UPDATE, Sept. 26: Sen. McConnell says the Senate will not vote on the bill.
By Al Cross
Kentucky Health News
Kentucky would be a big financial loser under Senate Republicans' last-ditch plan to repeal and replace the Patient Protection and Affordable Care Act. Sen. Rand Paul says he opposes the bill, but not for that reason; he says that it would "keep Obamacare," which he has vowed to repeal, and that a more limited reform he favors is on the way from President Trump.
It remains to be seen whether Kentucky's senior senator, Majority Leader Mitch McConnell, will bring the Graham-Cassidy bill up for a vote by Saturday, Sept. 30, the deadline to pass it with a simple majority under budget-reconciliation rules. He has said he intends to, but that was before Arizona Sen. John McCain said Friday afternoon that he wouldn't vote for the bill, making its passage unlikely.
Friday morning, Trump had pressured Paul, tweeting “Rand Paul, or whoever votes against Hcare bill, will forever (future political campaigns) be known as ‘the Republican who saved ObamaCare.’” Paul replied on Twitter, “Calling a bill that KEEPS most of Obamacare ‘repeal’ doesn’t make it true. That’s what the swamp does. I won’t be bribed or bullied.”
The next day, after McCain's announcement, Trump tweeted, “I know Rand Paul and I think he may find a way to get there for the good of the Party!” At a speech in Alabama that night, he said, “I haven't given up on him because I think he may come around.”
On NBC's "Meet the Press" Sunday, Paul said, “I’ve always been a ‘yes’ for repeal,” but said he opposes the bill because it keeps “almost all of the spending, and just re-shuffles it and block grants it to the states. . . . You’re keeping all the money we’ve been spending through Obamacare, most of it, re-shuffling it, taking the money from Democrat states and giving it to Republican states. I think what it sets up is a perpetual food fight over the formula.”
Paul had made the money-shuffling argument before, and it sounded weak to editors at National Review. The old-line conservative magazine went after him Wednesday, Sept. 20, implying in an editorial that Paul, a Bowling Green ophthalmologist, secretly doesn't want to change the Obamacare system that has provided free Medicaid for 470,000 Kentuckians and subsidized private insurance for 81,000.
"The senator’s objections to the bill amount to a case for improving it, perhaps in a conference committee after it passes the Senate," the editorial said. "They do not amount to a case for voting it down. The bill goes farther in the right direction than the 'skinny repeal' bill for which Paul voted earlier this summer. That bill abolished only the individual and employer mandates. . . . Graham-Cassidy is still much better than Obamacare. It abolishes the individual and employer mandates, caps per capita spending on Medicaid, blocks federal funds from going to insurance plans that cover abortion, and lets interested states attain freedom from some of Obamacare’s regulations."
The editorial concluded, "There has been widespread speculation that Paul is playing a game on Obamacare: that he does not really wish to see major changes to it and will find libertarian-sounding objections to any Republican bill that has a chance of passage. This speculation may be unfair. But Paul’s arguments for a no vote make so little sense, and are so hard to square with his previous votes, that it is getting harder to dismiss."
"Meet the Press" host Chuck Todd told Paul that the editorial implied "that you don’t really want to change the Kentucky system. There’s a lot of people in Kentucky that like the system. But you can’t get caught ever saying that."
Paul replied, "That is a personal insult to my character," calling the magazine "a bunch of neocons who don't like libertarians." Earlier, he said, "I started my political career campaigning against Obamacare," pledging repeatedly to repeal it. "I can't in good conscience vote to keep it . . . Once we do, the Republican name is on health care, and thsi isn't going to work."
National Review blogger Theodore Kupfer wrote Sept. 22 that Paul's money-shuffling argument is "not quite accurate. Three analyses of the bill, from the [liberal-leaning] Center on Budget and Policy Priorities, [consulting firm] Avalere, and the [federal] Centers for Medicare and Medicaid Services, have found that the change in federal health-care funding would be negative for states that expanded Medicaid under the Affordable Care Act. Among those states are Republican strongholds Arizona, Louisiana, Arkansas, Ohio, and Kentucky."
Other analyses predict Kentucky would be one of the big losers, because it was one of the states that expanded Medicaid in 2014 under then-Gov. Steve Beshear. The Kaiser Family Foundation estimates that Kentucky would get 19 percent less money in 2020-26, $5.4 billion, than current law provides. That would be the 10th largest percentage loss among the states. The New York Times produced a chart showing that in funding per person, Kentucky would be the eighth biggest loser among the 50 states and the 35 expansion states.
The charts show the estimated differences in what states would get under the bill compared to what they are projected to get under current law. In its overall chart, the Times colored orange the states represented by senators that voted against at least one version of Obamacare repeal bills in July, as Paul did.
The bill is being revised to attract votes from holdouts, but Paul remains opposed, The Washington Post reports. If Paul remains opposed, the bill seems unlikely to pass, since Republicans need 50 votes and hold 52 Senate seats. The bill has drawn widespread opposition from lobbying groups. "A bipartisan group of governors and several influential interest groups came out against the proposal," the Post noted. The Post's Elise Viebeck writes that the hurry-up process for the bill is "unusually chaotic," and Rep. John Yarmuth, D-Louisville, said the new version uses "phony numbers."
By Al Cross
Kentucky Health News
Kentucky would be a big financial loser under Senate Republicans' last-ditch plan to repeal and replace the Patient Protection and Affordable Care Act. Sen. Rand Paul says he opposes the bill, but not for that reason; he says that it would "keep Obamacare," which he has vowed to repeal, and that a more limited reform he favors is on the way from President Trump.
