is scheduled to hear testimony at 2PM Monday.

Earl Pomeroy, ex-president of the National Association of Insurance Commissioners is a Democrat and a former US representative from North Dakota. He says the Cassidy-Graham legislation is the Republican Party's "last gasp" to repeal and replace the PPACA before the 2018 elections.

"There are many Republican senators who have committed to voting for the bill who have not had time to fully consider it. The bill is being driven by calendar, not content."

"At the end of the month," says Pomeroy, "the ability to pass health reform with 51 votes using the budget reconciliation vehicle of 2017 expires, because we move into the 2018 fiscal year."

The time pressure linked to the Senate calendar gives the Cassidy-Graham proposal a political push, he says. "It's now-or-never."

Cost Forecasting

The Cassidy-Graham Plan has not been scored by the nonpartisan Congressional Budget Office. It aims to release a preliminary assessment this week. Others, such as Avalere, CMS, and the Kaiser Family Foundation have been weighing in.

This 11th-hour attempt to repeal and replace Obamacare is expected to result in health insurance and Medicaid coverage cutbacks equal to GOP legislation proposed earlier this year that would have cut more than 20 million people from healthcare coverage.

Republican candidates for Congress would pay a political price from a rollback of healthcare coverage, Pomeroy says.

"If the Republican Party votes to destroy the Affordable Care Act, that will be a political problem for Republicans for years to come. Millions [of Americans] will lose their coverage, and they will be extremely unhappy for many elections."

Passage would also create a political opportunity for the Democratic Party, he says. "The Democrats will be flat-out on the attack, and the Republican position on healthcare will be extremely defensive."

The course of healthcare reform through the 2018 election will turn on this week's Senate vote, Nicholas Manetto, prinicipal at Washington-DC-based law firm Faegre Baker Daniels.

"If Cassidy-Graham fails, it would embolden those in the Republican caucus who want to move away from healthcare and toward taxes or other issues, and it could potentially revive the bipartisan efforts that were terminated [last] week," Manetto says.

Predicting the Senate Vote

A razor-close vote is likely in the Senate this week, he says.

"The four most prominent names are [Republican] Senators Paul, Collins, Murkowski and McCain. Paul is opposed because in his view Cassidy-Graham does not do enough to scrap the ACA, while the other three were the pivotal 'no' votes during the summer. Sen. Collins certainly appears to be a likely 'no' given the concerns she has expressed on Medicaid."

McCain is a perennial "wild card," Manetto says. "Sen. McCain may be gettable—he is close with Sen. Graham."

"Murkowski remains a big question. Others to keep an eye on are senators like Rob Portman and Shelly Moore Capito, both of whom had significant concerns earlier in the year, particularly on the Medicaid side."

In a bid to solicit Murkowski's vote, special accommodations would have to be made in the bill for Alaska, Sen. Graham reportedly told conservative activists.

After seven years and more than 40 attempts to repeal and replace Obamacare, many Republican lawmakers in Congress are eager to drop healthcare as a priority issue, Manetto says.

"Much of the GOP caucus wants to move far away from healthcare toward taxes and other issues they see as being more favorable to them. You also have the reality of an election year that, before too long, will focus much attention on the polls."

Christopher Cheney is the CMO editor at HealthLeaders.


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