“ “They’re going to find they can’t pay for it, they’re going to find that it doesn’t work. . . . Now that will make it tough on everybody. Maybe that’s what it take to wise people up.”
Wednesday is the deadline for insurers to sign contracts with the federal government so that they can sell health plans on the ACA marketplaces for 2018. Many companies are hiking these rates by double digits, but they have suggested they would curb such increases if they had assurances that the federal government would provide cost-sharing reduction payments for all of next year. Those subsidies provide discounts to lower-income customers for their health plan’s deductibles and other out-of- pocket costs.” (A)

“Senate Republicans gave up on their last-ditch bid to repeal Obamacare Tuesday as opposition in their own ranks ended months of fruitless efforts to deliver on a seven-year promise, and leaders said they would turn instead to overhauling the U.S. tax system.
“We don’t have the votes” for the health-care bill, co-sponsor Bill Cassidy of Louisiana told reporters in Washington. “We’ve made the decision, since we don’t have the votes, we’ll postpone that vote.” (B)

“Graham said that “it’s not if but when” Republicans will pass his healthcare bill, but said there was still work to be done before the bill was passed.
“We know what we’re against,” Graham said. “We’ve had a hard time articulating what we’re for.”” (C)

“One idea — which hardly enjoys widespread support at the moment — is to tie both health care and tax reform to the 2018 budget.
Graham and Sen. Ron Johnson, who both sit on the budget committee, have advocated for this idea. It has raised concerns among Republican lawmakers and staff alike who know just how messy that could potentially be. One GOP aide bluntly described that scenario as “a nightmare.” “(D)

“That means the GOP must either work with Democrats to get eight more votes on a healthcare bill or wait for mount another effort under reconciliation rules in either the fiscal year 2018 or 2019 budget.
“Look, we haven’t given up on changing the American healthcare system, we’re not going to do that this week,” McConnell said. “But it still lies ahead of us.”” (E)

“The ACA has helped millions to get health coverage, bringing the number of people without insurance to historic lows and improving both access to care and financial security. But because people at higher incomes don’t qualify for the law’s tax credits, many of them face high premiums and high out-of-pocket costs ― in some cases, more than they paid previously and, in the worst instances, more than they can realistically afford.
Those higher costs are largely a function of the law’s new requirements on insurers ― to cover everybody, regardless of pre-existing conditions, and to provide comprehensive benefits with each policy. Republicans have decried these effects, but every plan they proposed would have left many millions without insurance and gutted protections for pre-existing conditions.” (F)

“Meanwhile, the Trump administration has threatened to stop reimbursing insurers for covering the out-of-pocket costs of low-income customers, as the ACA requires. To hold down premiums in the exchanges, Congress should find a way to spread costs more broadly and guarantee the reimbursements for out-of-pocket costs. And the Trump administration needs to stop treating the exchanges like the enemy and focus instead on helping people get coverage.
With Graham-Cassidy-Heller-Johnson off the table, senators should resume the bipartisan efforts to stabilize the markets that the GOP leadership snuffed last week. And although Paul may still blanch at spending money on healthcare subsidies, most of his colleagues were ready to vote for a proposal that would have dedicated tens of billions of tax dollars to subsidizing coverage and care. It would be hypocritical and cynical for those Republicans to oppose efforts to help the exchange customers who are feeling the pinch now.” (G)

