Murkowski could swing Senate for latest ACA repeal

Opponents of health care repeal at the U.S. Senate in July. (Photo by Liz Ruskin)

Defenders of the Obama health care law are applying as much pressure as they can to get Sen. Lisa Murkowski to vote no on the latest attempt to repeal the Affordable Care Act, and all eyes were on Murkowski at the Capitol Tuesday.

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Murkowski hasn’t announced how she’ll vote on the latest bill, known as Graham-Cassidy, but she was one of only three Republicans to vote against the last health care repeal bill, so she seems one of the most likely of her party to vote “no” again.

Another factor: Gov. Bill Walker just signed a letter asking Senate leaders to dump Graham-Cassidy. Reporters asked Sen. Lindsey Graham (R-S.C) what he thought of that.

“I don’t know the governor of Alaska,” Graham said. “Here’s what I would tell him: If you think you don’t like this bill, just watch (what) you’re getting coming, pal.”

Graham said his bill would send money directly to the states, with a lot more flexibility. He predicts the Obama health care law will fail.

“Chaos is going to reign. So I tell the folks in Alaska, we trust you with the money better than we trust a bureaucrat,” Graham said. “I hope you’ll take us up on the offer and look at it and reconsider.”

One option Murkowski had faith in may be off the table. The chairman of the Senate health committee was working on a bipartisan bill to stabilize the insurance markets, but Tuesday he announced an impasse.

Graham’s bill would end the subsidies for buying insurance on the exchanges, and it would stop the enhanced federal match for Medicaid expansion. It also has a per person cap on federal Medicaid funds. Instead, the states would get block grants and flexibility to design their own programs, starting in 2020.

The Congressional Budget Office hasn’t scored the bill yet, but the Center for Budget and Policy Priorities has done its own analysis. The left-of-center think tank said the block grants in the bill would fall substantially short of what states get now. CBPP Senior fellow Aviva Aron-Dine said all the ACA repeal bills would hit Alaska especially hard, because they don’t take into account the high cost of health care in Alaska and they remove the funding for Medicaid expansion. She said Graham-Cassidy does much the same.

“Alaska is once again one of the most harmed states, one of the states that faces more than 35 percent cut in its federal funding, relative to current law, just in the block grant, and then is hit by the (Medicaid) per capita cap,” Avon-Dine said.

By her estimates Alaska would get $255 million less in 2026. The bill doesn’t continue the block grants beyond that, so Aron-Dine counts Alaska’s loss as $844 million in 2027.

That’s if the bill even comes up in the Senate. Senate Majority Leader Mitch McConnell doesn’t sound certain.

“If we were going to act,” McConnell said, “We would have to act by Sept. 30.”

That’s the deadline for a process called “budget reconciliation.” After that, it will take 60 votes to pass a health care bill, and there are only 52 Republicans in the Senate.

Murkowski is telling reporters she wants to see how the bill would affect Alaska. She told NBC she’s open to voting for it if she’s convinced Alaska will not be disadvantaged. She said she still waiting for that data.

Sen. Dan Sullivan’s spokesman said Sullivan is still studying the bill, too.