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Graham-Cassidy Health Care Bill Likely Dead As McCain Announces Opposition

congress-healthcare

Arizona Senator John McCain has announced that he will vote against the Graham-Cassidy health care bill, which likely means that the measure is doomed and may not even be brought up for a vote:

WASHINGTON — Senator John McCain of Arizona announced on Friday that he would oppose the latest proposal to repeal the Affordable Care Act, leaving Republican leaders with little hope of succeeding in their last-ditch attempt to dismantle the health law.

(…)

“I cannot in good conscience vote for the Graham-Cassidy proposal,” Mr. McCain said. “I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it.”

McCain’s announcement comes with just eight days left for the Senate to pass the bill under the relaxed reconciliation rules that allow Republicans to push the measure through with a simple majority rather than having to obtain sixty votes in order to invoke cloture and proceed to a final vote. As I’ve noted before, at the start of the month the Senate Parliamentarian ruled that the reconciliation process comes to an end on September 30th, next Saturday. Already we know that at least two Senators, Susan Collins of Maine and Rand Paul of Kentucky have said they will not support the Graham-Cassidy bill and there is strong pressure on Alaska Senator Lisa Murkowski to do the same. Whether she does or not, though, the loss of three votes out of a 52 vote majority means that Senate Majority Leader Mitch McConnell would see the bill go down to defeat. In that regard, it’s worth noting that McConnel has indicated that he would not bring the measure to the floor for a vote unless he was sure that it would have at least the fifty votes needed to pass.

Theoretically at least, the Senate could reset the clock on reconciliation but that would require passing a new budget resolution, which seems unlikely in the short term. Additionally, Republican Senators and Members of Congress have already said that they want to use the next reconciliation period to pass tax reform. Since the reconciliation procedures can only be used for one bill at a time, that means that any future health care reform measure would need to go through regular order and would need sixty votes to pass. For obvious reasons, it’s unlikely that Graham-Cassidy or anything resembling it would receive sufficient Democratic support to make it past the sixty vote margin, especially since the opposition of Senators Collins, McCain, and Paul would mean that Republicans would need the support of at least eleven Democrats to get past the sixty vote margin.

This would seem to be the end of a saga that has lasted for the past three months, as well as an end for now to the Republican Party’s efforts to repeal and replace the Affordable Care Act. The latest iteration began, of course, after the House of Representatives passed the American Health Care Act with barely a vote to spare. At that point, the battle shifted to the Senate, where it ultimately proved to be a fruitless endeavor. After making clear that the AHCA had no chance at all of passing the upper chamber, Senate Republicans put forward the Better Care Reconciliation Act. As with the House bill, the BCRA was drafted behind closed doors without either committee hearings or public debate, and of course no input from Democrats. Almost immediately, though the BCRA ran into roadblocks.F First of all, Mitch McConnell’s plan to vote on the bill before the July 4th recess collapsed when the Congressional Budget Office released a devasting score for the bill. After that, BCRA quickly lost support and was pulled from the floor before voting could begin. After the recess, Senate Republicans put forward a revised plan that also received a bad CBO score and quickly came under fire. When it became obvious that this bill would also fail to get even the fifty votes required to pass the bill, McConnell proposed yet another plan that would repeal the Affordable Care Act without actually replacing it with anything, but that plan ended up falling apart after only eighteen hours. Undaunted, the Senate still refused to give up and decided to go forward even though it was unclear which direction they were heading. Ultimately, the Senate ended up voting on something they called “Skinny repeal,” which repealed only parts of the PPACA such as the individual and employer mandates and some other regulations. Bizarrely, though, even Senators who voted for that bill said they never intended for it to become law. Instead, they said it would be the basis to force a conference committee with the House in an effort to put together a bill that could get through both bodies. That effort, though, came to an end when McCain, who had just been diagnosed with cancer, returned to the Senate to deliver a late-night thumbs down that sealed the bill’s fate.

McCain’s announcement today seems to do the same thing, and do so with a finality that likely means that Republicans will not be able to revisit the idea of repealing and replacing the PPACA at any point before the 2018 midterms and, more importantly perhaps, the 2018 primary elections. This last point is important because the inability of Congressional Republicans to pass a health care bill and get it to the President’s desk has already been the subject of widespread criticism from both the President himself and from grassroots organizations that have devoted much of the past seven years to campaigning against Obamacare. This failure, if it comes to pass, could mean we’ll see a lot more primary challenges against incumbent Republicans in both the Senate and the House than we might have seen otherwise. This in turn could have a real impact on the battle for control of Congress if it means that incumbents end up getting defeated in the primaries and replaced by candidates further to the right who have problems in a General Election against candidates that are further to the right and who use the failure to follow through on seven years of promises on health care reform.

