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Graham-Cassidy, the latest Senate Republican effort to repeal large parts of the Affordable Care Act and transform Medicaid, appeared to have died its final death on Monday evening, when Sen. Susan Collins (R-Maine) joined Sens. John McCain (R-Ariz.) and Rand Paul (R-Ky.) in stating her intention to vote no on the bill if it comes up for a vote this week. The Senate GOP's ability to pass a health-care bill with just 50 Republican votes, through the budget reconciliation process, ends Saturday, and Republicans have committed to use next fiscal year's budget resolution to pass tax reform with only GOP votes. But in theory, Republicans could combine health care and tax reform in the same budget vehicle, and that idea is gaining steam.

Sen. Lindsey Graham (R-S.C.) and Sen. Ron Johnson (R-Wis.), both sponsors of Graham-Cassidy, are pushing to combine tax reform and health care, and Sen. Rand Paul (R-Ky.) and Senate Finance Committee Chairman Orrin Hatch (R-Utah) are among those interested in the idea. Others, including GOP House tax leaders, are wary of threatening tax reform by mixing it up with an ObamaCare repeal effort that has thwarted Republicans all year. "I think we need to move onto tax reform," said Sen. John Kennedy (R-La.), adding about Graham-Cassidy. "I think this bill's dead."

But it didn't earn the nickname "Zombie TrumpCare" for nothing. Johnson and Graham are both on the Senate Budget Committee, however, and if both joined all committee Democrats in voting against a budget resolution without health care, it wouldn't pass, meaning tax reform would be at an impasse, too. Both senators threatened to do that on Sunday and Monday. "I think this whole thing is going to get derailed by health care," a GOP lobbyist told Axios. "There are a lot of Republicans who are sick of dealing with health care," says Caitlin Owens at Axios. But President Trump and GOP donors large and small are insistent, and "as we've seen over the last 10 days, it becomes politically difficult for the GOP to ignore a glimmer of hope when it comes to repealing the Affordable Care Act." Peter Weber

September 25, 2017

Senate Republicans and President Trump have not given up on their last-ditch effort to significantly modify Medicaid and the Affordable Care Act, which needs to pass this week to avoid a filibuster from Democrats. On Sunday night, Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) released a new draft of their Graham-Cassidy bill, designed to win over holdouts in part by sending more money to Alaska, Maine, Arizona, and Kentucky, the home states of four key senators.

The new version of Graham-Cassidy also includes a special carveout for Alaska, a 25 percent increase in federal matching Medicaid funds. Sen. Lisa Murkowski (R-Alaska) has not said how she plans to vote, Sens. Rand Paul (R-Ky.) and John McCain (R-Ariz.) are pretty hard no votes, and on Sunday's CNN State of the Nation, Sen. Susan Collins (R-Maine) said it would be "very difficult for me to envision a scenario where I would end up voting for this bill," citing its changes to Medicaid, weakened protections for people with pre-existing conditions, and the lack of a Congressional Budget Office analysis of its effects.

In addition to the new funds for certain states, the new draft would make it easier for states to scrap federal insurance requirements, often without a waiver, including increasing the caps on out-of-pocket costs and allowing insurers to drop coverage for maternity care, mental health treatment, drug addiction, and other benefits now deemed essential. It would also allow states to create "multiple risk pools" for healthy and sick people. "This revised bill is tantamount to federal deregulation of the insurance market," said Larry Levitt of the nonpartisan Kaiser Family Foundation. "If there were any doubt that people with pre-existing [conditions] are at risk of being priced out of individual insurance, this bill removes them."

The main hospital, doctor, and insurance groups released a rare joint letter Saturday opposing the bill, though GOP donors are reportedly upset that ObamaCare is still law. Sen. Ted Cruz (R-Texas) told the Texas Tribune Festival in Austin that "right now, they don't have my vote. And I don't think they have Mike Lee's either," referring to a GOP colleague from Utah. Republicans can only lose two votes. Peter Weber

September 22, 2017

President Trump's badgering and other pressure tactics arguably backfired in July, when three Senate Republicans sank the previous last effort to repeal much of ObamaCare, but when you have a very large megaphone, you apparently use it.

Senate Republicans are holding a vote next week on the Graham-Cassidy health-care bill, and Sen. Rand Paul (R-Ky.) — who voted for the last GOP health-care bill, says he is a solid no on this one. The other Republicans up in the air are believed to be Sens. Susan Collins (Maine), John McCain (Ariz.), and Lisa Murkowski (Alaska) — though if Republicans let Alaska keep ObamaCare, who knows? Peter Weber

September 22, 2017

Weirdly, late-night comedian Jimmy Kimmel is now a big part of America's health-care debate. His critiques of the Graham-Cassidy health-care bill — after one of its sponsors, Sen. Bill Cassidy (R-La.), promised to oppose any bill that failed his "Jimmy Kimmel Test," which Graham-Cassidy appears to do — have hit a nerve perhaps because Kimmel is a goof and probably the least political of the late-night TV hosts. So on Wednesday, Theodore Kupfer at National Review published an article critical of Kimmel's audacity to weigh in on health care, as if he had "deep and hidden reservoirs of knowledge on risk-adjustment programs, the Medicaid expansion, or per capita caps." The article is titled, "Jimmy Kimmel, Policy-Wonk Wannabe," but the NRO social media editor posed it as a question:

It so happens that Politico had examined that question, and found that "in the war of words between Jimmy Kimmel and Sen. Bill Cassidy, the late-night host has the better grasp of health policy, health-care analysts say." So a lot of the responses to National Review's tweet were along those lines. But that was just the tip of the iceberg. If Kimmel isn't an expert, some asked, why are these guys being invited on cable news to talk health care?

