Cassidy, Graham drop new health care bill revisions in last-ditch effort to win over colleagues

Sept. 26--WASHINGTON -- As the Cassidy-Graham health care proposal received its first public vetting in a U.S. Senate committee Monday afternoon, Republican Susan Collins appeared to deal the plan a fatal blow by announcing her opposition.

Collins joined two other Senate Republicans -- Arizona's John McCain and Kentucky's Rand Paul -- in publicly pledging to vote against the proposal, leaving Republicans in the U.S. Senate short of votes just days ahead of Saturday's legislative deadline to pass the bill with a simple majority.

Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina, the proposal's authors, unveiled a revised version of their plan Monday morning that features a series of changes designed to convince skeptical Republican colleagues to back it. The new version of the Cassidy-Graham bill includes tweaks to its funding formulas to send more federal money to key states, including Collins' home state of Maine.

But Collins, in a lengthy statement outlining her opposition, appeared unmoved by the revisions, criticizing the rushed legislative process and last-minute changes.

"Sweeping reforms to our health care system and to Medicaid can't be done well in a compressed time frame, especially when the actual bill is a moving target. Today, we find out there is now a fourth version of the Graham-Cassidy proposal, which is as deeply flawed as previous iterations," Collins said. "The fact that a new version of this bill was released the very week we are supposed to vote compounds the problem."

The health care overhaul, touted by Cassidy and Graham as the Republicans' last viable shot at fulfilling pledges to repeal and replace the Affordable Care Act, is centered around repackaging billions of dollars in federal funding for Obamacare's Medicaid expansion and individual insurance subsidies into flexible block grants for states.

Louisiana also comes out better under the revised formula than the original incarnation of Cassidy-Graham. A newly inserted provision provides extra funding each year to states that expanded Medicaid after Dec. 31, 2015 -- a clause that would apply only to Louisiana and Montana.

The proposal would also allow states to roll back a number of the Affordable Care Act's regulations and minimum requirements for health insurance plans. Monday morning's revised version appears to expand the ability of states to opt out of those regulations, including limits on out-of-pocket expenses -- opening the door to skimpy but relatively cheap catastrophic insurance plans -- and requirements that insurers to cover certain health care services.

Cassidy-Graham would also repeal the individual mandate, a requirement that individuals carry health insurance or pay a penalty, and end a tax on medical devices, a controversial provision of the Affordable Care Act used to fund some of the law's health care benefits.

An initial analysis by the nonpartisan Congressional Budget Office released Monday says the latest version of the Cassidy-Graham bill would lead to significant cuts in federal health-care funding for states and likely leave millions fewer Americans with health insurance than under the Affordable Care Act, echoing the findings of a number of outside think tanks in recent days.

"The decrease in the number of insured people would be particularly large starting in 2020, when the legislation would make major changes to federal funding for Medicaid and the nongroup (health-insurance) market," the CBO wrote.

As moderate Republicans like Collins expressed concerns about cuts to Medicaid under Cassidy-Graham, a handful of harder-line conservatives -- led by Paul -- chafed at the size of the block grants. Paul reiterated his opposition to the bill in several interviews Monday, appearing to dash hopes he might still come around to support it.

Cassidy answered with a flat "no" when asked if there was any way to address Paul's concerns with the bill this week.

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Even before Collins' announcement, the odds appeared stacked against the Cassidy-Graham plan. Sen. Orrin Hatch, R-Utah, the chairman of the finance committee, told reporters as he walked into the hearing room Monday afternoon that it'd be "virtually impossible" to pass the bill.

Hundreds of opponents to the Cassidy-Graham effort began lining up around the U.S. Capitol grounds well before dawn Monday to pack the finance committee's afternoon consideration of the bill, its only scheduled hearing. Shouts and protests broke out as Hatch attempted to call the hearing to order.

Several minutes of chaos followed as Capitol Police officers pulled demonstrators -- many of them in wheelchairs -- from the room and cleared the surrounding hallways. Among the protesters were hundreds of people with disabilities who currently receive Medicaid-funded treatment at home and feared further cuts in the program would force them into nursing homes or other institutional settings.

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Cassidy spent more than an hour testifying before the committee, defending the proposal in frequently contentious exchanges with Democrats. Sen. Ron Wyden, D-Oregon, the ranking Democrat on the finance committee, called the Cassidy-Graham plan "a nightmare for millions of Americans" and suggested it was "about as popular as a prolonged root-canal."

Graham, responding to critics who've savaged the Cassidy-Graham planned cuts to the Medicaid program, shot back that the federally funded health care program was on an "unsustainable path," reiterating a point he and Cassidy have made repeatedly over the past two weeks.

Graham also let loose on proposals from a handful of liberal Democrats to create a single-payer health care system. Graham sought to frame the Cassidy-Graham bill as conservatives' best bulwark against single-payer and vowed to "drive a stake into the heart" of that plan.

Wyden and Cassidy tangled when the Democrat demanded a yes or no answer on whether the Cassidy-Graham bill would guarantee access to health insurance for those with pre-existing medical conditions.

The Affordable Care Act mandates that insurers charge sick and healthy customers the same premiums. The Cassidy-Graham plan would allow states to waive that requirement if they demonstrate how they'd continue to provide "adequate and affordable" coverage. The exact meaning of that clause has been hotly contested, with Cassidy declaring it a guarantee for those with pre-existing health conditions and with a number of health policy groups suggesting it falls far short of that. The preliminary CBO report also notes the bill would allow states to lift regulations and allow insurers to charge sick people more for insurance coverage.

Several health care experts and critics of the bill said the revisions to Cassidy-Graham unveiled Monday would further erode protections for those with pre-existing conditions by giving states greater flexibility to waive regulations.

"The revised Graham-Cassidy bill is in effect federal deregulation of the insurance market," tweeted Larry Levitt, senior vice president of the Kaiser Family Foundation, which focuses on health policy.

"If there was any question about Graham-Cassidy's removal of federal protections for pre-existing conditions, this new draft is quite clear," Levitt added.

It remained unclear Monday evening if Senate Majority Leader Mitch McConnell intends to press forward with a vote on the Cassidy-Graham plan this week. A number of Republicans have called for such a vote -- despite its likely failure -- in order to publicly register their own support.

But other Republicans appeared eager to move on to other party priorities amid the apparent implosion of the latest effort to repeal former President Barack Obama's signature legislative achievement.

Louisiana's Sen. John Kennedy offered limited support for the Cassidy-Graham plan -- "I felt like the concept was better than the Affordable Care Act" -- but suggested his Republican colleagues ought to shelve their efforts to overhaul the health care system for the time being after what he said was shaping up to be another failed attempt to dismantle Obamacare.

"I don't think the votes are there," Kennedy said. "I think it's time for us to move on to tax reform."

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