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Senate Republicans tweak Graham-Cassidy in latest bid to win votes

Time and votes are running short, but they’re still trying.

Lindsey Graham Bill Cassidy Alex Wong / Getty Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

Senate Republicans appear to be adding new funding to a revised version of their latest Obamacare repeal plan, a last-ditch attempt to keep the bill alive after a critical mass of senators said that they likely could not support it.

Vox obtained a copy of the revised bill sponsored by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) from a health care industry source and confirmed it with two other industry sources. Cassidy’s office did not immediately respond to a request to confirm the authenticity of the draft.

The new bill looks much the same as the old one — Obamacare’s funding is transformed into block grants for states to set up their own health care programs and Medicaid is overhauled with a federal spending cap — but there is notable additional funding.

The money seems to be targeted to certain states like Alaska, where Sen. Lisa Murkowski is a key swing vote on the legislation and who has been made an explicit target of the last-minute tweaks, and Medicaid expansion states more generally, which were hit hardest by the bill’s block-grant funding formula.

The new funding includes:

  • $750 million provided every year from 2023 to 2026 (totaling $3 billion) to states that expanded Medicaid under Obamacare after 2015.
  • $500 million for states that have set up an Obamacare waiver program — a provision likely directed at Alaska, which set up a reinsurance program through the law’s waiver program.
  • Additional federal Medicaid funding made available to certain high-poverty states, which also appears directed to Alaska.

The revised bill comes as Senate Republicans are running low on time and votes in their final bid to repeal and replace Obamacare. They are facing a Sept. 30 deadline to move the bill with only 51 votes, after which they would have to at the very least pass a new budget resolution to start the process over.

The vote count is also looking dim. Sen. John McCain (R-AZ) said Friday that he would oppose the bill, calling instead for a return to regular order and bipartisanship. Sen. Susan Collins (R-ME) sounded all but assured to be a ‘no’ vote in interviews on Sunday.

Sen. Rand Paul (R-KY) has consistently said he opposed the plan. He cracked the door open to support it Sunday — but only if the block-grant funding were significantly cut. Graham and Cassidy appear to be moving in the opposite direction in the revised bill. Other conservatives, like Sen. Ted Cruz (R-TX), have also said they oppose the bill as it is currently written.

Then there is Murkowski, perhaps the most closely watched vote. She has said repeatedly that she is reviewing estimates on how the bill would affect Alaska — and now much of the new funding in the revised plan would benefit her state.

According to Senate Republican estimates obtained by Vox along with the bill, Alaska would still see a $100 million federal funding cut by 2026 under the block grant — though the estimates say that, because the state would save money on its share of Medicaid expansion, the state would see a net 3-percent bump in funding. (It should be noted the GOP’s internal estimates have been rosier than those from outside groups.)

However, Murkowski has raised other concerns, such as protections for people with preexisting conditions — which Graham-Cassidy would roll back compared to Obamacare — and the rushed, secretive process that has produced the GOP’s health care plans.

Outside estimates of the original Graham-Cassidy bill estimated that the legislation would cut federal health care spending by $215 billion by 2026 and lead to 21 million fewer Americans having health insurance.

Vox’s Sarah Kliff reviewed the first version of the bill here.

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