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New study shows the Republican healthcare bill would leave up to 18 million more without insurance by 2019

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mithc mcconnell

The latest push by Republican to repeal and replace Obamacare would leave millions more without health insurance and likely cause costs to rise for Americans in the individual insurance market, according to a study published Wednesday.

The Graham-Cassidy-Heller-Johnson (GCHJ) legislation would change the way the federal government spends billions of dollars in federal healthcare funding. The shift would likely produce massive effects on the coverage and cost of Americans' health insurance.

The left-leaning Commonwealth Fund on Wednesday released an analysis of the GCHJ plan by using previous CBO scores for similar bills and other studies.

Here are the major findings from Commonwealth's Sara Collins:

  • 15-18 million more uninsured in 2019: The bill's repeal of the individual mandate, which compels people to sign up for insurance, would have immediate effects when it goes into place in 2019. Based on previous CBO scores of similar provisions, the jump in the number of people without insurance compared to the current system would be as high as 18 million in the first year.
  • 32 million more people uninsured after 2026: The bill also would shift funding for Obamacare's Medicaid expansion and individual insurance market subsidies into a lump sum given to states every year. The bill, however, simply cuts off those grants after 2026. Commonwealth said the roughly 32 million people projected to be beneficiaries of these programs would simply be cut off after that date.
  • Significantly higher premiums: Commonwealth also said previous CBO breakdowns of a mandate repeal showed premiums increases of 15% to 20% in the first year. "The majority of that increase would come from the repeal of the mandate penalties: insurers would expect that those who remained in the pool would be the least healthy," Collins wrote.
  • Undercut protections for people with preexisting conditions: States could apply for waivers to relax some of Obamacare's regulations if it brings down costs. While the bill does say the state has to continue to provide "adequate and affordable" coverage for people with preexisting conditions, Commonwealth said the leeway for the waivers could lead to the elimination of Obamacare's protections for these people. "It would allow states to apply for waivers that would let insurers charge people with health problems higher premiums, and change other ACA consumer protections such as bans on lifetime benefit limits and comprehensive coverage requirements," Commonwealth said.

A Congressional Budget Office score that includes the full effects of the bill on insurance coverage and individuals' cost burdens will not be ready in time for a vote. Republicans can only pass it without being blocked by a Democratic filibuster until the end of the month.

SEE ALSO: Jimmy Kimmel slams new Republican healthcare bill, says its author lied to him

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The GOP's furious push to pass a new healthcare bill to destroy Obamacare is coming into focus

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Mitch McConnell

  • The newest Republican Obamacare-repeal bill will go to the Senate floor next week, Majority Leader Mitch McConnell's office said.
  • It is unclear whether the GOP will have the needed 50 votes before the deadline to pass the bill.
  • The Graham-Cassidy-Heller-Johnson plan would lead to massive shifts in federal healthcare funding.

Senate Majority Leader Mitch McConnell's office said Wednesday that the leader would bring the latest Republican healthcare bill to the floor for a vote next week amid a furious GOP push to repeal the Affordable Care Act, the healthcare law also known as Obamacare, as a deadline looms.

The Graham-Cassidy-Heller-Johnson legislation was released one week ago by four Republican senators: Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson. It's most likely the party's last-ditch repeal effort for now.

The pressure is on because Republicans are attempting to use budget reconciliation to pass the bill, a process that would allow them to avoid a Democratic filibuster and pass the bill with only a simple majority. Republicans hold 52 seats in the Senate.

But the rules that allow Republicans to use reconciliation will expire at the end of September, per a ruling from the Senate parliamentarian, spurring intense urgency to pass the legislation.

The intention to introduce the bill to the floor most likely means the GOP is close to the necessary votes — and that McConnell may be pressuring some wavering members. Cassidy has told reporters that 48 or 49 Republicans support the bill.

Republican Sen. Rand Paul of Kentucky has already come out against the bill. Other possible holdouts include Sens. Susan Collins of Maine, Lisa Murkowski of Alaska, and John McCain of Arizona, the three Republicans whose "no" votes killed previous iterations of the Senate healthcare bill.

Democrats' opposition to the bill has been fierce. Senate Minority Leader Chuck Schumer on Tuesday attacked the bill on the Senate floor.

"What we do know is that this new Trumpcare bill, the Graham-Cassidy legislation, is worse in many ways than the previous versions of Trumpcare," Schumer said.

Democrats also complained that the bill would not receive a full score ahead of its introduction from the nonpartisan Congressional Budget Office. The score measures the effects on insurance coverage and costs for Americans. The CBO has said, though, that it will release a truncated score that examines the effect on the federal budget.

The bill must be projected to lower the federal deficit to qualify for reconciliation. The CBO said it would include in its score whether the bill would reduce the deficit more than the House's American Health Care Act, which passed that chamber earlier this year.

Studies from independent health-policy think tanks have found that the bill would have drastic ramifications in all corners of the healthcare market.

