Senators brace for showdown vote on GOP bill to replace Obamacare

Updated September 21, 2017 - 8:33 pm

WASHINGTON — Senators are girding for a showdown vote to repeal and replace Obamacare as the White House flexed its muscle Thursday to build public pressure and sway undecided GOP lawmakers.

Vice President Mike Pence hit the morning TV shows and said Republicans were very close to reaching the 50 votes needed in the Senate to repeal the Affordable Care Act and replace it with legislation that sends federal funds to states in block grants.

In an appearance on “Fox and Friends,” Pence said the bill is the “last, best chance” to repeal the ACA, commonly known as Obamacare.

Pence said on “CBS This Morning” that the Republican bill was a more efficient approach to provide health care through block grants to the states “instead of creating a one-size-fits all program in Washington, D.C.”

The bill was unveiled last week by Sens. Lindsey Graham, R-S.C., Bill Cassidy, R-La., Dean Heller, R-Nev., and Ron Johnson, R-Wis.

Heller opposed an earlier repeal bill because of cuts to Medicaid.

But the Nevada senator sponsored the new legislation that he said would increase federal spending for Nevada by redistributing federal funds in block grants with cuts to four states that currently receive 40 percent of the money: California, New York, Maryland and Massachusetts.

The bill also would give states flexibility to spend the funds on health care needs of choice and allow waivers of Obamacare regulations. It would also eliminate the individual and employer mandates.

But a study released this week by Avalere Health found that 34 states would see reductions in federal spending because of Medicaid cuts in the bill. It showed Nevada would lose $2 billion from 2020 to 2026.

A study by the nonpartisan Kaiser Family Foundation released Thursday reached similar conclusions.

That study estimates that states that did not expand Medicaid would see 12 percent more in block grant funding, while those that expanded the program would see cuts of roughly 11 percent.

Nevada would lose about $870 million in funds from 2020 to 2026, according to the Kaiser analysis.

The nonpartisan Congressional Budget Office has told Senate leaders that it cannot prepare a cost analysis that includes health insurance coverage estimates before the end of the month.

A group of bipartisan governors, including Republican Brian Sandoval of Nevada, have urged Senate Majority Leader Mitch McConnell to shelve the bill because of the Medicaid cuts and the shift in financial burden to states.

Sandoval led Nevada to expand Medicaid under Obamacare in 2012, and has repeatedly said he wants to insure continued coverage for those Nevadans who became eligible under the expansion.

Senate Democrats, including Catherine Cortez Masto of Nevada, oppose the repeal of Obamacare and plan to vote in a bloc against the Republican legislation.

Because Republicans hold a slim 52-48 majority, the GOP can afford to lose only two votes and still pass the bill with a tie-breaking vote by Pence. Three GOP defections would kill the bill.

Sen. Rand Paul, R-Ky., is opposed to the bill because it fails to fully repeal Obamacare. Three other GOP lawmakers still considering the bill are John McCain of Arizona, Susan Collins of Maine and Lisa Murkowski of Alaska.

They have been the focus of an intense lobbying effort by Graham, Cassidy and the administration as they seek to solidify a 50-vote majority to push the bill through the Senate.

Republican leaders face a Sept. 30 deadline that allows them to repeal and replace Obamacare with a simple majority under budget reconciliation rule. Once the rule expires, the GOP would need 60 votes to overcome a Democratic filibuster.

House Speaker Paul Ryan, R-Wis., has predicted passage of the Graham-Cassidy-Heller-Johnson bill in the House if approved by the Senate.

Democrats in the House are united in their opposition to the bill.

Rep. Dina Titus, D-Nev., citing a left-leaning Center for American Progress analysis, said the Senate bill would result in the loss of coverage for 37 million people by 2027, including 243,000 Nevadans.

Titus called the bill a “scam” that would “wreak havoc on Nevada families.”

Contact Gary Martin at 202-662-7390 or Follow @garymartindc on Twitter.

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