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. Cory says:

    My biggest problem with any of these attempts to change Obamacare is that several things were ridiculously obvious: 1) The President had no policy interest and vision for what a health care reform bill would/should do; 2) The GOP also never laid out a vision for where it wanted to see health care moving. Was this a first step towards a freer market? I have no idea. But, at the very least in hurt people in the short term; and 3) Passing a bill that impacts 1/5 or 1/6 or however much of the economy health care is just to show you passed something, anything, that you could say was an Obamacare repeal is entirely irresponsible. Getting a “win” with a giant festering turd of a bill is still a giant festering turd.

    And I say that as someone who also thinks Obamacare is a giant festering turd.

    Like or Dislike: Thumb up 4 Thumb down 7

  2. OzarkHillbilly says:

    the failure to follow through on seven years of promises on health care reform.

    Quite a world we live in when taking healthcare away from millions of people, blowing up our entire health insurance system, and closing thousands of rural hospitals is what the GOP considers “health care reform.” But hey, “Both sides…”, right?

    Highly-rated. Helpful or Unhelpful: Thumb up 29 Thumb down 0

  3. OzarkHillbilly says:

    @Cory: Yeah but Obamacare is a giant festering turd that is saving lives.

    Highly-rated. Helpful or Unhelpful: Thumb up 17 Thumb down 0

  4. Daryl's other brother, Daryll says:

    McCain is just looking to get his ass kissed…maybe a bribe like Murkowski is getting.
    Meanwhile he’s getting top-flute medical care, paid for by you and me.

    Like or Dislike: Thumb up 0 Thumb down 9

  5. Facebones says:

    @Daryl’s other brother, Daryll: I 100% agree that McCain is a media whore and the most dangerous place to stand is between him and a Sunday talk show green room.

    However, if this again stops the republicans from passing an insanely awful health bill that literally no one but the ultra rich donors want, then I’m ok with it. He’s welcome to have his fawning media coverage. He’s earned it, for once.

    Highly-rated. Helpful or Unhelpful: Thumb up 26 Thumb down 1

  6. teve tory says:

    If Graham Cassidy passes, two of my friends will very possibly die. One has sarcoidosis and the other has severe celiac disease. Obamacare saved their lives.

    Highly-rated. Helpful or Unhelpful: Thumb up 17 Thumb down 0

  7. Senyordave says:

    @OzarkHillbilly: Yeah but Obamacare is a giant festering turd that is saving lives.

    That is a bug as far as most of the GOP is concerned. One of the basic problems is that many of the GOP house members don’t seem to understand how insurance works. And many of their supporters are fine with coverage as long as they get and those less deserving don’t get it. Remember, keep your gubmint hands off of my Medicare.

    Like or Dislike: Thumb up 7 Thumb down 0

  8. Sleeping Dog says:

    Murkowski & Collins have safe seats and supporting Obamacare is popular in Maine & Alaska. This is McCain’s last term and he’s protecting other Repug Senators who don’t want to repeal Obamacare but run the risk of being primaried if they vote no. Can’t quite figure Paul’s opposition.

    Like or Dislike: Thumb up 8 Thumb down 0

  9. the Q says:

    The problem is the deals Democrats struck with the healthcare industry to get the law passed ensured that the flawed system would remain intact. And it has.

    Everyone is asking what the GOP’s repeal bill will look like, but where is Schumer/Pelosi on THEIR solutions to Ocare’s flaws.

    The basic deal that the Obama administration and the Democrats in the Senate had to make was to get more coverage for people. But they got more coverage for people at the same high prices that allow the drug companies to be so profitable, that allow the non-profit hospitals to be so profitable, that allow the device-makers to be so profitable — and that is the result that is Obamacare. For example, the big 5 HMOs share prices have gone up an average of 417% since 2011. The DJIA 220% in that same time frame. Same story with drug company stocks.

    The good news? my friends who hadn’t had access to doctors in years suddenly had access to health care. The bad news is that you and I and all the other taxpayers are paying the same high prices for that health care that dominated and completely screwed up the system in the first place.

    Our system is a mess. It needs to be totally blown up. Obama did the best he could, but the Dems did themselves a great disservice when they kept gainsaying any criticism of the system and glossed over the flaws to deflect GOP attacks.

    In Japan, all employees have to get a physical every year. They submit a certificate of compliance or they lose their job if they don’t.

