- The Washington Times - Friday, September 15, 2017

Senate Republicans pushing to replace Obamacare with state block grants are making real noise before their window to act closes, insisting they are just one or two votes shy and that President Trump can nudge their last-gasp bill to victory.

“We are thinking that we can get this done by Sept. 30,” Sen. Bill Cassidy, Louisiana Republican who co-wrote the bill with Sen. Lindsey Graham of South Carolina, said Friday.

Republican leadership seemed to greet the bill with a shrug when it dropped this week, yet Mr. Cassidy said the idea “took off” during a Thursday luncheon that focused on health care.

The senator said his informal whip count stands at “48 or 49” GOP votes, suggesting they are close to the 50-vote threshold needed to pass a bill, using Vice President Mike Pence as a tie-breaker.

There are “people coming out regularly and saying they’re for it, either privately or publicly,” Mr. Cassidy said.

Yet Sen. Rand Paul, Kentucky Republican, rejected the bill on Twitter as Mr. Cassidy spoke to reporters, lengthening the odds of success as the GOP continues to struggle with a seven-year promise to scrap the Affordable Care Act.

Under the plan, Obamacare money that pays for an expansion of Medicaid and that subsidizes coverage for many of those who buy insurance on the exchanges would be pooled and instead given to states as block grants. The states would then tailor the money to their own health care plans.

The bill would immediately repeal Obamacare’s individual mandate requiring people to get covered or pay a tax and its rule requiring large employers to provide coverage or face crippling penalties. It also scraps the 2010 law’s tax on medical device sales.

Senate Republicans must act before the end of the month to get something done under the 2017 budget, which helps the GOP avoid a Democratic filibuster.

Mr. Trump and GOP leaders are still smarting over the embarrassing failure of the repeal effort in July, though, so many stars must align for the new bill to be successful.

For starters, its authors are still waiting for the Congressional Budget Office to analyze the plan’s impact on spending, coverage and whether it saves enough money to satisfy budget rules.

Republican Sens. Ron Johnson of Wisconsin and Dean Heller of Nevada, who faces a tough re-election bid next year, have signed onto the plan. Yet Senate GOP leaders are demanding an airtight vote count before bringing a the bill to the floor, since falling a vote or two short has been the problem for them from day one.

Mr. Paul said he cannot support the bill because it leaves “90 percent” of Obamacare, including many of its taxes and coverage rules, in place. He said it amounts to “Obamacare lite.”

Sen. Susan Collins, Maine Republican who rejected previous repeal attempts, recently said she has “reservations” about how the plan would affect her state. She wants to keep the focus on bipartisan efforts to shore up the insurance markets as they exist.

Bill sponsors aren’t counting on red-state Democrats to replace Republicans dissenters, though feel some might hop on board if the 52-seat GOP majority fronts at least 50 votes.

“I’m pretty confident we’ll get there on the Republican side,” Mr. Cassidy said.

Sen. John McCain, Arizona Republican and key holdout, says he supports the bill but wants hearings, further straining the calendar.

And the House, which is away next week, would have to swiftly take up and pass another politically perilous bill before Oct. 1 — they approved their own Obamacare replacement in May — to clear the way for Mr. Trump’s signature.

Mr. Cassidy, despite his optimism, acknowledged that sponsors might have to try and pass the plan through a future budget, or some other opportunity.

“We are shooting for the 30th. If not, we’ll take it to the next vehicle,” he said.

Mr. Trump has cheered the effort in writing but shown few signs of selling the plan right now, as he pivots to tax reform, hurricane relief and the deportation status of 800,000 illegal immigrants who were brought to the U.S. as children.

“Without your voice, we cannot succeed,” Mr. Graham told Mr. Trump in a recent floor speech. “With your voice, we will be successful. But it’s going to take more than a letter. Get on the phone, start calling people.”

A poll released Friday suggests undoing the health care law remains a key priority for GOP voters.

More than 80 percent of Republicans said it is at least somewhat important for Congress to repeal and replace Obamacare before the end of the year, with more than half calling it “extremely” important, pollsters from Politico and the Harvard School of Public Health said.

Under the Graham-Cassidy plan, funding would be block-granted to the states based on their share of people who earn between 50 and 138 percent of the federal poverty level.

Starting in 2024, the level of funding would be partly based on enrollment levels — including among needier populations, so governors are incentivized to help low-income people instead of spreading the money around to people who don’t actually need it.

By 2026, the funding formula would put states on a level playing field, lifting up states that said they couldn’t afford to pay 10 percent of Obamacare’s Medicaid expansion and reining in high-spending states that, as Mr. Cassidy put it, have relied on federal taxpayers to boost economic development at home.

The Louisiana senator appeared to relish the arcane pieces of the puzzle in a Friday presentation to reporters, enthusiastically breaking down a series of spreadsheets on how states would fair under the reforms.

Bill sponsors say it is time to match wits with Democrats, who’ve defended Obamacare at every turn. Now, some Democrats are championing the type of single-payer system championed by Sen. Bernard Sanders of Vermont.

Mr. Cassidy and Mr. Graham are using the push for government-run care as a spur, saying Republicans must act fast to devolve power from Washington and move beyond an Obamacare model that’s been faulted by both sides of the aisle.

“Berniecare,” Mr. Cassidy said, “is an indictment of status quo.”

• Tom Howell Jr. can be reached at thowell@washingtontimes.com.

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