END OF 2018 OPEN ENROLLMENT PERIOD (41 states)

Time: D H M S

RED ALERT: Dammit, GRAHAM-CASSIDY IS ON THE MOVE!

For the next two weeks, ALL HEALTHCARE-RELATED ATTENTION needs to be on the following three issues:

FIRST: September 27th is the final deadline for ACA exchange insurance carriers to actually sign the contracts to participate in the 2018 Open Enrollment Period. Yes, the deadline to submit their rate filings already passed a week or so ago, and most of them are fairly settled in for next year, but until they actually sign the contract, they can still bail from the individual and/or small business exchanges...and given the massive uncertainty over Cost Sharing Reduction reimbursements and other sabotage efforts of Trump and Tom Price as well as the ongoing repeal/replace saga by the Congressional GOP, many (most?) of the carriers are deliberately waiting until the last possible minute to do so.

This means that any more significant developments or shakeups in the individual market will almost certainly lead to a bunch of carriers deciding they’ve had quite enough, thank you, throwing their hands up and saying “screw this noise; I’m outta here!”, which would leave not just a few but potentially hundreds of counties (and dozens of states?) “bare”, without any exchange carriers whatsoever. The next two weeks are a precarious, delicate moment for the ACA exchanges.

SECOND: The continuous and ongoing Trump/GOP sabotage efforts. As I noted earlier this week, since the Trump Administration is undermining the advertising/outreach efforts, grassroots organizations have stepped up to try and fill in the gap themselves. I’m partnering with the Indivisible ACA Signup Project to help get the word out.

THIRD AND MOST IMPORTANT, HOWEVER is that the Graham-Cassidy (or is it Cassidy-Graham?) Obamacare repeal/replace bill...dubbed by just about everyone as an extremely unlikely, last-ditch “Hail Mary” play, and with a September 30th deadline before the danger of it actually becoming law passes (due to 9/30 being the end of the fiscal year), is suddenly looking very much alive.

Here’s Indivisible Policy Director Angel Padilla:

INTEL: Republicans are lining up the pieces, including CBO score, for last-ditch effort to repeal ACA. Aiming for week of Sept. 25.

— Angel Padilla (@AngelRafPadilla) September 14, 2017

McConnell spent caucus lunch laying out plan for Graham-Cassidy, bumped next week's CHIP markup, and wants CBO score by end of next week.

— Angel Padilla (@AngelRafPadilla) September 15, 2017

Remember: Ryan jammed his bill though when everyone thought TrumpCare was dead. Light kills this bill. Need to kill it again.

— Angel Padilla (@AngelRafPadilla) September 15, 2017

The deadline for TrumpCare is Sept 30. If we can make it beyond 9/30, we kill TrumpCare for good.

— Angel Padilla (@AngelRafPadilla) September 15, 2017

Hearing McCain has been bought off. Sen. Boozman saying he 80% confident it'll get through Senate.

— Angel Padilla (@AngelRafPadilla) September 15, 2017

McConnell trying to build momentum for bill by telling reluctant Rs that McCain is on board. Govs will be key in stopping bill.

— Angel Padilla (@AngelRafPadilla) September 15, 2017

This is on Dems to stop now, esp after they cleared the calendar last week for this push. Dems need to slow down all senate biz, incl NDAA

— Angel Padilla (@AngelRafPadilla) September 15, 2017

Personally, I would have preferred the M4A rollout be delayed until at least October 1st (after the fiscal year ends and the Graham-Cassidy threat was truly dead) to avoid being what I felt was a distraction at a critical time. The M4A launch could have waited another 17 days or so; battling Graham-Cassidy can’t. Others may feel differently. Regardless, here we are, so going forward, for the next 16 days, this is where ALL healthcare focus needs to be.

Today is September 14th. They have 16 days to try and pull this off. Here’s more details from Bloomberg reporter Steven Dennis, who’s somewhat more doubtful they can pull it off but still setting off alarms everywhere:

NEW: Lindsey Graham thinks his health bill would get 47-48 votes if vote was today. Says McConnell told senators at lunch he is "all in."

— Steven Dennis (@StevenTDennis) September 14, 2017

Capito wants to see #'s for West Virginia. Sullivan says he's looking at it. Corker, Barrasso sound enthusiastic. Daines says it isn't dead.

— Steven Dennis (@StevenTDennis) September 15, 2017

Cassidy wooing Murkowski, Collins. Santorum too. Graham wants POTUS to put his shoulder into it like Obama did w/ACA.

— Steven Dennis (@StevenTDennis) September 15, 2017

Still seems like a very long shot, but...

— Steven Dennis (@StevenTDennis) September 15, 2017

McCain keeps saying he is very supportive of the concept but wants his gov & legislature to weigh in.

— Steven Dennis (@StevenTDennis) September 15, 2017

Santorum told me McCain theoretically gets you to 50 and there are no declared really hard noes yet. Collins hardest but he talked 2X today.

— Steven Dennis (@StevenTDennis) September 15, 2017

Most haven't focused on it and don't know details. Rand didn't realize it repeals the individual mandate, for example (it does).

— Steven Dennis (@StevenTDennis) September 15, 2017

Others who would need to vote Yes but are tough gets include Portman and Alexander, who is drafting a bipartisan fix. Neither signed on yet.

— Steven Dennis (@StevenTDennis) September 15, 2017

If they hit the triple bank shot and somehow pass this in the Senate by Sept. 30, House vote would be very dicey.

— Steven Dennis (@StevenTDennis) September 15, 2017

The pitch in the Senate is it takes money from states like Calif/Mass/MD/NY and reallocates it to other states so everybody gets same $

— Steven Dennis (@StevenTDennis) September 15, 2017

Well, AHCA only passed because Rs in those states voted for it.

— Steven Dennis (@StevenTDennis) September 15, 2017

Santorum says they might have to make up some Calif votes elsewhere. But his pitch is even they get 10 years to transition & they get same $

— Steven Dennis (@StevenTDennis) September 15, 2017

As always, they still have to get a score, clear Parliamentarian, and deal with an unlimited-amendment votearama. All by 9/30. LONG shot.

— Steven Dennis (@StevenTDennis) September 15, 2017

Like, really long. And McConnell has said they'll need to show they have 50 votes first. Which they do not have.

— Steven Dennis (@StevenTDennis) September 15, 2017

Fun fact: ACA's reconciliation bill was introduced March 17, 2010. Congress sent it to Obama's desk March 25.
Sometimes bills move fast.

— Steven Dennis (@StevenTDennis) September 15, 2017

For a quick summary of what Cassidy-Graham would do, Andy Slavitt has put together this handy cheat sheet:

It’s time to gear up one more time: CALL YOUR SENATOR AT (202) 224-3121 AND TELL THEM TO VOTE *NO* ON CASSIDY-GRAHAM.

UPDATE: A bit more from Andy Slavitt:

BREAKING: Sorry to say I just heard Graham Cassidy now has a plan to get to the floor for a vote this month. 1/

Bill sponsors have been trying to get leadership behind them. Now, Defense finishes up Monday and here are actions I'm hearing... 2/

Timelines being laid out, leadership conducting a a real whip count, press conference w governors being planned, pushing CBO. 3/

Still needs Byrdbath, CBO score & arm twisting, but they have clock time if they push it. As a reminder. 4/