    These physicals all paid by the gov’t. They’re thinking preventative. If they catch a condition in its early stages, its much cheaper to treat it then rather than later.

    Why can’t this simple measure be implemented here? Give adults and their dependents a voucher to get a basic physical, paid for by Uncle Sam once a year. The results are confidential. This one little change could pay huge dividends. And its cheap compared to other solutions.

    Thank McCain for being the maverick. Both sides need to sit down and come up with bipartisan solutions and stop with their own selfish interests.

    Like or Dislike: Thumb up 2 Thumb down 8

  10. Tony W says:

    @the Q:

    Why can’t this simple measure be implemented here? Give adults and their dependents a voucher to get a basic physical, paid for by Uncle Sam once a year. The results are confidential. This one little change could pay huge dividends. And its cheap compared to other solutions.

    Because Freedom.

    Also because unregulated capitalism would ensure the results were not confidential, but were rather given to a buddy of a congressman, who then sought rent-seeking protection to keep any competitors from accessing said data.

    Oh, and the voucher for a free physical would not be honored by any providers unless you added on $125 or more of additional services.

    You’re right – we need to blow up the system.

    Like or Dislike: Thumb up 8 Thumb down 0

  11. Barry says:

    @Daryl’s other brother, Daryll: “Meanwhile he’s getting top-flute medical care, paid for by you and me.”

    And every single one of the GOPpers are getting special, government-funded health care, which will not be on the chopping block.

    Like or Dislike: Thumb up 4 Thumb down 0

  12. MBunge says:

    Is it possible for every GOP House and Senate incumbent to lose in 2018? For over 20 years, Hillary Clinton’s epic failure on health care reform was pretty much the modern standard for political debacles but Republicans have managed to actually outdo her. They completely refused to have anything to do with Obamacare, spent seven years telling every single voter they were going to repeal it, and then put on an absolute clown show because in those seven years they never spent five minutes actually trying to come up with a vaguely viable replacement.

    And Trump really isn’t to blame for any of it.

    Just…wow. If Democrats can’t win back control of SOMETHING in 2018, what is it going to take?

    Mike

    Like or Dislike: Thumb up 2 Thumb down 8

  13. Tyrell says:

    These are some possible solutions to some of the health insurance problems.
    Rising costs – $1,000 a month for a premium is way too high and out of reach for most people. One way to help these people would be a system of tax credits and expanded deductions. A straight deduction for medical expenses instead of the ridiculous percentage of gross income.
    Medical costs must be contained and be realistic. Hospital charges $130 for a plastic water pitcher and straws. Ridiculous. Eliminate the “fee for service” process and come up with realistic prices.
    I pay $4cash for three months prescription. If I run it through insurance it is $10 for one month. There is something wrong with that.
    People need to start negotiating their hospital bills. Those statements are like the sticker prices on new cars: virtually meaningless. Check and question everything. Hospitals are usually glad to negotiate. They will reduce the amounts and set up good payment plans. In my case, after a year the hospital cancelled out the remainder of my bill. They said they would write it off and that most of those amounts are highly inflated anyway.
    Legalities and litigation needs more control, with limits on lawsuit awards.
    Have a basic no-frills Medicare plan available to all who want it. Offer additional options at a cost, such as dental, vision, orthodontics, cosmetic, fitness memberships: things that would attract the young people and bring a lot of money.
    Eliminate the mandates. Most people found ways around those anyway.
    Too many repetitive, overlapping, unnecessary tests, visits, and medications. The “let’s run that test one more time” mindset needs to change. Doctors seldom know how much costs really are. They just send it on to the insurance companies.
    The er should not be used as a family doctor. It should be used only for real emergencies, not sneezing, colds, and hangnails.
    Those are briefly some ideas that could improve medical care and reduce costs. The leaders must be clear on how much all this is going to cost and where the money will come from. The federal government’s charge card is about maxed out. Someday the bill will come due. There needs to be more realistic thinking about just what the government can, and should do.

    Like or Dislike: Thumb up 1 Thumb down 4

  14. Just 'nutha ig'nint cracker says:

    @Cory: “The GOP also never laid out a vision for where it wanted to see health care moving.”

    Sure they did, you just don’t want to acknowledge what the vision was:

    1. More money for us. 2) 4-Q.

    Like or Dislike: Thumb up 7 Thumb down 0

  15. Just 'nutha ig'nint cracker says:

    @Sleeping Dog: “Can’t quite figure Paul’s opposition.”

