Graham-Cassidy health care bill sets off clashes in Senate

Senators in both parties reignited the Obamacare repeal wars Monday, as Republicans claimed momentum for a last-chance repeal bill and Democrats told budget analysts to vet the legislation carefully, hoping to prolong a thorny debate before an end-of-month deadline.

Arizona Gov. Doug Ducey, a Republican, said the block grant proposal by Sen. Lindsey Graham, South Carolina Republican, and Bill Cassidy, Louisiana Republican, was the “best path forward to repeal and replace Obamacare.”

“Congress has 12 days to say ’yes’ to Graham-Cassidy. It’s time for them to get the job done,” he said in a prepared statement.

It was a critical endorsement for Senate sponsors trying to win over Sen. John McCain, an Arizona Republican whose rejection of a limited repeal bill in July stalled the party’s effort on health care.

Republicans have only until the end of next week to use a 2017 budget provision to pass an Obamacare repeal bill while avoiding a Democratic filibuster. Their fast-track instructions expire with the fiscal year on Sept. 30.

After multiple Republican failures this year, the Graham-Cassidy bill is the last idea standing. 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 health care exchanges would be pooled and instead given to states as block grants. The states would tailor the money to their own health care plans.

Vice President Mike Pence cheered the effort and Mr. Ducey’s support by posting on Twitter that it is “time to get the job done.”

Yet Mr. McCain remained a wild card in the debate by telling reporters he will continue to demand “regular order.” That is Capitol-speak for an orderly and open debate through committees — and evaluate the effort as it proceeds.

Democrats said Republicans already have failed Mr. McCain’s test.

“To have such a major bill that affects so many people be rushed through at the last moment in the dark of night, no discussion, no analysis, no real knowledge of how it affects each of our states, it’s legislative malpractice of the highest order,” said Senate Minority Leader Charles E. Schumer, New York Democrat. “If the Founding Fathers were looking at this chamber now and watching, they’d be turning over in their graves.”

Senate Democrats held the floor into the night to protest the push, saying the bill was just as harmful as the previous efforts they had panned.

Sen. Ron Johnson, Wisconsin Republican and chairman of the Homeland Security and Governmental Affairs Committee, tried to check a box by scheduling a Sept. 26 hearing on how states can reduce health care costs through block grants — the core idea behind the Graham-Cassidy plan — even as the Senate Health, Education, Labor and Pensions Committee works on a separate deal to stabilize the individual insurance market before Obamacare enrollment begins Nov. 1.

Yet Senate Finance Committee Chairman Orrin G. Hatch, Utah Republican, piled on late Monday by scheduling another hearing on Graham-Cassidy for Monday.

Even if Mr. McCain hops on board, it may be hard to squeeze enough votes from the Republicans’ 52-seat majority.

Republican Sens. Lisa Murkowski of Alaska and Susan M. Collins of Maine will be tough to persuade. They, too, rejected a “skinny” repeal bill in July.

Ms. Collins told reporters Monday that she is concerned about how the block grants would affect coverage and spending on Medicaid insurance for the poor in her state.

Sen. Rand Paul, a conservative Kentucky Republican, said he is a hard “no” because the bill preserves a chunk of Obamacare’s taxes and regulations.

“This does not look, sound or even smell like repeal,” Mr. Paul said.

Other senators haven’t taken a clear position on the bill, though its sponsors insist they have support from 48 or 49 Republicans in the chamber.

Among other hurdles, formal scorekeepers haven’t estimated the bill’s impact on spending and health care coverage, and the House would have to take or leave the bill as is before sending it to President Trump for his signature.

The Congressional Budget Office said it can produce a preliminary report on the bill by next week. It will describe whether the bill meets arcane budget rules needed to carve out Democrats, but estimates of the effects on the deficit or health insurance coverage will take several weeks.

Budget analysts said previous Republican repeal bills would add tens of millions of Americans to the ranks of uninsured within a decade.

Senate Democrats urged CBO Director Keith Hall not to cut any corners in his review of Graham-Cassidy, betting a full analysis would produce another unflattering score.

“A comprehensive CBO analysis is essential before Republicans force a hasty, dangerous vote on what is an extreme and destructive repeal bill. Members of Congress and the American people need to know the full consequences of Graham-Cassidy before any vote,” said a letter signed by Mr. Schumer, House Minority Leader Nancy Pelosi of California and the top Democrats on the House and Senate budget committees.

Meanwhile, Republican leaders asked the CBO to speed up the process so they can decide whether to act before the Sept. 30 deadline.

“The leader asked CBO to prioritize the score on the legislation. We expect regular staff briefings and member discussions to continue,” said David Popp, a spokesman for Senate Majority Leader Mitch McConnell, Kentucky Republican.

The bill would immediately repeal Obamacare’s individual mandate requiring people to obtain coverage 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, though other levies are kept in place.

Funding would be block-granted to the states based on their share of people who earn 50 percent to 138 percent of the federal poverty level. Starting in 2024, the level of funding would be partly based on enrollment levels.

By 2026, the funding formula would put states on a level playing field, lifting states that couldn’t afford to pay 10 percent of Obamacare’s Medicaid expansion and reining in high-spending states.

Liberal senators say the plan affords too much wiggle room to water down Obamacare’s mandated benefits and let insurers charge sicker Americans more than healthy ones, despite promises to protect the vulnerable. Most notably, they pointed to multiple studies that said many states would have deep cuts in funding.

Bill sponsors chafed at accusations that their bill would harm some consumers. They said states have to certify that they will provide “adequate and affordable care” to people with pre-existing medical conditions before waiving a part of Obamacare that bars insurers from pricing based on health status.

But Mr. Paul said his Republican colleagues risked unintended consequences in their rush to pass a health care bill. For instance, he said, by keeping much of Obamacare’s tax revenue, a Democrat-led Congress could direct more money to blue states later on.

“I don’t think that it’s been fully thought through,” Mr. Paul said.