Here's a rundown of the major provisions of the bill:

  • Shift to a block-grant system for federal healthcare funding to states. The bill would give states a lump sum of money to fund their healthcare needs, which differs from the current system, in which the federal government matches a percentage of a state's actual spending. The block grants would also be doled out in such a way that some states would end up getting more — especially those that did not expand Medicaid under Obamacare — while others would see their funding slashed.
  • Allow states to waive some Obamacare regulations. The bill would allow states to apply for waivers that would let them do away with Obamacare regulations if doing so would lower costs. While there is a provision in the bill that says insurers can't use this to deny coverage to people with preexisting conditions, experts say it could allow insurers to charge them more.
  • Maintain many Obamacare taxes. To avoid adding too much to the federal deficit — and being disqualified from reconciliation — the bill would preserve many major taxes created under Obamacare, such as the tax on net investment income. Other smaller taxes, like the medical-device tax, would be eliminated.
  • Eliminate the individual and employer mandates. People who do not sign up for insurance would not face a tax penalty under the plan, and companies would not be compelled to offer coverage, though states could pass their own mandates. A study by the Commonwealth Fund found that this would increase the number of uninsured by up to 18 million by 2019.
  • Pay cost-sharing subsidies through 2019. Such a move would help the insurance exchanges established by Obamacare stay stable in the short term — something Democrats have urged. When the block grants kick in, however, these payments would end.
  • Cut off all money after 2026. The large block grants to help states would be eliminated after 2026. Commonwealth estimated this would lead to about 32 million more uninsured people compared with the current system after that year.

SEE ALSO: Republicans seem to be confused about what exactly their new healthcare bill would do

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Here are the potential winners and losers of the latest Republican healthcare bill

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bill cassidy lindsey graham

As the timeline for the latest Republican attempt to repeal and replace Obamacare comes into view, there is a scramble to understand the implications of a bill that wss only introduced seven days ago.

Among the effects would be a shift of spending in federal healthcare money. The GCHJ includes a formula that would dole out federal funds to states in up-front, lump-sum payments called block grants. 

Experts say that would lead a system where some states would come out with a lot more funding, while most states would see a serious decrease in the money they get.

Avalere Health, a healthcare consulting firm, broke down which states would win and lose under the GCHJ.

"The Graham-Cassidy bill would significantly reduce funding to states over the long term, particularly for states that have already expanded Medicaid," said Caroline Pearson, senior vice president at Avalere, in a post on the findings. "States would have broad flexibility to shape their markets but would have less funding to subsidize coverage for low- and middle-income individuals."

The biggest winner would be Texas, which would see an additional $35 billion in funds through 2026, according to the analysis. The biggest loser would be California, which would see a decrease of $78 billion over the same timeframe.

All but two states that stand to gain funding under the plan voted for President Donald Trump in 2016.

Overall, Avalere found, federal funding to states for healthcare would decrease by $215 billion through 2026.

2026 GCHJ funding change v2

The legislation would do away with the block grants after 2026, meaning a significant source of funding would be suddenly cut off.

Avalere also examined the potential decline in funding through 2036 if the grants expire and are not renewed. In this case, federal funding toward healthcare would decrease by roughly $4.2 trillion dollars. Every state would see a decrease in funding against the current baseline, with a $4 billion cut for Wyoming and South Dakota being the smallest.

Here's a look:

2036 GCHJ funding change

SEE ALSO: The GOP's furious push to pass a new healthcare bill to destroy Obamacare is coming into focus

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TRUMP: I assumed when I won, I would 'sit down at my desk and there would be a healthcare bill'

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donald trump oval office

President Donald Trump on Wednesday praised the latest attempt from Senate Republicans to repeal and replace the Affordable Care Act, yet chided his party for a delayed and tedious process that has plagued his administration in its early months.

Trump commended the Graham-Cassidy-Heller-Johnson (GCHJ) legislation, saying it offered the best chance to repeal the "disastrous" law known as Obamacare.

"I think there is tremendous support for it," Trump said at the United Nations. "I actually think it is much better than the previous shot, which was very sadly let down. Again, you've been hearing about repeal and replace for seven years. They have a chance."

The statement followed tweets from the president Wednesday morning calling the new plan "GREAT!" Trump also blasted Sen. Rand Paul for his opposition to the bill.

Later Wednesday, Trump complained about the process by which Republicans have attempted to repeal and replace the law. He noted that the GOP promised to repeal the law for seven years — yet for the first eight months of the Trump administration have been unable to do so.

"I thought that when I won I would go to the Oval Office, sit down at my desk, and there would be a healthcare bill on my desk — to be honest," Trump said. "It hasn't worked out that way, and I think a lot of Republicans are embarrassed by it."

On Wednesday evening, Trump lauded the pending bill again on Twitter: "I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does! A great Bill. Repeal & Replace."

Experts say the latest Republican legislation would increase state flexibility for healthcare — but at the expense of billions of dollars in funding, weaker protections for people with preexisting conditions, and a significantly larger number of uninsured Americans.

Senate Majority Leader Mitch McConnell said Wednesday that he is planning to bring the bill to the floor next week.

Watch Trump's comments below:

SEE ALSO: The GOP's furious push to pass a new healthcare bill to destroy Obamacare is coming into focus

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Lindsey Graham implores colleague to back his GOP health bill 'for Arizona'

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Lindsey GrahamWASHINGTON (AP) — In an overheard phone call Wednesday, Republican Sen. Lindsey Graham leaned on a fellow senator to back his GOP health care bill despite “all its imperfections.”

Graham called the “Obamacare” repeal bill he co-authored a “historic opportunity” and asserted: “We’re going to vote. Everyone will be held accountable.”

Graham made his comments in a cellphone call in front of a passenger at Reagan National Airport before he boarded a flight. A reference to working “for Arizona” suggests Graham was talking to his good friend John McCain. Graham’s office did not dispute the quotes, nor confirm who was on the call.

Following the Associated Press' report, Graham's communications director said that the report contained "inaccurate information" and that Graham was being interviewed for Sean Hannity's radio show.

McCain is a key holdout on the legislation that may come to a vote in the Senate next week. He was the deciding “no” vote on the last GOP health care bill, in July.