(A) Senate GOP abandons latest effort to unwind the Affordable Care Act, by Juliet Eilperin and Sean Sullivan, http://www.msn.com/en-us/news/politics/senate-gop-abandons-latest-effort-to-unwind-the-affordable-care-act/ar-AAstYYp?li=BBmkt5R&ocid=spartandhp
(B) GOP Kills Health-Care Bill, Ending Obamacare Repeal Quest, by Laura Litvan and Steven T. Dennis, https://www.bloomberg.com/news/articles/2017-09-26/senate-gop-drops-obamacare-repeal-effort-for-lack-of-support
(C) IT’S OVER: Republicans will not vote on Graham-Cassidy health care bill, by Bob Bryan, https://www.aol.com/article/news/2017/09/26/its-over-republicans-will-not-vote-on-graham-cassidy-health-care-bill/23223713/
(D) Senate won’t vote on GOP health care bill, by Lauren Fox, MJ Lee, Dana Bash and Deirdre Walsh, http://www.cnn.com/2017/09/26/politics/health-care-republican-senate-vote/index.html
(E) IT’S OVER: Republicans will not vote on Graham-Cassidy health care bill, by Bob Bryan, https://www.aol.com/article/news/2017/09/26/its-over-republicans-will-not-vote-on-graham-cassidy-health-care-bill/23223713/
(F) The GOP’s Latest Obamacare Repeal Bill Is Dead, , by Jonathan Cohn, http://www.huffingtonpost.com/entry/graham-cassidy-failure_us_59ca9a35e4b07e9ca11f3d1b
(G) Editorial Graham-Cassidy is dead. Now stop treating Obamacare like the enemy and help get Americans health coverage, http://www.latimes.com/opinion/editorials/la-ed-graham-cassidy-dead-20170926-story.html

“The latest Republican push to repeal key parts of the Affordable Care Act appears to have met the fate of all previous Senate repeal efforts this year — it doesn’t have the votes needed to pass the chamber.
Maine Sen. Susan Collins announced Monday that she will oppose the bill, authored by South Carolina Sen. Lindsey Graham and Louisiana Sen. Bill Cassidy. Collins’ decision means three Republicans have now publicly said they are against the bill — and that is one more than the GOP could afford to lose…
Cassidy was asked earlier Monday on CNN whether Collins’ opposition would mean it’s over for the bill and said, “Yes, it is.” It’s not clear yet whether Senate Majority Leader Mitch McConnell will still bring the bill to the floor for a vote now that its fate is clear.” (A)

“Collins delivered a scathing assessment of the bill in a statement, saying the fourth version that the senators had produced in an effort to win over her vote and others’ “is as deeply flawed as the previous iterations.”
“Health care is a deeply personal, complex issue that affects every single one of us and one-sixth of the American economy,” she said. “Sweeping reforms to our health care system and to Medicaid can’t be done well in a compressed time frame, especially when the actual bill is a moving target.” (B)

“The proposal the Senate is considering that would repeal and replace the Affordable Care Act will result in millions losing health insurance and a $133 billion reduction in the deficit by 2026, according to the Congressional Budget Office’s report on the Graham-Cassidy legislation.
The CBO did not have enough time to estimate specifically how many people’s insurance would be affected as they have done when they have scored previous repeal bills. But, the analysis it released Monday evening says, “the number of people with comprehensive health insurance that covers high-cost medical events would be reduced by millions” compared to current law.” (C)

“Cassidy said Graham and Santorum facilitated conversations with Sens. Lisa Murkowski (Alaska), Susan Collins (Maine) and John McCain (Ariz.), whose states would receive more federal health-care funding under his revamped bill compared to a previous version…
But he acknowledged that the new version would indeed provide more funding to those states compared to the first iteration of his bill, stressing that it would include $1 billion more in block grants for Maine. And he expressed hope that Collins would support the measure.
“If there’s a billion more going to Maine . . . that’s a heck of a lot,” Cassidy said. “It’s not for Susan, it’s for the Mainers. But she cares so passionately about those Mainers, I’m hoping those extra dollars going to her state . . . would make a difference to her.”” (D)

“An internal GOP analysis, circulated to Senate offices, shows spending boosts states like Alaska and Kentucky — data that will almost certainly be used to sell the revised proposal in the days ahead.
But notably, those increases in the projection incorporate savings from ending the state match of Medicaid expansion. So in total, there is still a reduction in health care spending in these states when compared to current law. (For example, Alaska would get a $100 billion cut via its block grant in the bill, but the GOP analysis shows it would receive a boost of three percent.) The analysis also doesn’t address the overhaul of the Medicaid program, from an open-ended entitlement program to a per person cap.” (E)

