Who is for and against the Senate ObamaCare repeal bill

The Senate could potentially vote on the latest ObamaCare repeal-and-replace plan next week, but the bill has won mixed reviews inside and outside Congress.

The proposal, sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), would largely dismantle ObamaCare and convert its funding to block grants.

{mosads}States would get the funding to design their own programs, leaving some states with more money and others with less. Just what states would decide to do would likely vary across the country.

Here is where key players and stakeholders stand.

Health care groups: against

Powerhouse health groups like the American Hospital Association and the American Medical Association have come out against the Graham-Cassidy proposal in strong terms, warning that it could lead to coverage losses for millions of Americans.

Republicans, for the most part, have been unable to win over the support of these industry groups, which largely opposed every variation of the Senate’s repeal bills and the bill the House passed in May.

Democrats have been able to point to this opposition as proof from experts that the repeal bills have been flawed and are bad for patients.

While that gives Democrats a talking point, it’s clear Republicans aren’t swayed by this opposition.

The groups largely have been shut out of the process, and their opposition didn’t stop the Senate from voting on a repeal bill in July or the House passing its repeal bill in May.  

“This proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term,” AHA President Rick Pollack said in a statement Tuesday.

The AHA, which represents nearly 5,000 hospitals and other care providers, said the Graham-Cassidy proposal could put coverage at risk for “tens of millions” of Americans.

“In addition, the block grant to provide support for the expansion population expires in 2026, thereby eliminating coverage for millions of Americans.”

The American Medical Association, which represents one-third of the nation’s doctors, has similar concerns.

“Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care,” AMA CEO and Executive Vice President James Madara wrote in a letter to Senate leadership.

Sixteen patient and provider groups, including the American Cancer Society Cancer Action Network and the American Heart Association, signed on to a letter opposing the bill, warning that it would “negatively impact patients’ access to adequate and affordable health coverage and care.”

Other health-care groups that oppose the bill include: AARP, Association of American Medical Colleges, America’s Essential Hospitals, the Children’s Health Association and the March of Dimes.

Governors: mixed

The support of governors is crucial to the passage of the bill because not only do they have influence over the senators representing their states, but the Graham-Cassidy proposal would shift enormous responsibilities to their governments.

A group of 10 governors — five Democrats, four Republicans and one Independent — signed on to a letter opposing the bill Tuesday. The group includes Govs. Brian Sandoval (R-Nev.), Bill Walker (I-Alaska) and John Kasich (R-Ohio).

Walker’s opposition could weigh on Sen. Lisa Murkowski (R-Alaska), one of three Republicans to vote against the earlier Senate bill. She has said she’s waiting to see how the proposal will impact her state. Republicans are unlikely to be able to survive her defection.

Meanwhile, 15 Republican governors, including Wisconsin Gov. Scott Walker and Arkansas Gov. Asa Hutchinson, announced their support on Tuesday.

“Adequately funded, flexible block grants to the states are the last, best hope to finally repeal and replace Obamacare — a program which is collapsing before our very eyes,” the governors wrote.

Arizona Gov. Doug Ducey also endorsed the bill this week, saying it’s time for Congress to “get the job done” on repealing and replacing ObamaCare.

Sen. John McCain (R-Ariz.), another swing vote on the bill, has been consulting with Ducey on the bill and could be influenced by his support.

The Trump administration along with Graham and Cassidy have been hitting the phones, trying to win over governors to their proposal.

Insurers: AHIP opposes

America’s Health Insurance Plans, the main insurer trade group, came out on Wednesday against the bill, arguing it would destabilize the market.

The proposal would “have real consequences on consumers and patients by further destabilizing the individual market; cutting Medicaid; pulling back on protections for preexisting conditions; not ending taxes on health insurance premiums and benefits; and potentially allowing government-controlled, single payer health care to grow,” AHIP President and CEO Marilyn Tavenner said in a letter to Senate leadership. 

AHIP’s opposition was notable in that it did not take a position on the House repeal bill, though the did oppose a slimmed-down version that died in the Senate.

The Blue Cross Blue Shield Association said Wednesday it shares “the significant concerns of many health care organizations” about the bill.

“The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions,” the insurer said in a statement.

“The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans. Legislation must also ensure adequate funding for Medicaid to protect the most vulnerable.”

However, there are provisions in the Cassidy-Graham proposal that insurers could like.

For example, insurers would be able to charge older customers up to five times as much as they charge younger customers, though states could overrule this. Current law only allows insurers to charge older people three times as much as younger customers.

Insurers had been counting on a bipartisan effort in the Senate Health Committee to shore up ObamaCare’s markets for 2018, but Chairman Lamar Alexander (R-Tenn.) declared that effort dead on Tuesday. That bill was expected to extend ObamaCare’s insurer subsidies through at least 2018. The current repeal bill would also end those payments in 2020.

Conservative groups: split

Conservative groups like FreedomWorks and Freedom Partners have approached the Graham-Cassidy bill with caution.

Both groups have pushed for a full repeal of ObamaCare and have grown frustrated with Congress over the past few months for failing to do so. But as time is running out to use the 2017 repeal vehicle, FreedomWorks says senators should seriously consider the bill.

“The proposal … is far from perfect, and it’s not the repeal of ObamaCare that was promised,” FreedomWorks Vice President of Legislative Affairs Jason Pye wrote in a blog post this week.

“Nevertheless, FreedomWorks is treating it as what is likely to be the last serious attempt at health insurance reform before the Sept. 30 deadline for reconciliation under the FY 2017 budget resolution.”

Meanwhile, Freedom Partners says while it appreciates the new effort, it’s seeking “more clarity” on whether the bill provides relief from ObamaCare’s regulations and mandates.

Club for Growth, another conservative group, says the new proposal still falls “far short of a full repeal” and called for its authors to incorporate a controversial amendment from Sen. Ted Cruz (R-Texas) that would allow insurers to sell plans that don’t comply with ObamaCare regulations.

Tea Party Patriots, another conservative group, said it supports the proposal.

Senators

In the end, the only people supporting or opposing the bill whose votes will really count are the Senate’s 100 members.

Cassidy has said the bill is just a few votes shy of having the 50 votes it needs to pass, a total that would allow Vice President Pence to cast a tie-breaking vote.

Only one GOP senator, Rand Paul (Ky.), has said he won’t vote for the proposal. Cassidy and Graham have focused their energy in trying to win over the three Republican senators who voted against the last repeal effort: McCain, Murkowski and Susan Collins (Maine). Assuming the rest of the Republican conference supports the bill, excluding Paul, Graham and Cassidy could only afford for one more defection.

McCain has said he is talking the proposal through with his state’s governor, who announced his support for the bill earlier this week.

Murkowski says she’s still trying to understand how the bill would impact her states, which has the highest premiums in the country.

Collins, the most moderate member of the GOP conference, has expressed a number of concerns about the bill, specifically its treatment of people with preexisting conditions.