    Paul genuinely doesn’t believe the government should provide safety net items to the undeserving. He also doesn’t believe that blacks should be able to vote or have government protecting their rights. Basically, he’s an even more ig’nint (and repulsive) cracker than I am.

    Like or Dislike: Thumb up 7 Thumb down 0

  16. Terrye Cravens says:

    @Daryl’s other brother, Daryll: McCain has brain cancer. In all probability he is dying. Maybe he is trying to do the right thing. He is going to take enough crap from the crazy right, so why not give the man the benefit of the doubt?

    Like or Dislike: Thumb up 7 Thumb down 0

  17. Terrye Cravens says:

    @MBunge: Who says Trump is not to blame for any of it? He spent 2 years yammering about his great health care plan. Promising he would tell us all about it once he was elected. Not only was there no plan, he offered no leadership on the issue at all. None. In fact, he said the House bill was “mean” after he congratulated the House for passing it.

    The Republicans certainly screwed this up, but Trump did his part in this fiasco.

    Like or Dislike: Thumb up 13 Thumb down 0

  18. MBunge says:

    @Terrye Cravens: Who says Trump is not to blame for any of it

    I don’t believe that Trump ever said anything about health care that hadn’t already been said by the now sainted John McCain and basically every other Republican in DC. And I’m fairly sure that I remember news stories about how Trump didn’t want to move on health care first. He wanted tax reform. It was the GOP Congress that insisted on tackling an Obamacare repeal.

    Mike

    Like or Dislike: Thumb up 1 Thumb down 10

  19. Mister Bluster says:

    And Trump really isn’t to blame for any of it.
    This is what Donald Trump proposed for health care before he was elected.

    1. A complete repeal of the Affordable Care Act, as no citizen should be forced to buy health insurance.

    2. Congress should break down state barriers to allow insurance companies to offer plans in any state, as long as the plan is in compliance with state requirements.

    3. Give people the ability to deduct insurance premium payments from taxes, as businesses are already allowed this deduction. Further, Trump pushes for a review of Medicaid options to make sure everyone who wants healthcare coverage is able to afford it.

    4. Establish tax-free Health Savings Accounts, which could become part of an individual’s estate and passed on to heirs without an estate penalty. Additionally, all family members can use the account without penalty.

    5. Trump calls for price transparency from providers and hospital organizations, to allow individuals to shop for the best prices on treatments.

    6. Medicaid should be handled on the state level, including incentives, to ‘preserve our precious resources.’

    7. Break down barriers that prevent drug providers of less expensive, safe products from entering the free market. And consumers should be allowed access to safe, imported drugs from overseas.

    Republicans control both houses of Congress. The President is a Republican.
    What has Trump done to promote these seven items into legislation?
    His most profound contribution to the legislative process was when he said: “nobody knew that healthcare could be so complicated,”.
    I actually thought it was the dumbest thing he could say about the issue until the other day when he revealed that “I assumed when I won, I would sit down at my desk and there would be a healthcare bill”
    Of course it’s not his fault Bungles. He never thought he would have to do anything but sign the bill.
    This should tell you that he has absolutely no idea what he is doing.
    One of these days everyone will know this…except you!

    Like or Dislike: Thumb up 8 Thumb down 0

  20. panda says:

    @Tony W:

    Why can’t this simple measure be implemented here? Give adults and their dependents a voucher to get a basic physical, paid for by Uncle Sam once a year. The results are confidential. This one little change could pay huge dividends. And its cheap compared to other solutions.

    Um, under the ACA, each poicy, even the crappiest bronze ones, has to provide you three zero costs preventative visits to a doctor..

    Like or Dislike: Thumb up 7 Thumb down 0

  21. Barry says:

    @the Q: “Both sides need to sit down and come up with bipartisan solutions and stop with their own selfish interests.”

    At least you led with ‘both sides’.

    Like or Dislike: Thumb up 2 Thumb down 0

  22. wr says:

    @MBunge: Gosh, don’t you remember all those months when you were pretending not to be a Trumpie and he was running around saying he had a plan that would bring everyone great health care for a fraction of the cost of Obamacare, and he would put it into place his first day in office?

    It’s pretty tiresome to see you constantly posturing as the Only Pure and Wise Soul in the world. But when you broaden that out so that you and Trump are the only two, it’s just sad.

    Like or Dislike: Thumb up 8 Thumb down 0

  23. Barry says:

    @Tyrell: “One way to help these people would be a system of tax credits and expanded deductions. A straight deduction for medical expenses instead of the ridiculous percentage of gross income.”

    So if you had a $50K bill, you’d pay no taxes that year, and that would solve the problem?