“Top Republicans had amended their measure overnight, adding billions of extra dollars for states and easing coverage requirements under President Barack Obama’s statute to win over wavering GOP senators. Paul, R-Ky., had opposed the earlier version of the bill, saying it spent too much money.
Asked Monday if Paul’s position had changed, spokesman Sergio Gor provided a document listing three demands. It said the “primary” one was a “significant” reduction in $1 trillion in spending under Obama’s 2010 overhaul. Paul also wants elimination of requirements that insurers cover specified medical services and other coverage mandates, and establishment of “association” health plans consumers could join to pay lower prices.
“That’s the only way he gets to a yes,” Gor said in an email.” (F)

“This is like legislating blind,” said University of North Carolina political scientist Jonathan Oberlander, who has written extensively on the history of major healthcare legislation. “It is really hard to find an example of something where Congress was this reckless.” (G)

(A) 3 GOP Senators Oppose Graham-Cassidy, Effectively Blocking Health Care Bill, by Scott Detrow, http://www.npr.org/2017/09/25/553429714/3-gop-senators-oppose-graham-cassidy-effectively-blocking-health-care-bill
(B) Collins, Paul list concerns about Cassidy-Graham bill, by Sean Sullivan and Juliet Eilperin, https://www.washingtonpost.com/powerpost/new-version-of-health-care-bill-will-help-alaska-and-maine–home-of-two-holdout-senators/2017/09/25/24697f62-a188-11e7-b14f-f41773cd5a14_story.html?utm_term=.a23e190bad99
(C) ‘Millions’ May Lose Coverage Under GOP Health Bill, Says CBO Analysis, by Alison Kodjak, http://www.npr.org/sections/health-shots/2017/09/25/553459455/-millions-may-lose-coverage-under-gop-health-bill-says-cbo-analysis
(D) Cassidy on new health-care plan: ‘It’s not for Susan, it’s for the Mainers’, by Paige Winfield Cunningham, https://www.washingtonpost.com/powerpost/cassidy-on-new-health-care-plan-its-not-for-susan-its-for-the-mainers/2017/09/25/3dc5d74e-a20f-11e7-b14f-f41773cd5a14_story.html?ut
(E) Republican health care bill revised to target key votes, by MJ Lee, Lauren Fox, Phil Mattingly and Tami Luhby, http://www.cnn.com/2017/09/24/politics/revised-graham-cassidy-bill/index.html
(F) New blow to GOP health bill: Paul opposes revised measure, by Alan Fram, http://abcnews.go.com/Health/wireStory/health-care-bill-teeters-gop-adds-money-woo-50070227
(G) Senate Republicans unsure what their healthcare bill would do, even as they push ahead on it, by Noam N. Levey, http://www.latimes.com/politics/la-na-pol-obamacare-senate-mystery-20170924-story.html

“In fact, the Obamacare legislation required coverage of pre-existing conditions. This legislation does not change that. So pre-existing conditions continue to be covered,” Short said on CBS News’ “Face the Nation.”
While he assured that the proposed legislation “guarantees” that pre-existing conditions will continue to be covered, experts say that people with health problems or with pre-existing medical conditions could be charged more if the state they live in obtains a waiver from current requirements that forbid insurers from charging higher premiums based on health status.” (A)

“One of the biggest issues in the repeal/replace debate has been coverage for pre-existing conditions, genetic risks and chronic illness. Before the Affordable Care Act, insurers could deny coverage to people with diseases like diabetes or charge them much higher premiums. The ACA requires insurers to cover pre-existing conditions without charging more. The GOP bills passed or proposed would give states the power to waive that requirement. People with disabilities or chronic diseases, people who have had cancer, and parents of children born with health problems like late-night host Jimmy Kimmel say that could make insurance unaffordable.” (B)

