Outlook: The End of Obamacare Repeal (Again)?

Republicans’ next step is unclear as Graham-Cassidy measure appears doomed.

Sen. John McCain and Lindsey Graham
AP Photo/Cliff Owen
Alex Rogers
Add to Briefcase
Alex Rogers
Sept. 24, 2017, 8 p.m.

The long Republican quest to “repeal and replace” the Affordable Care Act will likely come to an end this week. Senate Majority Leader Mitch McConnell intends to call up a radical bill to convert the Obama-era law’s tax credits and subsidies into a block grant distributed to the states, and to cut and cap Medicaid, the health care program for the poor.

It’s unlikely that the bill can pass as drafted. Sens. Rand Paul of Kentucky, Ted Cruz of Texas, John McCain of Arizona and every Democratic senator currently oppose it—enough to defeat it.

McConnell needs one of those Republicans to flip, and to bring on board every other one in the Senate. It’s a difficult task. On Face the Nation Sunday, Sen. Susan Collins of Maine acknowledged it is “hard” for her to “envision” voting for a bill with substantial Medicaid cuts and weakened protections for those with preexisting conditions.

Overall, the federal government would spend $107 billion less for the block grants than it would under the ACA from 2020 to 2026, according to the Kaiser Family Foundation. But some states would win and others lose: Red states like Mississippi and Texas would get billions of dollars in aid at the expense of blue states like California and New York, which expanded Medicaid under the 2010 health care law. The Brookings Institute estimated the bill would increase the number of uninsured Americans by 21 million people.

In exchange for the block grant, states would set new regulations that could cut insurance costs for some, but also increase costs for those with preexisting conditions and allow insurance companies to offer skimpier coverage. Medicaid state directors and advocacy groups representing doctors, hospitals, insurance companies, and patients all oppose the last-ditch effort, while at least 15 Republican governors support it.

Collins and Sen. Lisa Murkowski of Alaska could repeat their summer performance with McCain to sink the health care bill. Murkowski has said she wants to evaluate how it would affect her state before announcing her position. Alaska would lose $275 million dollars in federal funding, an 8 percent cut, from 2020 to 2026, according to Kaiser. On Friday, Collins said that under the bill insurers could charge premiums “so high they would be unaffordable,” according to the Portland Press Herald.

Republicans on Capitol Hill don’t have much time to deliberate. At the end of the month, the Graham-Cassidy bill will lose procedural protections that allow passage in the Senate with a simple majority, rather than the 60 votes required for most major legislation. After that, Republicans expect to move onto tax reform—though some in the GOP hope to write a budget resolution that allows them to continue working on Obamacare repeal while also doing tax legislation with a simple majority.

Even if the Graham-Cassidy bill passed the Senate, it remains unclear how it would be received in the House, which would have to alter its schedule to take it up. House Republicans will take their first earnest shot this week at coming together on changes to the tax code. On Wednesday, the conference will meet off-site to talk through a framework for tax reform.

The House will also consider a reauthorization of a home-visiting program that allows federal, state, and local communities to check in on at-risk children in their homes. Another bill expected to be on the floor would cut off disability benefits to people with an outstanding arrest warrant for an alleged felony or an alleged violation of probation or parole.

Finally, the two chambers will have to deal with a reauthorization of the Federal Aviation Administration before Sept. 30, when the current authorization expires. Versions of such legislation have been floating around the two chambers, but they have not yet come to any consensus, meaning a short-term extension of the program is likely.

Outside of Washington, Republicans will be closely watching Tuesday’s balloting in Alabama, where GOP voters will choose between Sen. Luther Strange and former state Supreme Court Justice Roy Moore in the contest to fill the seat vacated by now-Attorney General Jeff Sessions. McConnell, President Trump, and much of the party establishment are backing Strange, while Moore has the support of many grassroots conservatives. The winner of the Strange-Moore matchup will face Democrat Doug Jones in December.

Here’s what else is on tap:


Representatives from Twitter will meet with the Senate Intelligence Committee in a closed setting Wednesday as the panel continues to investigate Russian interference in the 2016 election. The committee is scheduled to hold another closed hearing on Tuesday. Meanwhile, the House Intelligence Committee, which is conducting its own Russia probe, will hold an open hearing on Thursday focusing on the documents it has subpoenaed from the Justice Department and the FBI.