“Always believed it’s the replacement part that’s tripped us up,” Graham said on the call, referring to the “repeal and replace” mantra that Republicans used for years against President Barack Obama’s health care law. Seeking support for his own legislation, he said: “With all its imperfections, I hope you can.”

Graham and President Donald Trump have a history of bad blood, dating back to 2015 when the South Carolina senator called Trump a “jackass” for challenging his friend McCain’s heroism in the Vietnam War. Trump responded by giving out the senator’s private cellphone number and later branded him a “poor, poor, pathetic man.”

But in the last-ditch GOP attempt to upend Obamacare, Graham is counting on help from the president. “I talk with President Trump three times a day,” he said on the call.

SEE ALSO: Here are the potential winners and losers of the latest Republican healthcare bill

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'I'm not a serious person?': Jimmy Kimmel escalates his war against the Republican healthcare bill

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Jimmy Kimmel is not backing down in his battle with Republican lawmakers over new legislation that would overhaul the US healthcare system.

For the second night in a row, the late-night host attacked the authors of the bill, known as Graham-Cassidy, and implored viewers to oppose the measure.

Kimmel said during his show on Tuesday that one of the plan's authors — Sen. Bill Cassidy of Louisiana — lied to him when he said that any healthcare plan would have to protect people with preexisting conditions to earn his support.

Cassidy told Kimmel in May after the host's emotional monologue about his newborn son's open-heart surgeries that he wouldn't support any bill that would allow insurers to charge people with preexisting conditions more for coverage, dubbing it the "Jimmy Kimmel test."

But healthcare-policy experts have said the bill would allow states to apply for waivers that could lead to insurers doing just that.

After Kimmel said the bill failed the test, the senator said on CNN that the host "does not understand."

"Oh, I get it, I don't understand because I'm a talk-show host, right?" Kimmel said Wednesday night.

He proceeded to attack the bill's proposed cuts to federal healthcare funding and pointed to multiple medical-industry groups that have come out against the legislation.

"Which part of that am I not understanding?" Kimmel said. "Or could it be, Sen. Cassidy, that the problem is that I do understand and you got caught with your G-O-Penis out? Is that possible?"

Kimmel also said it was the "worst healthcare bill yet" and that Cassidy had gone back on his word.

The late-night host also went after others who had either told him to stay out of it or suggested he didn't understand the debate. Here's a rundown of his targets:

  • "Fox & Friends" host Brian Kilmeade:"The reason I found this comment to be particularly annoying is because this is a guy, Brian Kilmeade, who whenever I see him kisses my ass like a little boy meeting Batman."
  • Gov. Chris Christie of New Jersey: Christie, who opposes the bill, said Kimmel was "not a serious person" during an appearance on MSNBC. "I'm not a serious person?" Kimmel said on Wednesday. "I never got my head stuck in a bucket of fried chicken!"
  • Sen. Lindsey Graham of South Carolina, one of the bill's authors: Graham said Kimmel's comments on Tuesday were "garbage." Kimmel said: "I'm not going to attack Lindsey Graham for two reasons: No. 1, he's one of the few Republicans who stands up to Donald Trump, and No. 2, Lindsey Graham happens to look a lot like my Grandma Jane, who is now deceased."
  • President Donald Trump:"There's no way President Trump read this bill that he says is great," Kimmel said. "He just wants to get rid of it because Obama's name is on it. The Democrats should just rename it 'Ivankacare' — guaranteed he gets on board. Can you imagine Donald Trump actually sitting down to read a healthcare bill? It's like trying to imagine a dog doing your taxes."

Watch the full monologue:

SEE ALSO: New study shows the Republican healthcare bill would leave up to 18 million more without insurance by 2019

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GOP senator admits new healthcare bill could harm people with preexisting conditions, but says it won't happen

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One of the most hotly debated elements of the newest Republican attempt to repeal and replace the Affordable Care Act has come over the bill's protections for people with preexisting conditions.

While the authors of the Graham-Cassidy-Heller-Johnson plan say the bill protects people with preexisting conditions, critics and health policy experts argue that it leaves openings for those people to get charged much more for insurance.

One of the bill's authors, Sen. Bill Cassidy of Louisiana, got in a Twitter fight with NPR over the issue.

One GOP senator on Thursday, however, seemed to suggest that the new bill could leave sick Americans worse off. Sen. Jeff Flake of Arizona, a Republican supporter of the Graham-Cassidy bill, said on MSNBC's "Morning Joe" Thursday that the new plan could allow states to undermine protections for people with preexisting condition. He argued, however, that that wouldn't end up happening.

"There are provisions in there, I've heard it said, that would allow a race to the bottom and states to deny coverage or allow insurance companies to deny coverage [based] on preexisting conditions," Flake said. "If they're able to, de jure, de facto, they won't be able to."

Many policy experts have argued that the waivers created in the Graham-Cassidy bill could allow states to remove some of the regulations that protect people with preexisting conditions under Obamacare — as long as it lowers overall costs.

The legislation includes a line that states must show how their new system "intends to maintain access to adequate and affordable health insurance coverage for individuals with preexisting conditions."

The vague language, according to healthcare analysts and industry groups, gives significant leeway to the Department of Health and Human Services and states to determine the definition of "adequate and affordable." 

This could, in theory, bring down the overall cost for the system as sicker, more expensive to cover people would effectively be priced out of the system. Lowering the overall costs for insurers would allow them to lower premiums. It would, however, undermine the protections for sick people.

Flake acknowledged that possibility, but said it would never happen because states would not pass a law or request a waiver that included such a provision.

