UPDATE x3: Just when we thought we were out...GOP planning final Hail Mary play to repeal ACA this summer



(sigh) Stop me if you've heard this one before...this is an Op-Ed in the Washington Examiner from a columnist and failed Republican Congressional candidate:

Time and opportunity still exist to replace Obamacare.

...I reported in January that a number of conservative groups, under the leadership of former Sen. Rick Santorum, was working hard to craft a new Obamacare replacement...Behind the scenes, those groups...have continued to meet and tweak their plan, and they seem just a few weeks away from being able to unveil it.

...I listened in on a March 21 conference call among numerous interested parties, and received further updates within the past week from Santorum.

The White House has been quietly but constructively supportive of the project, I am told, and should provide strategic and communications support this time that is well planned, rather than the more seat-of-the-pants effort we all saw last year. Pence, in particular, has been personally engaged.

...The growing understanding, though, is that Republicans are already at risk of losing to a “blue wave” this fall anyway, and that bold action to energize conservative grassroots might be the only way to stop the wave.

The Left is going to be energized this fall regardless of what Congress does, and those parts of professional suburbia that just won’t vote for Republicans under Trump also aren’t going to become even more anti-GOP than they already are.

...But giving conservative voters a “win” on Obamacare would surely drive up Republican turnout.

That's literally the entire argument for what conventional wisdom considers a suicide effort; literally "We're screwed either way, but tearing healthcare away from up to 32 million people by 2027 might help get out the Republican vote this November!"

It's basically a "Salt the Earth behind you" strategy: The GOP already expects to take a shellacking in November anyway, so they might as well cause as much damage on the way out as possible.

Substantively, the bill design has evolved since January. It still uses the basic template of last year’s Graham-Cassidy bill, but only in the sense that it would remain a system of block grants to the states. As in January, it still envisions a significant expansion of health savings accounts — indeed, from January’s thought of doubling the existing number of HSAs, the new plan now may quadruple them — and also a guarantee that individuals served by state-government-run plans can opt-out and use the money in private markets instead.

The article goes on to explain that the other main difference between the prior version of Graham-Cassidy and this one is that it wouldn't damage states which have already expanded Medicaid under the ACA any more than it damages the states which haven't. See? Congressional Republicans don't discriminate--they hurt everyone equally!

I don't know what impact these tweaks would have on the eventual impact of the bill if it passed; perhaps a few million fewer would lose coverage. Perhaps a few more million would. Regardless, I may have to dust off my "How Many Would Lose Coverage in YOUR District?" spreadsheet one more time after all...

As a reminder, here's a review of the half-dozen or so repeal bills the GOP tried to ram through last year (I've cued it up to the relevant part starting at 9:30):

Here's Andy Slavitt's take via Twitter (converted to standard sentences):

This effort is being lead by back bencher Senators, donors and Rick Santorum in a campaign to convince Mitch McConnell to bring back reconciliation. Reconciliation is what allows legislation to pass w 50 votes plus Pence.

Much like the individual mandate was brought into the tax bill, this group hopes to build momentum by persuading the WH that this is possible and they have nothing to lose and everything to gain.

There are provisions to make a big payoff for Maine and Alaska. Remember those were states with 2 no votes on repeal. McConnell has said he doesn't want to do this for the same reason Paul Ryan and everyone Elenas retired [guessing autocorrect caused a glitch here]. Taking health care from people is not all that popular.

The Santorum counter argument: there will be a blue wave any way so we might as well activate the base.

UPDATE 5/16/18: Yep, sure enough...

RED ALERT: The White House and conservative groups are unveiling a new health care repeal bill this month. We obtained the summary document. 1/ 

— Topher Spiro (@TopherSpiro) May 16, 2018

As Spiro (of the Center for American Progress) goes on to note:

They will make a push to pass a budget resolution soon in order to ram this bill through with GOP votes. The public blowback must be massive and immediate.

This bill will attempt to bribe @lisamurkowski and @SenatorCollins. Flood their phones. Let them know as U.S. Senators they should care about the sick and poor in ALL states. #mepolitics COLLINS 202-224-2523 MURKOWSKI 202-224-6665

This bill absolutely guts protections for people with pre-existing conditions. It makes junk plans permanent and includes the CRUZ AMENDMENT to waive ACA protections.

This bill repeals the Medicaid expansion and slashes ACA funding by **20-25%.** Worse, it uses some of the money to pay for tax shelters for the wealthy (HSAs).

It gets much worse. Right now 100% of ACA funding goes toward lower-income and lower middle class people. This bill takes a 20-25% smaller pie for this population and cuts it again by at least 15% — even allowing states to slash it by up to **50%**!!!

All told, by 1) slashing the total pie and then 2) spreading that smaller pie up the income scale, cuts for lower-income and lower middle class people range from 32% to 62%. This is crippling and savage.

It gets much worse. If a state chooses to spend its block grant on Medicaid, this bill REQUIRES the state to allow healthy people to cash out their benefit. It puts a giant thumb on the scale for states to choose junk private insurance over Medicaid.

This bill engineers a MASSIVE redistribution of funding across all states, causing WIDESPREAD disruption. It targets blue states for massive cuts, funneling the money to red states and Alaska and Maine.

For those unfamiliar with the "Cruz Amendment", I wrote about it last summer. Needless to say, it's...awful.

I can't even today.

UPDATE 5/25/18: Here's another update from the Wall St. Journal (paywall protected):

New Push to Topple Affordable Care Act Looms

A group of Republicans and advocacy groups will soon release a proposal intended to spark another push to repeal the Affordable Care Act, resurrecting a potentially volatile issue in the months before the November midterm elections.

UPDATE 5/31/18: Here's the details, courtesy of the Washington Examiner. Sure enough, it's pretty much identical to the original Graham-Cassidy bill, expect that it wouldn't impact pre-ACA Medicaid:

Exclusive: Here are details of new plan to revive Obamacare repeal.

A group of more than 40 right-of-center healthcare experts led by the Heritage Foundation is expected to release recommendations to Congress next month on a new plan to overhaul Obamacare. The recommendation would convert Obamacare’s Medicaid expansion and insurance subsidies into a system of block grants to the states, according to a source familiar with the plan, with the exact growth formula to be determined by Congress. But, unlike previous Republican healthcare plans, it would not make changes to the funding or structure of traditional Medicaid. The plan would allow states that get the block grant to waive rules requiring plans to have essential health benefits and to maintain a single risk pool and it would give more leeway to insurers to charge more based on age.

States that waive the requirements would have to include another program to make sure those with serious conditions could get coverage, such as invisible risk sharing or high risk pools. The group said it was open to reforms to traditional Medicaid that had been part of previous plans, such as converting traditional Medicaid funding to a per capita cap or a block grant aimed at curbing growth of the program and giving more flexibility to states. But those reforms are not in the opening proposal as the group works with allies on Capitol Hill to garner support for another healthcare reform push, with one source telling the Washington Examiner that nobody has told them “hell no” on the recommendation.

Any bill could have a steep climb in the Senate, where due to the loss of the Alabama Senate seat, Republicans have at least one less vote than they did the last time a healthcare bill failed to win a majority (not including Sen. John McCain, R-Ariz., who has been away as he undergoes treatment for brain cancer). That means that they are unlikely to get something done even if Republicans manage to pass a budget resolution with reconciliation language allowing them to pass a healthcare bill with 50 votes (plus Vice President Mike Pence as the tiebreaker).