Elsewhere, the House Foreign Affairs Committee is set to hold a hearing Tuesday on the proposed State Department redesign. That same day, the Senate Armed Services Committee will have a hearing on Marine Corps Gen. Joseph Dunford’s reappointment to be chairman of the Joint Chiefs of Staff, and the Senate Foreign Relations Committee will look at “managing security assistance to support foreign policy.”

And on Thursday, the Senate Banking, Housing, and Urban Affairs Committee is scheduled to meet for a hearing on North Korea sanctions.


The Senate Energy and Natural Resources Committee meets Tuesday to consider two Trump nominees: Bruce Walker to be assistant Energy secretary for electricity delivery and energy reliability; and Steven Winberg to be an assistant Energy secretary for fossil energy. The House Natural Resources Committee gathers the same day to mark up a trio of bills on fisheries management. And a House Oversight and Government Reform subcommittee has a hearing examining America’s system for managing and storing nuclear waste.

In the midst of a severe wildfire season in the Western states, the Senate Environment and Public Works Committee has a Wednesday hearing on “Forest Management to Mitigate Wildfires: Legislative Solutions.” The House Natural Resources panel also has a subcommittee hearing that day on reducing the risk of wildfires.

The Senate Commerce, Science, and Transportation Committee takes up multiple nominations Wednesday, including retired Rear Adm. Timothy Gallaudet to be assistant Commerce secretary for oceans and atmosphere; and Howard Elliott to be administrator of the Transportation Department’s Pipeline and Hazardous Materials Safety Administration.


The Senate Finance Committee is slated to have a hearing Monday afternoon to consider the Graham-Cassidy proposal, but passage of the legislation appears unlikely after McCain announced his opposition to the bill Friday.

“As I have repeatedly stressed, health care reform legislation ought to be the product of regular order in the Senate,” the Arizona senator said in a statement lamenting the hurried process that produced Graham-Cassidy.

While negotiations on Obamacare repeal may continue, Congress will address other health care agenda items.

Lawmakers will also be facing crunch time to reauthorize funding for the Children’s Health Insurance Program. The spending for the program, which covered more than 8 million low-income kids in 2015, expires at the end of the month.

The Senate Veterans’ Affairs Committee will have a hearing on a very different health care issue: veteran suicide. And the House Veterans’ Affairs Health Subcommittee will consider a number of health-related bills, including a draft legislation to improve the Veterans Affairs Department’s health-professions educational-assistance program, on Tuesday.


Tax writers have a big week. The Big Six—the group of House, Senate, and White House officials working on a plan to overhaul the code—are set to release more information on the status of their negotiations.

It’s not likely to be the broad, unifying outline some tax watchers are hoping for, but it could be enough to help advance a budget. Conservative House members in the Freedom Caucus have said they want to see more details on tax reform before they vote on any budget, which leadership needs to pass a tax bill using reconciliation and bypass a Democratic filibuster in the Senate.

The tax principals are still working out major issues like target corporate and individual tax rates and the fate of deductions for state and local taxes and mortgage interest. They’re also working on the issue of whether to include new tax breaks, such as allowing companies to immediately write off the cost of certain capital investments, known as full expensing.

It’s still unclear how many, if any, of those will be resolved in the new Big Six statement, but tax writers and some White House officials have acknowledged that the Trump administration’s proposed 15 percent corporate rate is unlikely, and instead have proposed something in the low 20s. They’ve also softened their full-expensing proposal. In the last Big Six dispatch in July, they pledged to do “unprecedented expensing.” The group could offer more clarity on that phrase in the new document.

And Senate Finance Committee Chairman Orrin Hatch is downplaying the upcoming document as well, saying in a recent tax-reform hearing that the statement will merely be a nonbinding guidepost, and that his committee won’t “rubber stamp” any tax bill.

Before lawmakers can get to work advancing a tax bill, they must first pass a budget, and movement on that is happening. Sens. Pat Toomey and Bob Corker reached an agreement last week to advance a budget that would unlock between $1 trillion and $1.5 trillion in tax cuts over a decade. That’s not enough to cover all of Republicans’ proposed tax cuts and breaks through deficit financing, meaning that if they want to deliver an ambitious tax bill, they’ll have to do the politically difficult work of cutting deductions as well.