"In reality, is any governor or state legislature going to deny coverage based on preexisting conditions?" Flake asked.

"Yes, yes they are," host Joe Scarborough said in response.

SEE ALSO: 'I'm not a serious person?': Jimmy Kimmel escalates his war against the Republican healthcare bill

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Mike Pence makes bizarre dodge of question on GOP healthcare bill by quoting Thomas Jefferson

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Mike Pence

Vice President Mike Pence side-stepped a question about whether the Republicans' new Obamacare repeal and replace bill would guarantee health insurance for people with preexisting conditions as Obamcare does now.

"Fox & Friends" host Ainsley Earhardt brought up late-night host Jimmy Kimmel's impassioned condemnation of the bill, known as Graham-Cassidy, during a Thursday morning interview with the vice president. 

"You have folks like Jimmy Kimmel. They're worried about the preexisting condition thing because this will be up to the governors to decide how the money's disbursed, who gets coverage,"Earhardt said. "But with that, can you guarantee that these governors will make sure preexisting conditions are covered?"

Pence dodged the question.

"Thomas Jefferson said government that governs least governs best," he said. "I mean the question that people ought to ask is, who do you think will be more responsive to the health care needs in your community, your governor and your state legislator or a Congress and a president in a far-off nation's capital?"

The vice president then went on to say that the bill did, in fact, protect those with preexisting conditions, but excluded the word "guarantee."

"Graham-Cassidy, as its authors have said, contains all the same protections for preexisting conditions, as the president indicated," Pence said, seemingly referring to the president's recent claim that the new GOP bill "include[s] coverage of preexisting conditions."

(Trump tweeted on Wednesday, "I would not sign Graham-Cassidy if it did not include coverage of preexisting conditions. It does! A great Bill. Repeal & Replace.")

Pence argued that "almost anything would be better than Obamacare," which he claims is "collapsing across the country," and said the Graham-Cassidy bill is "our last best chance" to replace Obamacare. 

Critics of the bill argue that it would allow insurers to discriminate against people with preexisting conditions, raise premiums for middle-class families, allow lifetime limits on care, and leave tens of millions of Americans uninsured. They claim it would not simply shrink Obamacare — formally known as the Affordable Care Act — as some previous GOP proposals would have, but eliminate key Obamacare programs entirely, upending the national healthcare system.

The Congressional Budget Office will issue a preliminary analysis of the bill by early next week, but the report will not include an estimate of the legislation's effects on insurance coverage, perhaps the most important information. Congressional Republicans are rushing the bill to the floor before their September 30 deadline. 

Watch the clip below: 

SEE ALSO: Jimmy Kimmel slams new Republican healthcare bill, says its author lied to him

SEE ALSO: 'I'm not a serious person?': Jimmy Kimmel escalates his war against the Republican healthcare bill

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The heart-wrenching story of Jimmy Kimmel's infant son explains why he's so passionate about healthcare

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Jimmy Kimmel son

For the past two nights, late-night Jimmy Kimmel has been doing battle with Republican politicians and conservative media over the latest bill to repeal and replace the Affordable Care Act.

Some conservative outlets like the National Review and conservative commentators on Fox News attacked Kimmel for inserting himself into the debate over the so-called Graham-Cassidy healthcare legislation, arguing that he is going well beyond his expertise.

In his monologue on Wednesday night, Kimmel explained why the healthcare debate is personal for him and why he feels he needs to comment on it.

"The reason I'm talking about this is because my son had open heart surgery and has to have two more," Kimmel said. "Because of that, I learned that there are kids with no insurance in the same situation. I don't get anything out of this."

In May, Kimmel introduced his connection to the healthcare debate. His son Billy was born with tetralogy of fallot with pulmonary atresia, a rare heart defect requiring open heart surgery just hours after his birth.

The surgery and subsequent care would have cost massive amounts of money if not for insurance. Kimmel highlighted the fact that the Republican healthcare bill being considered at the time could have undermined protections that prevented insurance companies from imposing lifetime limits on patients.

Before Obamacare's implementation, many children born with serious illnesses like Kimmel's son could hit their lifetime cap at a young age, putting immense financial strain on their families. Additionally, children born with similar problems could be denied insurance or charged much higher premiums later in life since they had a preexisting condition.

"If your baby is going to die, it shouldn't matter how much money you make," Kimmel said during an emotional monologue following his son's birth. "I think that's something that whether you're a Republican, or a Democrat, or something else, we can all agree on."

Following the heart-wrenching monologue, Republican Sen. Bill Cassidy of Louisiana appeared on the show and pledged that any bill that came through Congress had to maintain protections on people with preexisting conditions and not allow lifetime limits. Cassidy even dubbed this the "Jimmy Kimmel test" and said he would oppose any bill that didn't pass the test.

Cassidy, however, is the author of the latest GOP healthcare bill — and many healthcare experts say his legislation could gut the protections he pledged to keep.

That fired up Kimmel again. He tweeted a picture Tuesday of himself with his son in his lap doing research for that night's monologue.

Kimmel argued during an emotional Tuesday night monologue that the Graham-Cassidy legislation did not meet the "Kimmel test." He said Cassidy had lied to his face.

While Kimmel admits he is not an expert, his comments are aligned with analysis from health policy analysts at the non-partisan Kaiser Family Foundation and Avalere Health. The left-leaning Commonwealth Fund and the Center for Budget and Policy Priorities, as well as the conservative-leaning Manhattan Institute, have also echoed his points.

SEE ALSO: 'I'm not a serious person?': Jimmy Kimmel escalates his war against the Republican healthcare bill

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KRUGMAN: Jimmy Kimmel has 'done more homework on health than any Republican senator'

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paul krugman

Paul Krugman on Thursday charged Republicans have not done their homework on healthcare.

