- The Washington Times - Tuesday, September 19, 2017

Senate Republicans scrambled for votes Tuesday on their last-ditch Obamacare repeal, with backers saying they are nearing the magic number to pass their bill before an end-of-month deadline.

Vice President Mike Pence delivered a pep talk to Senate Republicans and plotted strategy with Sen. Lindsey Graham of South Carolina, one of the chief architects of the proposed repeal.

The legislation won the support of key conservative lobby groups, though Republican governors’ objections threatened to derail the effort.

A handful of Republicans remain holdouts. Sen. Rand Paul of Kentucky has gone the furthest, saying he can’t support a bill that leaves too much of Obamacare in place.

But Mr. Graham remained upbeat. He said House Speaker Paul D. Ryan, Wisconsin Republican, has pledged to fight for passage on the other side of the Capitol if the bill clears the Senate.

“I’ve never felt better about where we’re at,” Mr. Graham said.

The renewed push for a Republican repeal dealt a death blow to a parallel effort, led by Sen. Lamar Alexander, Tennessee Republican, and Sen. Patty Murray, Washington Democrat, that was searching for bipartisan fixes to the struggling 2010 Affordable Care Act.

Mr. Alexander said late Tuesday that the focus on the repeal bill, coupled with Sen. Bernard Sanders’ proposal for a fully government-run “Medicare for all” system, left too little room in the middle for a bipartisan agreement.

“During the last month, we have worked hard and in good faith but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted,” Mr. Alexander said.

Ms. Murray said she is eager to get back to bipartisan talks, which could resume if Senate Republicans fail in their third attempt at repeal-and-replace.

The latest Republican proposal, sponsored by Mr. Graham and Sen. Bill Cassidy of Louisiana, would pool Obamacare money that currently subsidizes coverage for many who buy insurance on the exchanges and money going to expand Medicaid rolls, and siphon it all to the states as block grants. The states would tailor the money to their own health care plans starting in 2020.

States that have rejected federal dollars to expand their Medicaid populations under Obamacare would likely receive more money, while those that have taken the Medicaid deal could receive less funding than they expect.

States also would have more flexibility to decide on coverage rules that work best within their borders, replacing many of Obamacare’s mandates.

Mr. Pence said “the entire administration” supports the bill.

But it faced mounting opposition Tuesday from outside lobbying groups. The American Medical Association said the repeal bill would eliminate coverage for millions of Americans and destabilize health insurance markets.

The doctors said Congress should instead keep pumping money to insurance companies in “cost sharing” payments to stabilize premiums.

The House, after a false start, has passed its own repeal bill that would cancel intrusive mandates, cap Medicaid funding and allow states to waive some of Obamacare’s strict standards as long as states set up separate pools of funding for high-risk consumers.

Senate Republicans said the House bill was too harsh, and leaders wrote an alternative. But they struggled for support, canceling a planned vote in June and watching their revised proposal go down to defeat in July.

Dooming that last version were Sens. Susan M. Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona, who joined Democrats to defeat the proposed repeal.

Republican leaders are hoping to win them over, particularly now that they have lost Mr. Paul’s support.

Hopes of gaining Mr. McCain’s vote were heightened this week when Arizona Gov. Doug Ducey, a Republican, heaped praise on the latest bill.

But Alaska Gov. Bill Walker, an independent, signed onto a letter from a group of governors Tuesday. He said he is worried that the repeal bill would squash efforts to expand Medicaid to 36,000 Alaska residents and tamp down runaway premiums.

“That coverage must be protected — which is why I joined a bipartisan group of governors in a continued push for Congress to follow a thorough process. Health care should not be a partisan issue,” he said in a statement.

Bill sponsors hit back late Tuesday with a letter of support from 15 of the country’s 34 Republican governors. They said, “Obamacare is broken and the states are the best place to fix it.”

The Senate Finance Committee will hold a hearing on the bill Monday, though Mr. McCain refused to tip his hand Tuesday.

“I have nothing to say. I have nothing to say,” he told reporters.

Complicating matters, the Congressional Budget Office said it can produce only a preliminary report on the bill by next week.

That analysis will help determine whether the bill meets arcane budget rules needed to avoid a filibuster.

A full estimate of the bill’s effects on the deficit or health insurance coverage will take several weeks, but Republicans have only until Sept. 30 to take action under 2017 budget rules.

Democrats say the public deserves a full analysis of a bill that affects something as personal and far-reaching as health care.

“They’re afraid that the public will hate this bill,” said Senate Minority Leader Charles E. Schumer, New York Democrat. “They’re ashamed of it.”

Democrats also think a full score would show millions of Americans joining the ranks of uninsured under the bill while shining a light on provisions that have alienated Republicans. Those include Medicaid cuts and waivers that let states duck insurance regulations mandating equal prices for the healthy and sick.

The Graham-Cassidy bill says states must specify how they would provide “adequate and affordable” coverage for people with pre-existing conditions, though critics say that leaves far too much wiggle room.

“It is all hands on deck to defeat the latest version of Trumpcare, Graham-Cassidy,” House Minority Leader Nancy Pelosi, California Democrat, told her troops in an “emergency action” letter Tuesday. “House Democrats will be fully mobilized to amplify the organizing of outside groups and lift up the voices of families who would be devastated by Trumpcare.”

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

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