The last last-ditch effort of congressional Republicans to repeal and replace Obamacare will not go to a vote as the Senate GOP failed to rally enough votes for the Graham-Cassidy proposal.
The failure comes after firm no votes registered by Sens. Rand Paul, John McCain and Susan Collins. Alaska’s Sens. Lisa Murkowski and Dan Sullivan avoided taking a firm position on the proposal before leadership abandoned it.
Republicans were up against a Saturday deadline to repeal Obamacare through the budget reconciliation process, which would allow passage of the proposal with the votes of 50 senators and Vice President Mike Pence.
Murkowski had voted against earlier repeal efforts while Sullivan has supported them. Murkowski has long been critical of the process Republicans are using to rush repeals—which have generally been shown to have dramatic negative impacts on health-care funding and coverage in Alaska—to a vote.
Her criticism of this effort was no different.
“I appreciate the efforts of my colleagues, Senator Graham and Senator Cassidy, but they have run up against a hard deadline and a lousy process. Time has not been on their side,” Murkowski said in a prepared statement. “The U.S. Senate cannot get the text of a bill on a Sunday night, then proceed to a vote just days later, with only one hearing – and especially not on an issue that is intensely personal to all of us.”
She said, however, that some good came out of the effort behind the Graham-Cassidy repeal. She said the sponsors of the legislation came away understanding the problems facing Alaska better than before (they also happened to go way out of their way to load the bill with funding and exemptions that greatly benefited Alaska in a move that many called a blatant attempt to buy off some votes).
“Coming from the state that has the highest healthcare costs and the lowest population density, the numbers really do matter. I have been working for weeks to get true, accurate data about what this proposal would mean for Alaska. This has been a considerable challenge, and even today I am still seeking solid answers.”
Sullivan was more rosy in his assessment of the bill.
“The Graham-Cassidy bill, which I’m convinced would have brought more funds and more flexibility to Alaska, was compelling,” he said in a prepared statement. “Unfortunately, the process was rushed and we ran out of time to fully vet the data.”
Analysis by Graham and Cassidy showed a 3 percent increase in funding for Alaska in the latest revision of the bill, but did so by counting $277 million in state cuts due to the end of Medicaid expansion as additional funding. Without it, Alaska would have faced a roughly $100 million decrease in health care funding over the next decade according to their analysis.
Earlier analysis of the original proposal by other groups showed much larger cuts of the bill. The Alaska Department of Health and Social Services estimated the original version would have cut funding for Alaska by $1 billion over the next decade.
Sullivan also found a silver lining for the bill, noting that he expects Graham-Cassidy to be revived in the future (some have pointed out that the 2018 budget reconciliation would be a prime target for it to return).
“As a result of the delegation’s relentless work to educate our colleagues on Alaska’s challenges, I thoroughly expect that when this bill is reintroduced and reviewed, Alaska’s unique healthcare landscape will again be recognized, as it was in Graham-Cassidy,” he said.
Gov. Bill Walker, who has opposed Graham-Cassidy from the get go, also released a statement saying that health-care debate must continue but with bipartisan input.
“While work on this particular bill may have ended, the conversation about health care must not end. Status quo is not a long-term option,” he said. “Alaskans will continue to be leaders on this issue, and I intend to convene my fellow governors to tackle health care reform in a bipartisan manner.”
Future of health care
It’s unclear what path congressional Republicans and President Donald Trump will take now that the window has closed on the easiest route to repeal Obamacare.
At the very least, Alaska’s individual health insurance marketplace can rest relatively easy. Thanks to the creation of the state reinsurance program, Alaska is expecting insurance rates to fall by 26 percent on average in 2018.
The program works by allowing insurance companies to get supplemental insurance from the state to cover people with high-cost health conditions. The program is paid with federal funds made available through overall savings on insurance premium tax credits and is expected to be neutral on the federal deficit.
Sen. Susan Collins, R-Maine, has actually introduced a bill that would streamline the process for other states to come up with their own reinsurance programs. It would allow other states to easily copy parts of Alaska or Maine’s reinsurance programs and modify them to suit their needs.
Its fate, along with bipartisan efforts to stabilized the health care markets, is up in the air. The passage of any measure now will require bipartisan agreement between Democrats and Republicans in both the Senate and House, which is something Republican leadership has so far not been interested in pursuing.