“The GOP’s latest attempt at an Obamacare repeal bill seemed to take more fatal blows Sunday, with Republican Sens. Susan Collins and Ted Cruz announcing they will likely not vote for the legislation.
Cruz’s call is especially surprising since he voted for earlier bills attempting to repeal and replace Obamacare, and even authored an amendment to help usher one of the failed bills through the Senate…
Cruz said the bill — which calls for Obamacare to be dismantled in favor of state-based plans — doesn’t match his desire to see a more competitive health care market…
Collins, from Maine, said her “no” vote is all but official… “It’s difficult for me to envision a scenario where I would end up voting for this bill,” she told CNN’s “State of the Union.”
“We already have a problem under the Affordable Care act with the cost of premiums and deductibles, and finally, I’m very concerned about the erosion of protections for people with pre-existing conditions.” (C)

“Sen. Lindsey Graham, R-S.C., directly addressed fellow Republican Sen. Rand Paul of Kentucky over his opposition to the latest GOP bill aiming to repeal and replace Obamacare, saying the new legislation would “save a lot of money.”
“Rand Paul objects to the taxes, but when you look at the bill, Rand, we save a lot of money over time for Medicaid,” Graham said in an interview with ABC News Chief Global Affairs Correspondent Martha Raddatz on “This Week” Sunday. “We’ve put a cap on Obamacare growth to make it more sustainable, more affordable, more flexible.”” (D)

“Short meanwhile on Sunday continued to claim that under Graham-Cassidy, people with pre-existing conditions would be “protected,” although in the current version of the bill, that is not as straightforward.
The requirements would be loosened compared to what is currently law under the Affordable Care Act.
Under Graham-Cassidy’s language, a state must show how it “intends to maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions” if it requests a waiver. However, it offers no additional guidance or details on how that would be binding, leaving major questions for coverage for people with pre-existing conditions. (E)”

(A) WH’s Marc Short claims Graham-Cassidy guarantees coverage for pre-existing conditions, https://www.cbsnews.com/news/whs-marc-short-claims-graham-cassidy-guarantees-coverage-for-pre-existing-conditions/
(B) Biggest Flash Points In The Graham-Cassidy Health Care Bill, by NANCY SHUTE, http://www.npr.org/sections/health-shots/2017/09/24/552891450/biggest-flash-points-in-the-graham-cassidy-health-care-bill
(C) Sens. Ted Cruz and Susan Collins announce opposition to Graham-Cassidy health care bill, by Jason Silverstein, http://www.nydailynews.com/news/politics/ted-cruz-susan-collins-announce-opposition-gop-health-bill-article-1.3517860
(D) GOP health care act sponsor to a Republican opponent: The bill will ‘save a lot of money’, by NICKI ZINK, http://abcnews.go.com/Politics/gop-health-care-act-sponsor-republican-opponent-bill/story?id=50047278
(E) White House ‘Planning’ on Health Care Vote This Week, by KAILANI KOENIG, https://www.nbcnews.com/politics/congress/white-house-planning-health-care-vote-week-n804271

The Byrd rule, however, restricts what can be considered under budget reconciliation. If a provision of a bill is considered an “extraneous matter” or something “merely incidental” to the federal budget, it can be stripped out of the legislation….
A previous iteration of the Senate GOP’s healthcare bill, the Better Care Reconciliation Act, already showed what may happen with the waivers in the new bill. During the Byrd bath, the waivers in the BCRA that allowed the loosening of EHBs and other regulations were deemed to have nothing to do with the budget and were ordered stripped from the bill.
Health-policy experts say this could indicate that the waivers in the Graham-Cassidy bill will also have to be stripped.” (A)

“The fundamental thing to understand about Senate Republicans’ latest attempt to repeal Obamacare is that the bill under consideration would not just undo the Affordable Care Act—it would also end Medicaid as we know it and our federal government’s half-century commitment to closing the country’s yawning gaps in health coverage. And it would do so without putting in place any credible resources or policies to replace the system it is overturning. If our country enacts this bill, it would be an act of mass suicide…
The Graham-Cassidy bill goes even further than the bill passed by the House. It would bring to a virtually immediate end not only the individual and employer mandates but also the whole edifice of the Medicaid expansion, insurance exchanges, and income-based coverage subsidies set up under the A.C.A. Graham-Cassidy expects all fifty states to then pass, and implement, alternative health systems for tens of millions of people within two years—with drastically less money, in most states, than the current law provides. This is not just impossible. It is delusional.” (B)

