By THOMAS KAPLAN
WASHINGTON – With time running short, the authors of the latest plan to repeal and replace the Affordable Care Act shifted money in the bill to Alaska and Maine, which are represented by Republican senators who appear reluctant to support it.
The revised version of the bill, authored by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, would provide extra money for an unnamed “high-spending low-density state,” a measure seemingly aimed at Alaska and its holdout Republican senator, Lisa Murkowski, who has yet to say how she will vote. It would also send money toward Maine, whose Republican senator, Susan Collins, said on Sunday she would almost certainly vote no.
Cassidy circulated a table on Sunday showing the state-by-state effect of the revised bill from 2020 to 2026. It indicated that Alaska would receive 3 percent more money under the bill than under current law, while Maine would get 43 percent more.
However, the numbers and the calculations could not be independently confirmed. Similar estimates prepared by Cassidy’s office for the earlier version of the bill differed significantly from estimates by the Kaiser Family Foundation and health policy consulting firms, which said that most states would receive less money than under current law.
Still, the aim seemed clear. Collins said on Sunday that she was all but certain to oppose the proposal, bringing to three the Republicans who have publicly voiced opposition – enough to end the bill’s chances this week as time runs out on a last-ditch effort to repeal the Affordable Care Act.
In addition, Sen. Ted Cruz, R-Texas, said he had not yet been won over and suggested that Sen. Mike Lee, R-Utah, had the same stance. Sen. Rand Paul of Kentucky, the first Republican to come out against the measure, once again criticized the bill in blunt terms, despite pressure from President Donald Trump to rethink his opposition.
“It’s very difficult for me to envision a scenario where I would end up voting for this bill,” Collins said on CNN’s “State of the Union.” “I have a number of serious reservations about it.”
The cascade of critical comments left Trump and Republican leaders on the precipice of failure in their 11th-hour attempt to fulfill the party’s promise to dismantle a cornerstone of President Barack Obama’s legacy.
Already, Paul and Sen. John McCain of Arizona, who announced his position on Friday, had pushed the bill to the edge of failure. McCain issued a plea for bipartisanship on a matter as consequential as health care.
Republican leaders can afford to lose no others in the narrowly divided chamber, and they have only until the end of this month to pass the bill in the Senate using procedures that shield it from a Democratic filibuster.
Senators returned to the Capitol on Monday in what could be a bruising week for Trump and the Senate majority leader, Sen. Mitch McConnell of Kentucky. In addition to the health care drama that is looming in Washington, voters in Alabama will vote on Tuesday in a closely watched Republican Senate runoff, and a loss by Sen. Luther Strange would be a setback for both Trump and McConnell.
The health bill’s authors scrambled to get back on track. The revised version of the Graham-Cassidy bill is generally similar to the original version unveiled on Sept. 13.
But it now would allow states to set many of their own health insurance standards without getting waivers from the federal government. States could, for example, allow insurers to omit some of the benefits they are now required to provide, like coverage for maternity care, mental health care and drug addiction treatment.
Under the revised bill, states could set their own limits on out-of-pocket costs that differ from the federal limits. Under the Affordable Care Act, the annual limits are now $7,150 for an individual health plan and $14,300 for a family plan.
The new version of the bill would give decision-making authority to the administrator of the Centers for Medicare and Medicaid Services, now Seema Verma. The initial version gave the authority to the secretary of health and human services, Tom Price.
Under the revised bill, it appears that a state could allow insurers to set higher premiums based on a person’s health status, though not on the basis of sex or genetic information. In applying for federal grants, state officials would have to describe how they would “maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions.”
All of this might be too late. Changes to the bill’s funding formula to win over Murkowski might cost it support with conservatives. And the hasty revisions could only strengthen concern that Congress would be moving forward on a bill that has not been properly vetted. The Congressional Budget Office is set to release a partial analysis of its effect as soon as Monday, but that report will not include the latest changes.
Speaking to reporters in New Jersey on Sunday, Trump seemed to be looking ahead to the next big legislative goal for Republicans – overhauling the tax code – even as he talked up the Graham-Cassidy bill and applied pressure to resistant senators.
“Eventually, we will win on that,” he said of repealing the health law. “My primary focus, I must tell you – and has been from the beginning, as you can imagine – is taxes.”
But Graham and Cassidy were not giving up.
“We’re moving forward, and we’ll see what happens next week,” Graham said on ABC’s “This Week.” “I’m very excited about it. We finally found an alternative to Obamacare that makes sense.”
Marc Short, the White House director of legislative affairs, said on NBC’s “Meet the Press” that a Senate vote was planned for this week. But a spokesman for McConnell declined to affirm that timeline on Sunday.