The Nobel winning economist and New York Times columnist tweeted Thursday that late-night talk-show host Jimmy Kimmel knows more about the current healthcare debate than GOP lawmakers.

"Think about what it means that Jimmy Kimmel has evidently done more homework on health than any Republican senator over the past 8 years," Krugman said.

Kimmel has been waging a war against Republicans for months over their attempts to repeal and replace the Affordable Care Act and is now battling one of the latest bill's authors, Sen. Bill Cassidy.

The host pointed out that the bill undermines protections for people with pre-existing conditions, which most health policy experts agree with. Cassidy, on the other hand, has denied this despite the analysis.

Krugman has not been shy about his distaste for the new bill, which has become known as the Graham-Cassidy bill behind two of its authors, Cassidy and Sen. Lindsey Graham. The economist has taken issue with the rush to pass the bill before the Congressional Budget Office has the chance to score the bill.

"Graham-Cassidy is bum's rush to stampede Rs before CBO can do its job," Krugman tweeted Wednesday. "But independent analyses are devastating."

In addition to specific issues about the bill, Krugman did say that the broader goals of the Graham-Cassidy bill align with long-term efforts on healthcare by the GOP.

"Everything Graham-Cassidy are doing — snatching health care from millions with false claims and cooked numbers — is standard R practice," Krugman said. "And has been for a long time — the old 'use raw dollars to pretend you're not cutting' thing goes back to Gingrich/Medicare in the 90s."

Here are a few of Krugman's tweets on the bill:

 

 

 

 

SEE ALSO: GOP senator admits new healthcare bill could harm people with preexisting conditions, but says it won't happen

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The healthcare bill could blow up in the GOP's face because of an obscure Senate rule

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graham cassidy mcconnell

In just more than a week, the Graham-Cassidy healthcare bill has gone from its introduction as a fringe proposal to a serious prospect for overhauling the US healthcare system.

Despite its rapid rise, the latest Republican attempt at repealing and replacing the Affordable Care Act, the healthcare law better known as Obamacare, faces challenges both policy-based and political.

Perhaps one of the biggest challenges for the bill will come next week when the Senate parliamentarian — an umpire of sorts for the chamber's rules — takes a look at the bill.

The parliamentarian will evaluate whether parts of the Graham-Cassidy bill violate a provision known as the Byrd rule — and if certain aspects of the bill run into trouble, it could throw the entire legislation into jeopardy.

A bit about the Byrd rule

The Byrd rule, named for the West Virginia senator Robert Byrd, was passed in 1985 to erect guardrails on the types of bills that could be brought up through budget reconciliation.

Reconciliation allows a bill to pass the Senate with just 50 votes and no threat of a filibuster to block the bill. Republicans, who control 52 Senate seats, are using the process to try to pass the Graham-Cassidy bill through the Senate without any Democratic votes.

The Byrd rule, however, restricts what can be considered under budget reconciliation. If a provision of a bill is considered an "extraneous matter" or something "merely incidental" to the federal budget, it can be stripped out of the legislation.

Byrd hunting

The Graham-Cassidy bill will most likely be reviewed under the Byrd rule — a process colloquially known as a "Byrd bath"— sometime next week.

Most healthcare experts say the focus will be on the bill's proposed waivers that would allow states to relax Obamacare regulations, most notably so-called essential health benefits. EHBs are health services, including emergency-room visits and prenatal care, that Obamacare mandated must be covered under insurance plans. Under Graham-Cassidy, states could ease these rules or even eliminate EHBs if they could show that doing so would bring down overall health costs.

trump mcconnell

A previous iteration of the Senate GOP's healthcare bill, the Better Care Reconciliation Act, already showed what may happen with the waivers in the new bill. During the Byrd bath, the waivers in the BCRA that allowed the loosening of EHBs and other regulations were deemed to have nothing to do with the budget and were ordered stripped from the bill.

Health-policy experts say this could indicate that the waivers in the Graham-Cassidy bill will also have to be stripped.

"My own prediction is that the parliamentarian is likely to strike the waiver provision," said Daniel Hermel, an assistant law professor at the University of Chicago.

"The state innovation waivers were cloaked in budgetary language (a state could qualify for a waiver only if it produced a plan that would not add to the federal deficit), but the parliamentarian evidently saw that the intent was to transform health insurance markets rather than save the federal government money," Hermel wrote in a post on Tuesday.

bill cassidy lindsey graham

The language for the waivers, however, has been slightly tweaked from the BCRA's iteration, designed to hold up under the Byrd bath. As Vox's Dylan Scott reported, some experts believe it could be successful.

Others, like the University of Michigan law professor Nicholas Bagley, say the parliamentarian won't be fooled by what they see as a rewrite with a crystal-clear purpose.

"The waiver provision is not *exactly* the same; it's been drafted to dodge reconciliation concerns," Bagley tweeted Wednesday. "But the dodge is transparent."

If the waivers are eliminated, the bill would simply shift the funding from the current percentage-based system, which adjusts based on how much money states actually spend, to the lump-sum block grants in the Graham-Cassidy bill. The block grants are much less generous overall than the current system.

In such a circumstance, states would get less funding for healthcare with little of the freedom proposed by the bill's authors.

SEE ALSO: GOP senator admits new healthcare bill could harm people with preexisting conditions, but says it won't happen

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Trump threatens to brand Rand Paul as 'the Republican who saved Obamacare'

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rand paul donald trump

President Donald Trump on Friday urged Republican senators on the fence about voting for the Graham-Cassidy healthcare legislation to not be the "Republican who saved Obamacare," zeroing in on Sen. Rand Paul of Kentucky.