What every state stands to gain or lose under Graham-Cassidy, according to CMS.
Highlight and click on http://www.beckershospitalreview.com/hospital-management-administration/what-every-state-stands-to-gain-or-lose-under-graham-cassidy-according-to-cms.html

“The states with populations that would be hurt most by such a scheme aren’t California and New York, but cash-strapped, smaller, mostly-rural states or Rust Belt states that decided to expand Medicaid, often in order to meet extraordinary statewide health crises. These states are not liberal bastions Graham claims are favored by Obamacare; rather these states—Louisiana, Arkansas, Arizona, Kentucky, Ohio, Indiana, Maine, Iowa, Alaska, New Mexico, North Dakota, West Virginia, and Montana—are largely dominated by Republicans, and make up a large swathe of the party’s geographic base.” (C)

“One area where states would get more discretion under the bill involves their obligation to cover Americans with pre-existing conditions. States would be permitted to waive pre-existing condition protection as long as they still provide “adequate and affordable” coverage — but what qualifies as “affordable” is left undefined.
What will be the effects of these changes? Consumers will almost certainly see rising premiums and health care costs because subsidies are being replaced. There may be less coverage provided if states aren’t able to do more with less, as Cassidy and Graham are purporting. But no one really knows the extent of the cost or coverage changes. Supporters of the bill are intentionally vague about what the effects will be, saying that states know better how to allocate money, that they shouldn’t have Obamacare forced upon them, and, essentially, that we’ll see what happens when it happens…
Adequate and affordable” coverage for consumers with pre-existing conditions is a concept that’s so nebulous it’s useless…”(D)

“Since money is fungible and the block grants have few strings attached, states can in effect use the cash to fund projects that have nothing to do with health care. This is how: All states would need to do is identify existing state health care programs that qualify for block grant funding, thereby freeing up the state dollars currently devoted to those program to be used in whatever way the state wishes. If this were a state’s goal, the legislation makes it easy to achieve….” (E)

“Coalitions of health professionals that have spoken publicly against the measure so far include the American Medical Association (“Provisions violate longstanding AMA policy”), the American Psychiatric Association (“This bill harms our most vulnerable patients”), the American Public Health Association (“Graham-Cassidy would devastate the Medicaid program, increase out-of-pocket costs, and weaken or eliminate protections for people living with preexisting conditions”), the National Institute for Reproductive Health (“the Graham-Cassidy bill preys on underserved communities … a clear and present danger”), and Federation of American Hospitals (“It could disrupt access to health care for millions of the more than 70 million Americans”). (F)

“Americans by more than a 20-point margin prefer the existing federal health care law to the latest, imperiled Republican alternative — another challenge to the GOP’s long-held effort to repeal and replace Obamacare.
The public supports Obamacare over the proposed Graham-Cassidy bill by 56-33 percent in a new ABC News/Washington Post poll. Intensity of sentiment also is on the current law’s side: Forty-two percent strongly prefer it, nearly twice as many as strongly prefer the GOP plan.
The result is similar to public views on the previous GOP repeal-and-replace effort, which failed in July. Americans preferred Obamacare to that plan by 50-24 percent, again with a 20-point advantage for the current law in strong sentiment.” (G)

“For months now, proposals to repeal and replace the Affordable Care Act have risen and fallen in the House and the Senate, almost always uniting health care providers and patient advocacy groups in opposition but winning support among conservatives, including Republican policy makers. But the version drafted by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana — and hastily brought into the spotlight last week — went further.
It brought much of the health care world together to stop it, an effort that appears to have succeeded — not for ideological reasons, but for the simple reason that administrators, caregivers, advocates and insurers believed it could not work.” (H)