Several people noted that the occupant of the Oval Office doesn't exactly have a long health-care résumé, either:

Others, like Nancy Sinatra, asked why National Review thinks Kimmel doesn't have the right to weigh in:

And then Jason Helgerson, who runs New York State's Medicaid program, stepped in and dropped the mic:

Twitter: Ask, and ye shall receive. Peter Weber

September 22, 2017
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On Thursday, the National Association of Medicaid Directors (NAMD), a group representing the Medicaid directors from all 50 states, joined other medical and patient advocacy groups in opposing the latest Senate Republican bill to repeal the Affordable Care Act, named after sponsors Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.). The bill would scrap ObamaCare's subsidies for consumers and Medicaid expansion and redistribute that money as state grants, in what the NAMD board of directors calls "the largest intergovernmental transfer of financial risk from the federal government to the states in our country's history."

The Medicaid directors said they don't want that risk, especially without being consulted first, and they called a Congressional Budget Office score — which Graham-Cassidy won't have before voting — "the bare minimum required for beginning consideration." Setting up entire new health-care programs in 50 states requires an enormous amount of work and resources, NAMD said, and "the vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities."

Andy Slavitt, administrator of the Centers for Medicare and Medicaid Services from 2015 until January and an opponent of repealing ObamaCare, said all 50 Medicaid directors coming out against Graham-Cassidy was "very unusual," and Sen. Chris Murphy (D-Ct.), was similarly impressed:

The Senate plans to vote on the bill next week. You can read the NAMD's full statement here. Peter Weber

September 21, 2017

Senate Republicans are planning to vote next week on the Graham-Cassidy health-care bill, and they can only lose two Republican senators to squeak it through with the vice president's tie-breaking vote. One of the Republicans who says he's a yes on Graham-Cassidy, Sen. Jeff Flake (Ariz.), came on Stephen Colbert's Late Show Wednesday night and explained his thinking. "Why not wait to know what you're voting on before you affect one-sixth of the American economy?" Colbert asked. "Let me say, I want a bipartisan solution," Flake replied. "Part of the problem with ObamaCare is that it was pushed through by one party, and we're going to have the same kind of problem if we just do this long-term," but right now, 200,000 Arizonans don't have viable insurance options.

Flake said he thinks health care is better managed at the state level, and that governors will do a better job than federal officials at enabling health care for less money. (The last GOP health-care bill in July was supported by just 6 percent of Arizona voters, according to one poll.) Colbert asked Flake if he thinks Republicans have the votes to pass it, and he said yes. "It's going to come down to the final few senators," he said. "I hope we can. Like I said, people in Arizona are hurting, and that's who I'm responding to. We've got to fix it in a bipartisan way going forward — obviously it is never good for one party to push something through on its own. In the meantime, we've got to make sure that everybody has insurance." Flake did not connect those two thoughts, exactly, but you can watch his full argument below. Peter Weber

September 21, 2017

Senate Republicans plan to vote next week on the Graham-Cassidy health-care bill, despite opposition from every major medical and patient health association, the insurance trade group AHIP, Blue Cross Blue Shield, every Democrat, Jimmy Kimmel, President Trump's ally Gov. Chris Christie (R-N.J.), and a handful of other Republican governors, and no Congressional Budget Office analysis of its effects on consumers and coverage. The legislation is believed to have the support of at least 48 Republican senators, with Sens. Susan Collins (Maine) and Rand Paul (Ky.) voicing opposition — though Paul also opposed earlier versions of similar bills and voted for them anyway — and Sens. John McCain (Ariz.) and Lisa Murkowski (Alaska) noncommittal. It needs 50 votes to pass. With so much at stake, CNN dabbled in a little bit of body-language analysis from video of the Senate floor on Wednesday evening. You can watch below. Peter Weber

September 20, 2017
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On Tuesday evening, Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, said that he was ending bipartisan negotiations for a bill to stabilize health insurance markets and make a few changes to the Affordable Care Act, because after four hearings and involved negotiations, his group had "not found the necessary consensus among Republicans and Democrats." The unexpected decision appears aimed at shoring up support for the Senate GOP's last-ditch plan to repeal ObamaCare, sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), by removing any alternative legislation.

Sen. Patty Murray (D-Wash.), the top Democrat on the HELP Committee and Alexander's main negotiating partner, said she is "disappointed that Republican leaders have decided to freeze this bipartisan approach and are trying to jam through a partisan TrumpCare bill," adding that she is still committed to reaching a bipartisan deal. Alexander said that especially since Graham-Cassidy gained steam, appetite within his party for his bill was very low. "I know how to get bipartisan results, but I'm not a magician," he said.

Republicans expect to start voting on Graham-Cassidy next Wednesday, Axios reports, before a Sept. 30 deadline for passing a health-care bill with only 50 votes, with no Democrats. The Congressional Budget Office won't have its analysis on how much the bill would affect coverage or its costs for consumers until October. On Tuesday, a group of 11 governors, including five Republicans and independent Gov. Bill Walker (Alaska), urged the Senate to drop Graham-Cassidy, joining AARP, the American Medical Association, the American Hospital Association, and other patient advocacy groups, plus Jimmy Kimmel.

Sens. Susan Collins (R-Maine) and Rand Paul (R-Ky.) are believed to be opposed to the bill, and Sens. Lisa Murkowski (R-Alaska) and John McCain (R-Ariz.) are seen as the key votes on the measure — three GOP no votes, and it doesn't pass. Haley Bird at the Independent Journal Review notes:

Graham-Cassidy would convert ObamaCare's subsidies and Medicaid payments to block grants to states, allowing each state ample leeway to decide coverage rules and patient protections, plus cut Medicaid sharply and change its structure. Graham argues that it's the last barrier to "socialism." Peter Weber

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