Prospects for Graham’s health care plan growing dim

Sen. Lindsey Graham’s journey to repeal and replace the Affordable Care Act that started as a lonely crusade has in just one week picked up both followers and steam – but prospects for winning congressional approval remain murky.

Despite a handful of Senate GOP co-sponsors and high-profile endorsements from governors and conservative thought leaders around the country, the South Carolina Republican still lacks the 51 votes needed to pass his bill to reshape the American health care system.

Graham has just 12 calendar days to seal the deal. Republican lawmakers have been seeking to repeal and replace Obamacare through a procedural maneuver known as reconciliation, which allows the Senate to limit debate with 51 votes. Republicans control 52 of the Senate’s 100 seats.

The House is in a recess this week, and the Senate is expected to leave midday Wednesday because of the Jewish holiday. The two chambers do not plan to reconvene until next Monday.

The 51-vote threshold expires on Sept. 30, though. After that, it will again take 60 votes to cut off a filibuster on health care, almost certainly an impossible task.

Graham’s ability to deliver depends on a number of factors, many of which are beyond his control.

The crux of his legislation is that all money spent on Obamacare would be sent back to states as block grants to be used for health care purposes exclusively. States’ rights Republicans see this approach as a return to federalism, a way of getting Washington out of the kind of decision-making best left to local officials who understand their communities best.

But ideological purists see Graham’s bill as “Obamacare-lite.” By maintaining the law’s taxes on the wealthy as a way to finance the block grants, the bill doesn’t really repeal the law, critics argue.

“Graham/Cassidy keeps Obamacare and tells the states to run it,” Sen. Rand Paul, R-Ky., tweeted, referencing the bill’s other lead sponsor, Republican Sen. Bill Cassidy of Louisiana. “No thanks.”

Other Republicans have expressed concerns. Sen. Susan Collins, R-Maine, said last week she did not think the new proposal would adequately cover Medicaid costs. Sen. Lisa Murkowski, R-Alaska, is reportedly undecided. She and Collins are both supporters of Planned Parenthood, a national women’s health services provider that performs abortions. Graham’s bill would defund Planned Parenthood.

Many lawmakers are concerned about the process. They’re uneasy about not putting a major piece of legislation through the standard legislative process featuring committee hearings and a full cost analysis from the Congressional Budget Office.

The CBO announced Monday it could produce “preliminary” findings early next week, but a fuller picture of the legislation’s long-term impact would not be available for “at least several weeks,” long past the Sept. 30 deadline.

That means Graham backers would be forced to justify moving ahead without a complete picture of how states would fare under his bill. The CBO won’t be able to quickly predict how many Americans would lose or gain insurance, whether premiums would rise or by how much and if the overall legislation would add to the national deficit.

This is weighing heavily on Sen. John McCain, R-Ariz., who along with Collins and Murkowski voted to kill the Senate GOP’s last health care overhaul effort back in July.

McCain, who was diagnosed with aggressive brain cancer this summer, is struggling on a number of fronts: He wants to support his close friend, Graham, but insists health care legislation is too monumental to be rammed through the process without enough time for debate or a chance to offer amendments.

At the same time, McCain has relied on the counsel of Arizona Gov. Doug Ducey, who announced on Monday he was supporting the Graham bill.

Graham’s own governor in South Carolina has so far remained noncommittal, a sign of just how politically risky many Republicans see this exercise.

Speaking to reporters in the state capitol Monday morning, Gov. Henry McMaster said he was still “studying” the proposal, despite having had multiple conversations with Graham and personal pleas from Pence.

McMaster’s unwillingness to offer a full-throated endorsement – or any endorsement – won’t sink the effort. But Graham has made wooing governors a centerpiece of his longshot strategy. And with Graham seeking to sell the bill as a consensus-builder among the Republican Party, Democrats opposed to his measure could seize on McMaster distancing himself as a sign the legislation does not have sufficient support to move ahead.

McMaster hasn’t elaborated on why he’s been slow to endorse the health care legislation, but he could fear backlash from conservatives who share Paul’s view that the proposal doesn’t fully repeal Obamacare.

He may also be worried about unknowns in a bill to dramatically transform the country’s health care system. Facing re-election and multiple primary challengers next year, McMaster would be faced with guiding the transition into a new health care system that is likely to be controversial and take time to work out inevitable kinks — and could end up not being as beneficial to the state as proponents have sold it.

“I think most things would be better than Obamacare,” McMaster told reporters Monday. “Of course, block grants are much better than other ways to do things … but again, this is a very serious question, and I’m studying it very closely.”

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