The president had embraced the legislation in recent days, making telephone calls to wavering senators and dispatching Vice President Mike Pence to Capitol Hill to try to build support for its passage. Mr. McCain’s announcement that he would not vote for it came just hours after the president had warned in a Friday post on Twitter that any Republican who opposed the measure “will forever (future political campaigns) be known as ‘the Republican who saved ObamaCare.’ ”
On Saturday, Mr. Trump appeared to be nurturing hopes that the legislative effort could be kept alive. He expressed hope that Mr. Paul would rethink his opposition to the Graham-Cassidy measure, without explaining why the Kentucky senator, who had complained that the bill left the Affordable Care Act’s essential structure intact, might do so.” (I)

(A) The healthcare bill could blow up in the GOP’s face because of an obscure Senate rule, by Bob Bryan, http://www.businessinsider.com/graham-cassidy-health-care-bill-byrd-rule-2017-9
(B) If the U.S. Adopts the G.O.P.’s Health-Care Bill, It Would Be an Act of Mass Suicide, by Atul Gawande, https://www.newyorker.com/news/news-desk/if-the-us-adopts-the-gops-health-care-bill-it-would-be-an-act-of-mass-suicide
(C) The Real Losers of the Graham-Cassidy Health-Care Bill, by VANN R. NEWKIRK II, https://www.theatlantic.com/politics/archive/2017/09/graham-cassidys-false-redistribution/540438/
(D) John McCain’s no vote won’t necessarily kill Graham-Cassidy health bill, by Jennifer Fitzgerald, https://www.cnbc.com/2017/09/22/graham-cassidy-repeal-bills-huge-unknowns-for-consumers-commentary.html
(E) What the CBO Might Have Said about Graham-Cassidy, by ROBERT VERBRUGGEN, http://www.nationalreview.com/corner/451642/what-cbo-might-have-said-about-graham-cassidy
(F) Doctors: No. Physicians rarely agree on anything as strongly as they do that the Graham-Cassidy health-care bill is harmful, by JAMES HAMBLIN, https://www.theatlantic.com/health/archive/2017/09/do-no-harm/540333/
(G) Public prefers Obamacare to Graham-Cassidy, 56-33% (POLL), by GARY LANGER, http://abcnews.go.com/Politics/public-prefers-obamacare-graham-cassidy-56-33-poll/story?id=50031499
(H) Why the Latest Health Bill Is Teetering: It Might Not Work, by SHERYL GAY STOLBERG, and ROBERT PEAR, https://mobile.nytimes.com/2017/09/23/us/obamacare-repeal-graham-cassidy-mccain-trump.html
(I) Trump Laces Into McCain Over His Opposition to Health Care Bill, by JULIE HIRSCHFELD DAVIS, https://www.nytimes.com/2017/09/23/us/politics/trump-mccain-graham-cassidy-health-care-obamacare.html?mcubz=0

“As I have repeatedly stressed, health care reform legislation ought to be the product of regular order in the Senate. Committees of jurisdiction should mark up legislation with input from all committee members, and send their bill to the floor for debate and amendment. That is the only way we might achieve bipartisan consensus on lasting reform, without which a policy that affects one-fifth of our economy and every single American family will be subject to reversal with every change of administration and congressional majority.
“I would consider supporting legislation similar to that offered by my friends Senators Graham and Cassidy were it the product of extensive hearings, debate and amendment. But that has not been the case. Instead, the specter of September 30th budget reconciliation deadline has hung over this entire process….” (A)

The latest Republican effort to dismantle the Affordable Care Act stood on the brink of failure Friday after Sen. John McCain (R-Ariz.) announced his opposition to the proposal and Sen. Susan Collins (R-Maine) said she was leaning against it.
The intensifying resistance dealt a potentially decisive blow to the renewed attempt to fulfill a seven-year-old GOP promise. McCain joined Sen. Rand Paul (R-Ky.) in formally opposing the plan, leaving party leaders one senator away from defeat.
Friday’s developments forced Senate Majority Leader Mitch McConnell (R-Ky.) and President Trump into a difficult corner. They must now decide whether to continue to pursue a vote that increasingly appears likely to fail, or short-circuit the endeavor and deal with the backlash after another unsuccessful try. (B)