"Rand Paul, or whoever votes against Hcare Bill, will forever (future political campaigns) be known as 'the Republican who saved ObamaCare,'" Trump tweeted.

Paul came out against the bill soon after its introduction because, in his view, it does not go far enough in repealing Obamacare. Paul said he would vote against the measure, leaving the future of the bill in doubt.

Moderate Republican senators, including Susan Collins of Maine and Lisa Murkowski of Alaska, have not said which way they lean on the bill. The GOP can only afford two defections for it to pass. 

The Graham-Cassidy bill is Republicans' last chance to repeal Obamacare using the budget reconciliation method, which allows legislation to move forward with a simple majority. If the bill does not pass by September 30, the GOP would need Democratic support for any healthcare measure.

Paul, however, expressed his displeasure that the Graham-Cassidy maintains many of the taxes created under Obamacare and continues to fund its Medicaid expansion — albeit at a lower amount than the current system. The senator shot back on Twitter after the president's tweet.

"No one is more opposed to Obamacare than I am, and I've voted multiple times for repeal," Paul said. "The current bill isn't repeal."

 

 

Senate Majority Leader Mitch McConnell said he intends to bring the Graham-Cassidy bill to the floor next week.

SEE ALSO: GOP senator admits new healthcare bill could harm people with preexisting conditions, but says it won't happen

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Democratic congressman: McCain won't support GOP health bill because 'he's staring death in the face'

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A Pennsylvania congressman predicted this week that Sen. John McCain won't support the GOP's newest efforts to repeal and replace the Affordable Care Act because the Republican senator, recently diagnosed with an aggressive form of brain cancer, is "staring death in the face." 

Democratic Rep. Matt Cartwright, taped while speaking at a town-hall event Tuesday, said he was somewhat worried about McCain's vote on the bill, known as Graham-Cassidy. But he suggested McCain's illness would help him "make good choices."

"Man, something tells me McCain, he's staring death in the face right now, so he's probably going to make good choices and he's not going to bend to political pressure," Cartwright said. 

The senator's daughter, Meghan, condemned the remark on Twitter on Thursday, calling it "disgusting and macabre."

Cartwright put out a statement later on Thursday apologizing for his comments and expressing his "deep admiration" for McCain. 

"I want to express my deep admiration for Senator McCain and gratitude for his service to our nation. I have reached out to apologize directly to him and his family for my statement about his illness, which I agree was insensitive, and which has clearly offended the McCain family,"Cartwright said. "I know he will continue to fight for the people of Arizona and this country during his courageous battle with this disease. I wish him a speedy and full recovery."

McCain returned to the Senate full-time two weeks ago after undergoing brain surgery this summer and won accolades from Democrats when he became one of three Republicans to vote against the GOP's last healthcare bill. 

The senator has consistently insisted that Congress "return to regular order" and work out bipartisan legislation with committee markups and hearings. 

"Our healthcare insurance system is a mess. We all know it, those who support Obamacare and those who oppose it. Something has to be done,"McCain said in July. "We Republicans have looked for a way to end it and replace it with something else without paying a terrible political price. We haven't found it yet, and I'm not sure we will. All we've managed to do is make more popular a policy that wasn't very popular when we started trying to get rid of it."

While McCain is under pressure to yield to his Republican colleagues — and the bill's cosponsor, Lindsey Graham, is a close friend — he told reporters on Monday that he would continue to press for "regular order." 

"I am not supportive of the bill yet," McCain said of Graham-Cassidy. "It's not so much 60 votes that I care about, it's a bipartisan approach to the issue is what I mostly care about."

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A new analysis says 21 million more people would have no insurance under the new GOP healthcare bill

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Over 20 million more people could go without health insurance if the Graham-Cassidy healthcare legislation is signed into law, according to a study from the Brookings Institution published Friday.

The nonpartisan Congressional Budget Office told lawmakers that it was unlikely to release a full score of the legislation with coverage effects. Matthew Fiedler and Loren Adler at Brookings used previous CBO models to attempt to determine the new plan's potential effects.

The study estimated that 21 million more people would be without coverage in 2026 than under the current system. It also estimated that the number would skyrocket to 32 million after a large portion of the bill's proposed healthcare funding runs out in 2026.

Even that scenario is a best-case one, Adler and Fiedler wrote. From the study (emphasis added):

"This estimate likely understates the reductions in insurance coverage that would actually occur under the Graham-Cassidy legislation, particularly toward the beginning and end of the seven-year period, because it does not account for the challenges states will face in setting up new programs on the bill's proposed timeline, the possibility that uncertainty about the program's future will cause market turmoil toward the end of the seven-year period, or the bill's Medicaid per capita cap and other non-expansion-related Medicaid provisions."

The Brookings analysis follows a breakdown from the Commonwealth Fund estimating that 15 million to 18 million more Americans would be without coverage by 2020 and that 32 million would be without coverage in 2027.

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Fiedler and Adler said decreased funding under Graham-Cassidy and uncertainty surrounding the systems states would set up in 2020 added some degree of doubt to their analysis. But they said the study was more likely to undershoot the number of people who would lose coverage.

If more states were to loosen regulations from the Affordable Care Act, the law better known as Obamacare, using a waiver system set up in the bill, that number would increase, the study said.

The increase in uninsured people would be fueled in part by the short time frame before states shift to block grants and have to set up their own insurance systems.