    Like or Dislike: Thumb up 3 Thumb down 0

  24. grumpy realist says:

    @MBunge: Did John McCain promise a “wonderful new plan, cheaper and will cover everybody!”?

    I. Don’t. Think. So.

    Like or Dislike: Thumb up 0 Thumb down 0

  25. gVOR08 says:

    Via Balloon Juice, NYT has a good article on the Republicans’ obsession with repealing Obamacare. Senate Republicans had record off-year fundraising in March with 7 million. They got 2 million in July and August. Sen Cory Gardner is in charge of their fundraising.

    “Donors are furious,” one person knowledgeable about the private meeting quoted Mr. Gardner as saying. “We haven’t kept our promise.”

    The Republican donor class apparently hate Obamacare. It may be because they feel they’re taking a tax hit, but I suspect a lot of it is ideology. And they want some paper savings from repeal to enable tax cuts for themselves. In any case, the Republican donor class are eager to screw over the public for a few dollars in their own pockets. And their minions in Congress are eager to please.

    Like or Dislike: Thumb up 1 Thumb down 0

  26. JohnMcC says:

    @gVOR08: Actually one could think of this health care bill and it’s relationship to GOP donors as an extension of the Governor Bob McDonnell rule. It’s constituent service of a rather unsightly but perfectly normal sort.

    Like or Dislike: Thumb up 0 Thumb down 0

  27. Mikey says:

    @gVOR08:

    In any case, the Republican donor class are eager to screw over the public for a few dollars in their own pockets. And their minions in Congress are eager to please.

    Today’s Republican Party. Motto: “Fuck you, I got mine.”

    How sad that a party founded on such lofty ideals has sunk to this level of banal venality.

    Like or Dislike: Thumb up 1 Thumb down 0

  28. Mikey says:

    Oops, forgot to smooth out my language. Can a mod please release my comment? It’s an appropriate use of profanity..

    Like or Dislike: Thumb up 0 Thumb down 0

  29. KM says:

    @the Q:

    Why can’t this simple measure be implemented here?

    Like Tony said, FREEDUM.

    I’ll give you an example resistance to such basic ideas even with great incentives. Where I work, there’s health initiatives programs that cut your insurance premiums down and give you cold hard cash for participating. Things like group walks, weigh-ins, drink more water programs, etc. One in particular was the weigh-in: an initial after Thanksgiving (when we’re all fat) as your baseline and then you need to maintain or lose for the next few months. It’s $100 each month you can do so. Step on the scale in the breakroom on the first of the month and boom, cash.
    Over a grand a year just to not gain weight. Free money to do the right thing.

    So far, only *eight* people have made it to date, myself included. Eight out of hundreds at our location. The initial sign up was anemic and straight up died the second month in. When the CEO inquired as to why so few were taking advantage of this, he got a slew of complaints that it was “violating their dignity” and that the company had no right to force them to do thing to get “their money”. See, the prevailing opinion was the company should just be giving them the money for Victoza instead of asking them to lay off the doughnuts. He owes them healthcare but has no right to try and reduce healthcare costs by asking them to *gasp* try and not get any fatter.

    Americans don’t like being told what to do. They want to be fat, stupid and free to continue to be fat and stupid. We’d see bloody rebellion in the streets if companies were allowed to demand something as simple as a physical once a year as a non-negotiable job requirement.

    Like or Dislike: Thumb up 3 Thumb down 1

  30. Mister Bluster says:

    …appropriate use of profanity.

    Fvckin’ A…

    Like or Dislike: Thumb up 1 Thumb down 0

  31. Tyrell says:

    @KM: How about the few people like me – I am underweight. My doctor told me I could stand to gain some pounds. I have tried, but always fall back, even after a weekend of milk shakes, protein shakes, and sundaes. No rewards for gaining weight, even when recommended?

    Like or Dislike: Thumb up 0 Thumb down 1

  32. Bob@Youngstown says:

    @Daryl’s other brother, Daryll:

    Meanwhile he’s getting top-flute medical care, paid for by you and me.

    What is your point to this comment? Are you complaining that McCain is getting “top-flight” medical care or that his care is being subsidized by “you and me”?

    I am on medicare, consequently my care is being subsidized by everyone that pays taxes. Unless you are private pay for your healthcare there are many people that are subsidizing your medical expenses.

    So are you suggesting that McCain ought be on private pay?

    SO, Just what do you know about McCain’s healthcare and his insurance or lack thereof?

    Like or Dislike: Thumb up 0 Thumb down 1