“..Here’s a giveway about how bad the new Senate health care bill is: Bill Cassidy, one of its authors, keeps trying to sell it by telling untruths. “The relatively new phenomenon of just ‘up is down’ lying about your bill’s impacts is jarring,” says Loren Adler of the USC-Brookings-Schaeffer Initiative on Health Policy.
Most egregiously, Cassidy is claiming that the bill would not ultimately deprive sick people of health insurance. That’s false, as NPR calmly explained when Cassidy said otherwise. In fact, the bill — known as Graham-Cassidy — would free states to remove insurance protections for people with pre-existing conditions. Without those protections, insurers could price such people out of the market.
“If you get cancer (or even have a family history of it) or your child is born with a birth defect — among many, many other health issues — you could find yourself unable to buy insurance. Without insurance, you could be denied crucial treatments. In a tangible way, Graham-Cassidy would harm millions of Americans.” (C)

Bernard Tyson, chairman and CEO of the sprawling Kaiser Permanente nonprofit health system: “At Kaiser Permanente, we believe that changes to our nation’s health care laws should increase access to high-quality, affordable care and coverage for as many people as possible. The Graham-Cassidy bill does not meet any of those tests,” .. “The block grant proposal in the bill would erode coverage of needed medical services and pose major issues for state budgets. Repealing the individual mandate without alternative incentives for enrollment will lead to fewer people enrolled and higher premiums,” he said. Doctor and hospital groups like the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC) have similarly denounced the legislation.” (D)

“The current language in Cassidy-Graham — which the Senate may vote on next week — complies with conservatives’ litmus test. But activists acknowledge the Senate parliamentarian will probably strip the Hyde language from the measure altogether, meaning that federally subsidized plans could keep covering abortions.
In the last go-round, that’s exactly what conservatives were worried about, too: that the Hyde amendment would be eliminated from the (now defeated) Better Care Reconciliation Act pushed by Senate Republicans under special rules governing the budget process. (That’s the vehicle Republicans are using to try to overturn much of the ACA because it doesn’t require Democratic votes.) Democrats believed that the parliamentarian agreed with them in that the Hyde language had to go, though Republicans said that guidance wasn’t final.” (E)

“…because it was bipartisan, non-extreme and did not afford the Republican Senate a win for the sake of winning and the chance to get back in the good graces of the manifestly unfit and unstable president, Senate Majority Leader Mitch McConnell (R-Ky.) stepped in to nix it.
That is what, according to multiple sources, happened yesterday as Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) cleared the decks on substantive issues. But then Alexander got yanked back. He hinted at the pressure he was under when he told the press he was “not a magician.” Too embarrassed to acknowledge he’d been stomped on by McConnell, he put out a patently disingenuous statement. “Senator Murray and I had hoped to agree early this week on a limited, bipartisan plan to stabilize 2018 premiums in the individual health insurance market that we could take to Senate leaders by the end of the month,” he said. “During the last month, we have worked hard and in good faith, but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted.” In fact the only problem was his majority leadership, desperately straining to please the president with a partisan, fly-by-night repeal of Obamacare.” (F)

4 charts that explain what Graham-Cassidy will do, By Chris Cillizza and Sam Petulla, highlight and click on http://www.cnn.com/2017/09/22/politics/cassidy-graham-charts/index.html

‘…Since the bill doesn’t define what “access to adequate and affordable coverage” means, critics say that it is effectively sanctioning a return to the days before the A.C.A., when sick people in many parts of the country found it extremely difficult and costly to get health coverage.
Usually, in these types of disputes, the nonpartisan analysts at the Congressional Budget Office act as the arbiters. When “scoring” a health-care bill such as Graham-Cassidy, they go through each of its major proposals and provide numerical estimates of its likely effects. In this instance, though, the Republicans are exploiting the fact that the C.B.O. hasn’t had time to do a detailed analysis of their bill—it is expected to produce just a truncated report before next week’s vote.” (G)

