Graham-Cassidy is dead, but budget reconciliation could bring back Obamacare repeal in 2018

With Republicans’ failure to get enough votes for their Graham-Cassidy health care plan, efforts to repeal Obamacare are dead again — for now.

On the September 25 episode of The Weeds, Sarah Kliff, Ezra Klein, and Matt Yglesias discuss Graham-Cassidy, budget reconciliation, and a white paper on improving the SNAP benefits program.

The Graham-Cassidy proposal saw some changes since the Weeds crew last discussed the proposal, including the addition of an extra $750 million in funding for states that expanded Medicaid after 2015. But as Sarah points out: “It turns out there are two states that are eligible for this money — Montana and Sen. Cassidy’s home state of Louisiana.”

Even those changes weren’t enough to win 50 votes, and on Monday, Maine Sen. Susan Collins announced her opposition to the bill, joining Sens. Rand Paul (R-KY) and John McCain (R-AZ). Of course, the Republican effort to repeal Obamacare is far from over. As Ezra explains, Republicans could push the health care debate into 2018 by passing a new budget resolution with new reconciliation instructions.

Budget reconciliation, Ezra says, is “a fast-track budget process by which they can reconcile their spending and taxing. In doing this, [a bill] gets to go through a quick process in the Senate and the House; it can’t be filibustered.” This allows a bill to pass with just 50 Republican senators plus a tie-breaking vote from Vice President Mike Pence, as opposed to the normal 60 votes.

“Graham-Cassidy is dead, but thanks to the reconciliation process we just talked about, there is at least some level of support to keep this running through this time next year,” Sarah says.

Here’s Sarah explaining fully what Graham-Cassidy had set out to do:

So what they did felt very reminiscent of the path that most of the Senate Republican bills have taken toward failure.

The bill essentially block-grants the entire amount of Affordable Care Act funding. We have seen some analysis come out showing how badly certain states are hurt. It is an overall $200 billion budget cut to overall Obamacare funding, and then it is just distributed in a vastly different way. It takes money from states that have expanded Medicaid and sends it to states like Mississippi and Alabama that have done literally nothing to implement the Affordable Care Act, and then it puts a per capita cap on Medicaid. All of that taken together, according to Avalere, a health research firm, leads to $215 billion in budget cuts.

So that’s Graham-Cassidy 1.0. Graham-Cassidy the sequel, much like action movies, is not actually that different, just changed a little bit around the edges. You have some weakening of insurance regulations to please the Rand Pauls and Ted Cruzes of the world.

In Graham-Cassidy 1.0, you had to apply for a waiver and say, “I want insurance companies to charge older people more, and charge sick people more,” and the federal government would have to give you a waiver to do that. In the new version, it is very little oversight. It essentially says you just have to send the federal government a description of the rules you are getting rid of and a description of how you plan to protect people with preexisting conditions. There is no mechanism to say, “That’s not a very good description,” or, “I don’t think that plan really protects people with preexisting conditions.” You just kind of send your letter to the federal government with the plan for Mississippi, and that’s the way they could get rid of some really key Obamacare regulations.