It remains to be seen whether Kentucky's senior senator, Majority Leader Mitch McConnell, will bring the Graham-Cassidy bill up for a vote by Saturday, Sept. 30, the deadline to pass it with a simple majority under budget-reconciliation rules. He has said he intends to, but that was before Arizona Sen. John McCain said Friday afternoon that he wouldn't vote for the bill, making its passage unlikely.
Friday morning, Trump had pressured Paul, tweeting “Rand Paul, or whoever votes against Hcare bill, will forever (future political campaigns) be known as ‘the Republican who saved ObamaCare.’” Paul replied on Twitter, “Calling a bill that KEEPS most of Obamacare ‘repeal’ doesn’t make it true. That’s what the swamp does. I won’t be bribed or bullied.”
The next day, after McCain's announcement, Trump tweeted, “I know Rand Paul and I think he may find a way to get there for the good of the Party!” At a speech in Alabama that night, he said, “I haven't given up on him because I think he may come around.”
On NBC's "Meet the Press" Sunday, Paul said, “I’ve always been a ‘yes’ for repeal,” but said he opposes the bill because it keeps “almost all of the spending, and just re-shuffles it and block grants it to the states. . . . You’re keeping all the money we’ve been spending through Obamacare, most of it, re-shuffling it, taking the money from Democrat states and giving it to Republican states. I think what it sets up is a perpetual food fight over the formula.”
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| U.S. Senator Rand Paul, R-Ky. (file photo) |
"The senator’s objections to the bill amount to a case for improving it, perhaps in a conference committee after it passes the Senate," the editorial said. "They do not amount to a case for voting it down. The bill goes farther in the right direction than the 'skinny repeal' bill for which Paul voted earlier this summer. That bill abolished only the individual and employer mandates. . . . Graham-Cassidy is still much better than Obamacare. It abolishes the individual and employer mandates, caps per capita spending on Medicaid, blocks federal funds from going to insurance plans that cover abortion, and lets interested states attain freedom from some of Obamacare’s regulations."
The editorial concluded, "There has been widespread speculation that Paul is playing a game on Obamacare: that he does not really wish to see major changes to it and will find libertarian-sounding objections to any Republican bill that has a chance of passage. This speculation may be unfair. But Paul’s arguments for a no vote make so little sense, and are so hard to square with his previous votes, that it is getting harder to dismiss."
Paul replied, "That is a personal insult to my character," calling the magazine "a bunch of neocons who don't like libertarians." Earlier, he said, "I started my political career campaigning against Obamacare," pledging repeatedly to repeal it. "I can't in good conscience vote to keep it . . . Once we do, the Republican name is on health care, and thsi isn't going to work."
National Review blogger Theodore Kupfer wrote Sept. 22 that Paul's money-shuffling argument is "not quite accurate. Three analyses of the bill, from the [liberal-leaning] Center on Budget and Policy Priorities, [consulting firm] Avalere, and the [federal] Centers for Medicare and Medicaid Services, have found that the change in federal health-care funding would be negative for states that expanded Medicaid under the Affordable Care Act. Among those states are Republican strongholds Arizona, Louisiana, Arkansas, Ohio, and Kentucky."
Other analyses predict Kentucky would be one of the big losers, because it was one of the states that expanded Medicaid in 2014 under then-Gov. Steve Beshear. The Kaiser Family Foundation estimates that Kentucky would get 19 percent less money in 2020-26, $5.4 billion, than current law provides. That would be the 10th largest percentage loss among the states. The New York Times produced a chart showing that in funding per person, Kentucky would be the eighth biggest loser among the 50 states and the 35 expansion states.
Paul has sent Trump a list "of what it would take to get him from no to yes," Jonathan Swan of Axios reports. "It's hard to see how they'd stop at least half a dozen moderate Republican senators dropping their support" for the bill. The list includes "a significant reassessment of this trillion-dollar spending machine," making Obamacare rules optional for states, and expanding association health plans, something that can't be done under budget-reconciliation rules -- but maybe by Trump alone.
Paul repeated on NBC what he told Kentucky interviewers last week, that the Trump administration will act "in the next couple of weeks" to start implementing his plan for a national-association health plan, in which anyone could enroll. That could create a group with great bargaining power, but the plan would also be exempt from most Obamacare rules, allowing people to buy thinner, cheaper coverage and taking them out of the Obamacare markets, perhaps weakening them.
Kentucky's other senator was asked Sept. 20 why he would support a bill that would cost the state billions in federal funding. McConnell spokesman Robert Steurer cited Gov. Matt Bevin's support of the bill with 14 other Republican governors, and quoted McConnell as saying:
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| Mitch McConnell (Reuters photo) |
Jennifer Haberkorn of Politico writes, "If successful, Graham and Cassidy would accomplish what McConnell couldn’t: Make good on the GOP’s pledge to undo Obamacare and transform Medicaid from an open-ended entitlement into a capped program. Critics say the result would be draconian cuts that would throw millions off of their health coverage and endanger the most vulnerable Americans."
McConnell is taking a political risk with Graham-Cassidy, after failing to get a repeal bill through the Senate in early August and strongly backing appointed Sen. Luther Strange in an Alabama primary against defrocked judge Roy Moore, who has made McConnell's leadership an issue. Moore is favored to win the Sept. 26 runoff primary.
"McConnell may figure he has nothing left to lose," write Burgess Everett and John Bresnahan of Politico. "He’s already taken a huge political hit for failing to repeal Obamacare. And Republicans say privately that if McConnell didn't take one final stab, he'd be lashed by Trump for giving up. . . . McConnell clearly sees an upside in showing Trump and the GOP base that Republicans haven't abandoned repeal. After weeks of declining to endorse the latest health-care bill, McConnell has embraced Graham and Cassidy’s bill as the Sept. 30 deadline approaches, endorsing it on the floor and playing up the bill on social media."
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