Healthcare Déjà Vu

Senate Republicans plan to vote on a new healthcare proposal next week before the GOP runs out of time to deliver on its promise of repealing and replacing Obamacare.

Republicans failed to coalesce around a healthcare package earlier this year, although party leaders modified the bill several times trying to find a compromise between the GOP’s conservative and moderate wings.

Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana resurrected the Republican effort last week with a new proposal. Together they’ve gained considerable support but still lack the 50 votes needed to pass the measure. Unless something changes, the last-ditch effort will end the same way as before—in failure.

The first time Republicans tried to pass a healthcare reform package, GOP Sens. Lisa Murkowski of Alaska, Susan Collins of Maine, and John McCain of Arizona shot down the effort. None of the three have said they will vote any differently this time around.

Murkowski maintains she’s waiting to see data on how the Graham-Cassidy bill would affect her home state. But she’s not going to get those numbers before the vote.

The nonpartisan Congressional Budget Office (CBO) announced this week it would not be able to complete a full analysis of the bill before the Sept. 30 deadline. The agency aims to release some basic budgetary estimates required by reconciliation rules early next week, but it won’t provide details about practical implications of the bill, including how it will affect premiums and how many people could lose their healthcare coverage.

Collins told reporters this week she fears the Graham-Cassidy bill would charge people with pre-existing conditions more money for coverage in some states.

This bill is similar to the last GOP healthcare proposal in some respects. It immediately removes two of the Affordable Care Act’s most unpopular provisions: the individual and employer mandates to buy health insurance. The bill also repeals the medical device tax and defunds Planned Parenthood for one year.

But it structures the U.S. healthcare system much differently. It seeks to grant states more discretion in how they can spend healthcare funds. It also axes many of the federal Obamacare taxes and subsidies. Instead, states would receive block grants to allocate any way they want. The bill takes money that would have gone to premium tax credits and the Medicaid expansion under Obamacare and divides it among individual states. Some states would end up with more money for healthcare costs while others would see a decrease, compared to current law.

McCain has made few comments on the substance of the bill and continues to tell reporters he wants “regular order.” The senior senator from Arizona doesn’t like the bill rushing through the chamber so quickly without a full analysis from the CBO and sufficient time for debate.

Meanwhile, on the other side of the Republican ideological spectrum, Sen. Rand Paul of Kentucky said he would vote against the bill because it does not repeal enough of Obamacare, granting the Obama-era overhaul “amnesty” instead.

“Rand Paul is a friend of mine but he is such a negative force when it comes to fixing healthcare,” President Donald Trump tweeted Wednesday. “Graham-Cassidy Bill is GREAT! Ends Ocare!”

Despite opposition, Senate Majority Leader Mitch McConnell, R-Ky., intends to hold a vote on the Graham-Cassidy bill next week. But it will be another wasted effort unless he can persuade at least two naysayers to change their minds.