WASHINGTON — Sen. Ben Sasse, R-Neb., is hardly enthusiastic about his party’s latest, last-ditch health care proposal.
He doesn’t feel it goes far enough in dismantling the Affordable Care Act and overhauling the country’s health care system — and yet he’s likely to vote for it as a “less bad” option than the status quo.
“Every Republican in America from dogcatcher to president promised we were going to repeal and replace Obamacare so I’m disappointed that we have failed to deliver on repeal and replace,” Sasse told The World-Herald.
The pending proposal is named after its GOP co-authors, Sen. Lindsey Graham of South Carolina and Sen. Bill Cassidy of Louisiana.
“Graham-Cassidy isn’t repeal and it isn’t replace, but I think it is a modest improvement over the current mess,” Sasse said.
The proposal garnered positive remarks from all four Republicans representing Nebraska and Iowa. And a number of Republican governors back the idea, including Nebraska’s Pete Ricketts and Iowa’s Kim Reynolds.
Republicans have been promising for years to repeal ACA, more commonly referred to as Obamacare, and appeared to be in position to do so this year after adding control of the White House to their congressional majorities.
But lawmakers have struggled to unify behind specific legislation, and the effort seemed to stall out just before they left for the August recess.
Now there is renewed momentum for the Hail Mary proposal offered by Graham and Cassidy.
The core of their plan is to eliminate the signature ACA subsidies that individuals use to purchase insurance plans and instead provide money directly to the states in the form of block grants.
It also would eliminate increased funding for states that expanded their Medicaid programs and place a per capita cap on future growth of Medicaid spending. The Medicaid changes could have a more significant impact on Iowa than Nebraska, given that Iowa expanded Medicaid and Nebraska didn’t.
Some ACA rules would remain in place, such as the requirement to cover people with pre-existing conditions and allowing children to stay on their parents’ plans until the age of 26. But states could obtain waivers that would allow insurers to charge those with pre-existing conditions more or simply not offer certain coverage.
Supporters say that new approach would empower states to explore innovative ideas. But a slew of insurers, health care providers and patient advocate groups have lined up against the bill, which critics say would endanger vulnerable populations that rely on Medicaid and undermine protections for those with pre-existing conditions.
American Hospital Association President and CEO Rick Pollack said in a press release that the proposal puts at risk coverage for millions of Americans.
“This proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term,” Pollack said.
Republicans are up against a Sept. 30 deadline to get the bill through the Senate on a majority vote — which they can achieve with Republican-only support. After the deadline, any proposal would require 60 votes and therefore have to be bipartisan. It remains unclear, however, whether the Republicans can get 50 of their 52 members on board.
A bipartisan group of 10 governors wrote a letter urging Congress to reject Graham-Cassidy and instead consider bipartisan legislation through the regular legislative process.
Still, the proposal has the support of the Iowa and Nebraska governors.
A Reynolds spokesperson said in a written statement that the current marketplace in Iowa is collapsing and that the ACA has to be replaced.
“Right now, the Graham-Cassidy bill is the only bill that accomplishes the governor’s health reform principles,” according to the statement. “The governor believes this model can work for the repeal and replacement of Obamacare.”
And all four Republican senators representing Nebraska and Iowa sounded like yes votes in interviews with The World-Herald.
“Nebraska looks like it will be treated more fairly in the dispersion of the funds and be able to make decisions at a state and local level,” Sen. Deb Fischer, R-Neb., said.
Sen. Joni Ernst, R-Iowa, said she still has questions about the proposal but downplayed a suggestion that it would cause Iowa to lose out on Medicaid funding.
Sasse said the proposal would allow states to test a variety of ideas and offered as an example the expansion of health savings accounts.
“You’re much more likely to get actual health care reform over time if you have governors and state legislatures involved,” Sasse said.
Sasse has emphasized the importance of bringing “portability” to the health care system — making it easy for people to obtain and keep coverage that travels with them across job and geographic changes.
He’s not sure Graham-Cassidy would advance the cause of portability, but it’s possible governors could experiment in ways that improve the situation, he said.
That includes setting up interstate compacts that would make it easier to carry insurance across state lines.
As for those with pre-existing conditions, Sasse suggested that the percentage of people who are actually “uninsurable” is smaller than many believe.
“We can solve that problem,” Sasse said. “We have social welfare safety net programs that can solve that problem.”
Sen. Chuck Grassley, R-Iowa, is leaning toward supporting the proposal, praising the idea of returning power to the states and evening out the distribution of federal spending on health care.
But he also acknowledged the political dynamics at play.
Grassley said he could give 10 reasons why the bill shouldn’t be considered but noted that Republicans have promised for years to pass repeal legislation.
“You have a responsibility to carry out what you said in the campaign,” Grassley said. “That’s pretty much as much of a reason as the substance of the bill.”