Republicans pinning Obamacare repeal hopes on one more health care bill

WASHINGTON — With just three weeks left in the GOP's campaign to repeal Obamacare, a group of three senators — buoyed by a promise that President Trump would sign their bill — is launching a last-ditch effort to pass legislation.

The measure, introduced by Sens. Lindsey Graham, R-S.C., Bill Cassidy, R-La., and Dean Heller, R-Nev., would give states block grants to decide their own health insurance systems. The senators say that if states want to keep their Obamacare programs, they can, and if they want to repeal and do an entirely new system, they can also do that.

Most of the taxes that are part of Obamacare would remain in place to provide funding for the block grants.  

Senators are running short on time because the budget procedure they would use to pass the legislation with a simple majority will expire at the end of the month.

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“It appears that the repeal and replacement of Obamacare is dead, unless the Senate can act by the end of the month,” Rep. Mark Meadows, R-N.C., chairman of the conservative Freedom Caucus, told USA TODAY Wednesday. Meadows, who chairs the hardline conservative House Freedom Caucus, was a key player in a compromise amendment that ultimately brought on dozens of conservatives and got the repeal-and-replace legislation through the House in May.

“All hopes are on Sen. Graham and his willingness to move something through the Senate, outside of that, it’s not looking very optimistic," Meadows continued.

Just this week, Graham and Cassidy met with Vice President Pence on Capitol Hill to discuss their proposal and also participated in a conference call with governors. Their effort got a boost Wednesday after White House adviser Kellyanne Conway said on Fox that Trump would sign the measure if it made it to his desk.

Cassidy, a physician, told USA TODAY he and other sponsors are trying to drum up support, including among governors who he said can wield influence with senators.

“It will take both the president committed to it, but also probably the governors because everybody understands that governors are the ones who implement this, and if they sign off, I think folks can be comfortable,” said Cassidy, who serves on the Senate Health, Education, Labor and Pensions Committee.

Sen. Roger Wicker, R-Miss., who backs the bill, said Trump's support helps their effort. “The president’s interest in this indicates that it has a chance," he said.

Sen. John McCain, R-Ariz., said Wednesday he liked the proposal, but he cautioned he would not commit to supporting it without seeing the final legislation and talking to Arizona’s governor.

McCain cast the critical vote that killed the Senate effort for a scaled-down repeal at the end of July.

“I want to see the final legislation and understand its impact on the state of Arizona before taking a position,” McCain said. “Any effort to replace Obamacare must be done through the regular order of committee hearings, open debate and amendments from both sides of the aisle.”

But regular order takes time, and there are just a few weeks left to pass a bill under budget reconciliation rules.

After the ability to use reconciliation ends, senators would have to go back to the usual requirement of getting 60 votes in order for health care legislation to pass — an almost impossible task given Democrats have been united against any efforts to repeal the Affordable Care Act. Republicans have 52 seats in the Senate, with Democrats and independents holding 48.

“The clock is ticking — Sept. 30 with this reconciliation vehicle,’’ said Sen. John Thune of South Dakota, a member of Republican leadership. “In order to use that a lot has to happen. I think it’s a kind of a double bank shot that that could get done."

Cassidy said lawmakers are looking to get the measure scored by the nonpartisan Congressional Budget Office possibly as early as next week and go through the legislative process in the next two to three weeks.

“There seems to be some hope, not a lot, but you can bet we’re pushing it hard,” Marilyn Musgrave, vice president of government affairs at Susan B. Anthony List and a former congresswoman, told USA TODAY.

SBA List is an anti-abortion organization that is pushing Graham-Cassidy because it includes a provision that would defund Planned Parenthood.

Not everyone is convinced.

“There are a lot of different ideas that have been brought up at the the committee,‘’ Sen. Susan Collins, R-Maine, a member of the HELP Committee, told reporters Wednesday.

The most interest, she said, seems to be in modest legislation to stabilize the insurance markets in order to lower premiums, an idea that has been the focus of hearings before the HELP Committee this week.

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Sen. Tim Kaine, D-Va., who is also on the HELP panel and is a former governor, said he doesn’t expect movement any time soon on the Graham-Cassidy bill.

“It will be part of the longer-term discussion,’’ Kaine said Thursday. “That proposal hurts Virginia pretty badly so that’s not going to be one that I support." 

Frederick Isasi, executive director of Families USA, said the Graham/Cassidy plan for block grant funding would be harmful to low and moderate-income families.

“The cuts in the Graham-Cassidy proposals are just as harsh and extreme as any of the repeal proposals that the Senate rejected over the summer,’’ Isasi said in statement Thursday.

Massachusetts Gov. Charlie Baker, a Republican, said during a HELP committee hearing Thursday he doesn’t support the Graham/Cassidy bill, which he said would cost his state billions of dollars over the next four or five years.

Meanwhile, on Friday, a bipartisan group of House members who call themselves the Problem Solvers Caucus will be joined by Colorado Democratic Gov. John Hickenlooper and Ohio Republican Gov. John Kasich to discuss their compromise proposal.

Contributing: Michael Collins