"States would have only around 15 months to get new policies in place to do so before insurers would need to begin developing products for 2020 and only about 27 months before the new rules would have to be in effect," Fiedler and Adler wrote. "For comparison, the process of drafting and implementing the ACA began close to five years before the new rules would be in effect. It seems likely that many states would simply fail to meet this timeline or meet the timeline only by deploying ineffective policies."

The researchers concluded that the Graham-Cassidy bill would most likely cause destabilized individual insurance and Medicaid markets and vastly increase the number of people in the US without coverage.

Read the full study at Brookings »

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Key senator leaning against voting for GOP healthcare bill, blasting it for gutting preexisting-conditions protections

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Republican Sen. Susan Collins said Friday that she was leaning toward voting against the GOP's latest legislation to overhaul the US healthcare system, citing the bill's potential to increase premium costs for people with preexisting conditions.

According to the Portland Press Herald, Collins said at an event in her home state of Maine on Friday morning that she was moving closer to being another definitive "no" vote on the bill, known as Graham-Cassidy. Republican Sen. Rand Paul of Kentucky has already come out publicly against it.

"I'm reading the fine print on Graham-Cassidy," Collins said, according to the Press Herald. "The premiums would be so high they would be unaffordable."

She added: "I'm just trying to do what I believe is the right thing for the people of Maine."

The Graham-Cassidy bill would not erase the protections under the Affordable Care Act, the healthcare law also known as Obamacare, preventing insurance companies from outright denying coverage to those with preexisting conditions, but it could allow for more expensive premiums. The bill would also permit states to opt out of providing benefits such as prescription drugs, which could result in more people paying out of pocket.

However, an architect of the bill disagrees. During an interview with the conservative talk-radio host CL Bryant on Thursday, Louisiana Sen. Bill Cassidy said that while states could develop programs of their own, the bill mandated fair coverage for people with preexisting conditions.

"We have language in there that says a governor may decide he wants to try, or she wants to try, to lower healthcare costs and can come up with a plan to do so, but whatever plan they have must make sure that those with preexisting conditions have access to affordable and adequate coverage," Cassidy said.

SEE ALSO: GOP senators say the 3rd time might be the charm on repealing Obamacare

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John McCain just dealt the GOP's latest healthcare bill a critical blow

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Sen. John McCain of Arizona, the Republican who delivered the final blow to the previous attempt to overhaul the US healthcare system, may have done the same when he came out against the GOP's latest healthcare legislation on Friday afternoon.

In a statement, McCain said the lack of "regular order" in crafting the legislation was what pushed him away.

"I would consider supporting legislation similar to that offered by my friends Senators Graham and Cassidy were it the product of extensive hearings, debate, and amendment," McCain said. "But that has not been the case. Instead, the specter of September 30 budget reconciliation deadline has hung over this entire process.

"We should not be content to pass health care legislation on a party-line basis, as Democrats did when they rammed Obamacare through Congress in 2009," McCain added. "If we do so, our success could be as short-lived as theirs when the political winds shift, as they regularly do. The issue is too important, and too many lives are at risk, for us to leave the American people guessing from one election to the next whether and how they will acquire health insurance. A bill of this impact requires a bipartisan approach."

McCain's opposition puts the bill — known as Graham-Cassidy for two of its authors, Sens. Bill Cassidy and Lindsey Graham — on the brink of defeat.

Sen. Susan Collins of Maine, a fellow Republican, said on Friday that she was leaning against voting for the bill, and Republican Sen. Rand Paul of Kentucky has also come out strongly against it. Republicans can afford only two defections for the legislation to pass.

McCain also pointed to the lack of clarity surrounding the effects of the bill if it were to become law. The nonpartisan Congressional Budget Office announced it would not be able to provide a full estimate of the bill's impact by September 30, the deadline for the GOP's ability to bypass the Senate's usual 60-vote threshold and instead pass the bill with a simple majority.

The longtime Arizona lawmaker also said he thought some senators were making a genuine attempt to fix what he believes is a broken healthcare system, but that the process of the Graham-Cassidy bill was not in accordance with how the upper chamber should operate.

"I hope that in the months ahead, we can join with colleagues on both sides of the aisle to arrive at a compromise solution that is acceptable to most of us and serves the interests of Americans as best we can," McCain said.

SEE ALSO: Key senator leaning against voting for GOP health bill, blasting it for gutting preexisting conditions protections

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Jimmy Kimmel thanks McCain for 'being a hero' and coming out against GOP healthcare bill

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After three nights of attacks on the GOP's healthcare bill, late-night host Jimmy Kimmel celebrated Republican Sen. John McCain's announcement Friday that he would vote against the bill, known as the Graham-Cassidy legislation.

"Thank you @SenJohnMcCain for being a hero again and again and now AGAIN," Kimmel tweeted minutes after McCain made his decision public. 

McCain's "no" vote will likely sink his party's final effort to repeal and replace the Affordable Care Act, better known as Obamacare. 

In a statement on Friday afternoon, McCain insisted that healthcare "is too important an issue" to be rushed through Congress and that Republicans must work across the aisle.

"I cannot in good conscience vote for the Graham-Cassidy proposal," he 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."

Kimmel has repeatedly spoken out against Republicans' attempts to repeal and replace Obamacare following the birth of his son, Billy, who underwent emergency open-heart surgery.

The comedian has implored his viewers to oppose the bill while blasting its authors, particularly Republican Sen. Bill Cassidy. The senator appeared on Kimmel's show last May and promised to oppose any bill that fails to protect those with preexisting conditions, who are currently protected from being denied coverage or charged more under Obamacare. 