The House Ways and Means Committee has no hearings scheduled, but House Republicans have a half-day retreat on tax reform scheduled on Wednesday. A spokesman for the House Republican conference said the meeting is to give members an opportunity to talk through the framework and offer feedback.


Protesters are set to descend on Washington this week to push for stronger federal net-neutrality protections that prevent the blocking, slowing, or prioritizing of data by internet service providers. A slew of progressive tech organizations—including the Electronic Frontier Foundation, Free Press, and Fight for the Future—are directing activists to picket the Federal Communications Commission’s monthly open meeting on Tuesday (while the FCC’s Republican leadership is currently looking to roll back the commission’s net-neutrality rules, it will not be considering any such order on Tuesday).

Protests will move to the Hill on Wednesday, with organizers planning a march around the Capitol and meetings with lawmakers. The activists are expected to call on Congress to rein in the FCC’s attempt to roll back neutrality rules and to prevent neutrality legislation, which Republicans have expressed some interest in pursuing.

Lawmakers will have to wait for more information on Kaspersky Labs, the Moscow-based cybersecurity and antivirus firm that was banned from working with any federal agencies earlier this month. The House Science, Space, and Technology Committee had planned to hear from company founder Eugene Kaspersky on Wednesday, along with a representative from the Homeland Security Department and several other panelists, but the hearing was delayed indefinitely due to scheduling issues. Kaspersky Labs is alleged to possess close ties to Russian intelligence, and both lawmakers and intelligence officials have cautioned that the use of its products may open up U.S. agencies to foreign espionage.

The Senate Commerce Committee will vote Wednesday on the nomination of Walter Copan to lead the National Institute of Standards and Technology. One of the agency’s primary tasks is the implementation of the new NIST Cybersecurity Framework, a set of best practices designed to improve network security both at federal agencies and within the private sector. It’s expected that Copan’s extensive experience working at the crossroads of public and private institutions will assist NIST in that endeavor.


Trump plans a heavy focus on tax reform this week both in town and on the road. On Monday, he will meet with the leaders of groups he hopes will lobby for tax cuts. On Tuesday, he will meet with members of the House Ways and Means Committee that will take the first crack at crafting a bill. On Wednesday, he will travel to the Indianapolis area to lay out some details of his tax plan and put pressure on Democratic Sen. Joe Donnelly, one of the White House’s top hopes to cross the aisle and support a bill. On Friday, he will address the board of the National Association of Manufacturers, a group with a big voice in any tax reform package. His one break from taxes will come on Tuesday when he will welcome to the White House Spanish Prime Minister Mariano Rajoy.

Adam Wollner, Daniel Newhauser, Erin Durkin, Casey Wooten, Brendan Bordelon and George E. Condon Jr. contributed to this article.
What We're Following See More »
House Committee Calls Mark Zuckerberg To Testify
9 minutes ago

"The House Energy and Commerce Committee will summon Facebook CEO Mark Zuckerberg to testify, following recent revelations that Trump-linked Cambridge Analytica improperly obtained information on some 50 million Facebook users. 'We believe, as CEO of Facebook, he is the right witness to provide answers to the American people,'" said Reps. Greg Walden and Frank Pallone. On Wednesday, Zuckerberg told CNN that he was open to testifying. "The House panel said it plans to send a formal letter to Facebook in the days ahead."

Tillerson Receives Applause for Farewell Remarks
20 minutes ago
House Passes Omnibus Spending Bill
21 minutes ago
House Intel Officially Votes to End Probe
2 hours ago
"The House Intelligence Committee on Thursday voted in a party-line vote to release its controversial, Republican-authored report on Russian interference in the 2016 election, bringing to a close a contentious chapter defined by committee infighting. The report will not immediately be made public. It must first be sent to the intelligence community for a declassification review."
Trump’s Top Lawyer Resigns
2 hours ago

"The president’s lead lawyer for the special counsel investigation, John Dowd, resigned on Thursday." Dowd, who took over Trump's legal defense last summer, "ultimately concluded that Mr. Trump was increasingly ignoring his advice." Trump has expressed willingness to "sit for an interview with the special counsel’s office, even though Mr. Dowd believed it was a bad idea."


Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.