Republicans in the U.S. Senate have just over a week, until Sept. 30, to pass an Obamacare repeal bill with a bare majority (instead of 60 votes). But in the rush of whip counts and CBO scores, don’t forget: This is an incredibly dangerous debate for Republicans. The public, through a variety of poll results, has made plain that it doesn’t like what the GOP is doing.

The latest YouGov poll, for example, found that 38 percent of respondents picked Democrats as the party that would do “a better job handling the problem of health care”; 24 percent picked Republicans. The Affordable Care Act, meanwhile, has a positive net favorable rating, and the various GOP repeal-and-replace bills have generally polled terribly.
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Only in government does modestly slowing spending growth mean severe “cuts.” Opponents of the Graham-Cassidy-Heller-Johnson (GCHJ) proposal to change ObamaCare falsely claim that it will result in massive spending cuts, especially in Medicaid. That simply is not true.

The bill does not spend fewer dollars. In fact, under this bill, taxpayers will spend more over the next 10 years than they are spending right now. The “severe” change being referenced in almost every news story is a reduction in the rate of growth. Some ObamaCare supporters have even claimed that Congress will be unable to afford the GCHJ block grants.
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With time running short, the authors of the latest plan to repeal and replace the Affordable Care Act shifted money in the bill to Alaska and Maine, which are represented by Republican senators who appear reluctant to support it.

The revised version of the bill, written by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, would provide extra money for an unnamed “high-spending low-density state,” a last-minute change seemingly aimed at Alaska and its holdout Republican senator, Lisa Murkowski, who has yet to say how she will vote. It would also send money toward Maine, whose Republican senator, Susan Collins, had said earlier on Sunday that she would almost certainly vote no.
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John McCain is an American war hero with many political accomplishments. That legacy, though will be diminished by not one but two decisions to kill Republican health-care reform. And no one should let Senator Rand Paul off the hook, either.

Mr. McCain said in a Friday statement that he “cannot in good conscience” vote for a proposal from Lindsey Graham and Bill Cassidy that would devolve ObamaCare funding to the states, as well as repeal the medical-device tax and the employer and individual mandates. The deadline to pass the bill with 51 votes is Sept. 30 thanks to arcane Senate budget procedures. Mr. McCain’s no vote almost certainly dooms the project, as Mr. Paul has already declared his opposition and Susan Collins of Maine is thought to be a reliable no vote as well.

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The last train is leaving Reconciliation Station. Republican efforts to repeal and replace Obamacare — derailed just weeks ago — now seem back on track. GOP senators Lindsey Graham of South Carolina, Bill Cassidy M.D., of Louisiana, Dean Heller of Nevada, and Ron Johnson of Wisconsin seek 47 more votes (including, if necessary, that of Vice President Mike Pence, to break a 50–50 tie) to pass their legislation within the Senate’s filibuster-proof reconciliation window. It closes September 30. Having snored through August, Republicans are scrambling to keep the repeal/replacement pledges that secured them the House, Senate, and White House.

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Sen. John McCain (R-Ariz.) on Friday announced that he will vote against the latest proposal to repeal ObamaCare, potentially dooming the legislation and, with it, the GOP’s last shot at passing a health care overhaul this year.

“I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried,” he said in a statement, referring to the legislation spearheaded by GOP Sens. Lindsey Graham (S.C) and Bill Cassidy (La.).
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Democrats once liked a federalist solution to health care, and Sen. Lindsey Graham was one of those who worked with them. In 2007 he and Wisconsin Democrat Russ Feingold proposed the State-Based Health Reform Act that would have given states even more freedom than Graham-Cassidy. But these days Democrats fear that state laboratories would discredit the command and control approach to health care that they hope will lead to single-payer. The choice Republicans face isn’t between Graham-Cassidy or some bipartisan beau ideal. Their choice is to pass their own bill, which now means Graham-Cassidy, or fail again and cede the health-care advantage to the single-payer wing of the Democratic Party.

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Based on estimates, overall federal funding for coverage expansions and Medicaid would be $160 billion less than current law under the Graham-Cassidy bill over the period 2020-2026. Thirty-five states plus the District of Columbia would face a loss of funding. Federal funding under the new block grants would be $107 billion less than what the federal government would have spent over the period 2020-2026 for ACA coverage. A typical Medicaid expansion state would see an 11% reduction in federal funds for coverage compared to an increase of 12% in a typical non-expansion state.

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Two GOP senators are likely “no” votes: Kentucky’s Rand Paul and Maine’s Susan Collins. But Arizona’s John McCain, who spoiled this summer’s attempt at ObamaCare repeal, seems unlikely to repeat his performance and sandbag his good friend Lindsey Graham. That means the 50th vote will come down to Alaska’s Lisa Murkowski, who says she’s still trying to decide how the bill will affect her state. If Ms. Murkowski is honest with her constituents—and about her numbers—Alaska needs a “yes” vote.

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As the Graham-Cassidy (Heller-Johnson) health care bill appears to achieve a rapid intensification of support, so too have lies and exaggerations about its contents. Some people are very mistrustful about the states’ willingness and ability to provide a regulatory environment in which broad segments of society will have decent health care. The competency and motivation of the states needs to be compared not to some fantasy federal government with unlimited resources, constant benevolence and technical competence, but to a federal government that in fact is deeply in debt and that has proven itself inept at creating stable health insurance markets.

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