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    The Latest Obamacare Repeal Effort (this one stands a chance)
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    The Latest Obamacare Repeal Effort (this one stands a chance)

    September 2017

    A latest Obamacare repeal effort is on the table and it’s worth taking note of. This bill likely stands the best chance at passing out of anything we’ve seen. Here’s what you need to know.

    The bill, popularly known as Graham-Cassidy, would eliminate Obamacare’s Medicaid expansion, subsidies for private insurance, the individual and employer mandates, the pre-existing condition requirement, and payments to insurers to reduce out-of-pocket costs. Instead, it would block grant about $500 billion of federal spending to states over 10 years (to 2026), and states could use that money to cover health care costs as each sees fit -- with relatively few restrictions. States could, for example, eliminate Obamacare rules requiring that insurance cover a minimum package of benefits or the requirement that healthy and sick customers are charged the same. Come 2027, they could either repeal, repair, or keep their Obamacare programs. Block grants would likely decrease federal funding to large states that currently spend more on health care, like NY and CA, as that money would be redistributed to states that spend less, say TX and AL. Small states that rely heavily on Obamacare’s Medicaid funding would also be hit hard. Obviously, there’s some opposition.

    From Democrats, the main argument is that the plan would reduce the number of insured individuals as mandates for coverage and funding disappear. And from opposing Republicans, namely Senator Rand Paul of KY, who vows to kill anything reeking of “skinny repeal”, this doesn’t go far enough in repealing Obamacare. Without key Republican votes, the math gets tough. Complicating this is the fact that there’s a huge redistribution of money looming for the states, and “losers” include states with must-get senators. Will they vote “against” their states? Only time will tell, but the bill can only lose one more vote before it fails completely.

    Still, there’s a fighting chance, maybe the best we’ve seen yet. Here’s why:

    1. Obamacare repeal is still a huge Republican talking point.

      Republicans have been promising to repeal Obamacare since 2010, and this bill appears to be their last chance to do it. The president and congressional leadership are ready to move on to tax reform. It’s possible the prospect of a win on an issue paramount to their base could be a powerful motivating force.

    2. The policy reflects the conservative ideal that states are better able to manage their health care programs than the federal government.

      At the end of the day, Graham-Cassidy allows each state to try its hand at health-care policy (backed by a federal lump sum payment). That’s a conservative ideal, one bound to help reluctant Republicans swallow the pill.

    3. There’s no time to waste.

      Republicans will have to pass this thing using a special budget procedure called reconciliation. That process allows them to pass the bill without needing any support from Democrats. But there’s a rub: It must be done by September 30 when the fiscal year ends. After September 30, the bill would have to be passed in the Senate by traditional means. At that point, it would need 60 supporting votes to avert a Democratic filibuster. It just doesn’t have it. That pressure could prompt holdouts to take a chance and vote yes.

    The CBO indicated it would offer an initial assessment by “early next week,” and I imagine we’ll have a better feel for where senators stand on the bill once that happens. Obamacare continues to be a major uncertainty for small businesses. Keep your eye on this final attempt at repeal, just as we are.  

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