Cassidy dubbed it the "Jimmy Kimmel test." But earlier this week, Kimmel accused Cassidy of lying "right to my face." 

Kimmel, echoing the consensus of healthcare experts, has argued that Graham-Cassidy would not protect people with preexisting conditions from being charged more for coverage, would allow insurers could opt out of providing essential health benefits, and would cut hundreds of billions of dollars in federal funding for healthcare.

SEE ALSO: Jimmy Kimmel blasts Trump, Graham, Cassidy in 3rd night of attacks on Republican healthcare bill

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Trump launches into early morning tweetstorm on John McCain, Graham-Cassidy healthcare bill

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President Donald Trump went on a Twitter tirade Saturday morning attacking a wide variety of targets over the new GOP healthcare bill.

Trump's main focus was drumming up support for the latest Republican attempt to repeal and replace Obamacare, the Graham-Cassidy bill, in addition to disinviting the Golden State Warriors from the White House

The president started off by attacking Sen, John McCain, who announced Friday that he would vote against the bill due to the rushed process being used by the GOP to shove the bill through the Senate. Republicans have until September 30 to pass the bill on a party-line vote.

"John McCain never had any intention of voting for this Bill, which his Governor loves," Trump tweeted. "He campaigned on Repeal & Replace. Let Arizona down!"

McCain also was one of three Republican senators to vote down the earlier attempt by Republicans to repeal Obamacare in July. The Arizona senator implored his colleagues to return to regular order and hold bipartisan talks to come to a solution on healthcare, which he said is not what happened with Graham-Cassidy.

Interestingly, Sen. Lindsey Graham — an author of the bill — is one of McCain's close friends in the Senate. Trump made mention of this connection as well, calling Graham "L.G."

"Large Block Grants to States is a good thing to do. Better control & management," the president said. "Great for Arizona. McCain let his best friend L.G. down!"

Sen. John McCain (R-AZ) speaks with reporters ahead of the party luncheons on Capitol Hill in Washington, U.S., September 19, 2017. REUTERS/Aaron P. Bernstein

Trump also used Twitter to pressure two other Republican lawmakers to support the bill. One, Sen. Rand Paul, already said he would not support the bill because it did not go far enough in repealing Obamacare.

"I know Rand Paul and I think he may find a way to get there for the good of the Party!" said Trump.

The other, Sen. Lisa Murkowski, voted against the healthcare bills in July but has not given a definitive answer on the Graham-Cassidy bill.

"Alaska had a 200% plus increase in premiums under ObamaCare, worst in the country," Trump tweeted. "Deductibles high, people angry! Lisa M comes through."

So far both McCain and Paul have come out definitively against the bill, and Sen. Susan Collins said she is "leaning" towards a no vote. If three Republicans vote against the bill, it will fail. Senate Majority Leader Mitch McConnell intends to bring the bill to the floor for a vote some time next week.

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President Trump attacks John McCain, NFL players, and Steph Curry in wild Saturday — here's the rundown

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What a day.

President Donald Trump was active on Twitter Saturday, sparking confrontations with major figures in two different professional sports leagues, attacking Sen. John McCain for his announcement that he will vote against the newest GOP healthcare bill, and leaning on other Republicans to support the healthcare plan.

Here's a rundown of Trump's busy Saturday:

And if that wasn't enough, there was even more news:

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Top doctor, hospital, and insurance groups release joint statement urging the Senate to reject Graham-Cassidy bill

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A group of six major doctor, hospital, and insurance groups released a joint statement on Saturday condemning the latest GOP effort to repeal and replace the Affordable Care Act, urging the Senate to reject the Graham-Cassidy bill.

"While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable healthcare market that provides access to high-quality care and affordable coverage for all,"the statement said.

"The Graham-Cassidy-Heller-Johnson bill does not move us closer to that goal. The Senate should reject it."

The groups that issued the statement included the American Medical Association, American Academy of Family Physicians, American Hospital Association, Federation of American Hospitals, America's Health Insurance Plans, and the BlueCross BlueShield Association.

Each of those groups — and more than a dozen others— has already individually condemned the Graham-Cassidy bill, but Saturday's statement marked the first time they had done so as a collective.

The statement said the groups agreed that the bill would undermine safeguards for patients with pre-existing conditions, dramatically cut Medicaid and introduce a future "funding cliff," weaken the individual insurance market, and introduce an unworkable timeframe to implement the bill's changes.

"State and industry leaders will need to completely transform their individual insurance markets and Medicaid programs in little more than a year — an impossible task," the statement said.

The bill— written by Sens. Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson — would set up federal funding in block grants, which states would use to fund healthcare. That's different from how funding is distributed now, as a percentage of what states spend, and it could drastically change what states receive.

In the statement, the groups called for senators to work on a bipartisan solution instead.

As of Friday, the future for the Graham-Cassidy bill looked dismal, after Republican Sen. John McCain of Arizona announced he intended to vote against the bill. Sen. Rand Paul of Kentucky, a fellow Republican, had already come out strongly against it, as had Republican Sen. Susan Collins of Maine.

As Republicans control 52 seats in the Senate, they would have to persuade at least one of those three senators to vote for the bill in order to pass it with a simple majority under the budget reconciliation process. The GOP must pass the bill by September 30 otherwise it will be subject to the Senate's usual 60-vote threshold.

But some, including President Donald Trump, have speculated that Paul or Collins could still change their minds before the bill comes to a vote.

"I know Rand Paul and I think he may find a way to get there for the good of the Party!" Trump tweeted on Saturday.

Lydia Ramsey contributed reporting.

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