“If the latest Republican bill to repeal Obamacare passes, 21 million fewer people will have insurance by 2026, according to a new analysis Friday…
The authors of the Brookings study cautioned that the effects of the bill were difficult to predict given the many paths individual states could take, but they looked a variety of scenarios based on how much block grant funding states devoted to coverage and on how many states maintained Obamacare’s protections for patients with pre-existing conditions, which states could weaken under the bill.
At the same time, the report said that its conclusion “likely understates the reductions in insurance coverage,” because it doesn’t consider potential turmoil if states can’t enact a functional health care system by 2020, when they would transition from Obamacare to the new block grants. Experts have also warned that the bill could cause premium spikes and instability as insurers struggle to manage the shift from Obamacare’s exchanges, which are already in fragile shape. Some areas could be left without any insurers on the individual market.” (H)

“Sen. Rand Paul (R-KY) has consistently said he opposes the plan, arguing that it keeps too much of Obamacare for his support. Sen. Susan Collins (R-ME) has not taken a definitive position, but she has raised concerns about how the bill affects people with preexisting conditions and its Medicaid cuts. She is widely considered a “no” vote.
There are a few others, most notably Sen. Lisa Murkowski (R-AK), who haven’t yet said whether they support or oppose the bill, but whose support is thought to be in doubt.
McCain’s opposition comes with the clock ticking down for Senate Republicans to repeal Obamacare. The special privileges they are using to pass a bill with only 51 votes and avoid a Democratic filibuster expire on September 30. After that, they would need to start the process over by passing a budget resolution.
Senate leaders had said that they intended to bring Graham-Cassidy up for a vote next week, though it’s not clear if they would still hold the vote knowing that the bill would fail.” (I)

(A) Sen. John McCain says he cannot support Graham-Cassidy Obamacare repeal bill, by Christina Wilkie, https://www.cnbc.com/2017/09/22/senator-john-mccain-says-he-cannot-support-graham-cassidy-obamacare-repeal-bill.html
(B) Latest GOP effort to dismantle Obamacare on the brink of failure after defections, byy Sean Sullivan, Juliet Eilperin and Kelsey Snell, https://www.washingtonpost.com/powerpost/mccain-says-he-will-vote-no-for-gop-health-care-bill-dealing-major-blow-to-repeal-effort/2017/09/22/077ba8a4-9fc0-11e7-9c8d-cf053ff30921_story.html?deferJs=true&outputType=default-article&utm_term=.6e18092ebe3d
(C) Senator Cassidy, Please Stop Lying about Health Care, by David Leonhardt, https://www.nytimes.com/2017/09/21/opinion/cassidy-graham-health-care.html?_r=0
(D) One of America’s Most Influential Health Care CEOs Just Trashed the Graham Cassidy Obamacare Bill, by Sy Mukherjee, http://fortune.com/2017/09/20/graham-cassidy-obamacare-kaiser-permanente-ceo/
(E) The Health 202: Cassidy-Graham’s abortion ban workaround, by Paige Winfield Cunningham, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/09/22/the-health-202-cassidy-graham-s-abortion-ban-workaround/59c4196030fb0468cea81a6b/?utm_term=.665c3649c4d0
(F) The McConnell mentality keeps the Senate and Congress dysfunctional, by Jennifer Rubin, https://www.washingtonpost.com/blogs/right-turn/wp/2017/09/20/mcconnell-mentality-keeps-the-senate-and-congress-dysfunctional/?utm_term=.b1808d926aa3
(G) The Graham-Cassidy Health-Care Bill Is a Clear Danger to People with Preëxisting Conditions, by John Cassidy, https://www.newyorker.com/news/john-cassidy/the-graham-cassidy-health-care-bill-is-a-clear-danger-to-people-with-preexisting-conditions
(H) Study: 21 Million More Uninsured Under Graham-Cassidy Health Care Bill, by Benjy Sarlin, https://www.nbcnews.com/politics/congress/study-21-million-more-uninsured-under-graham-cassidy-health-care-n803801
(I) John McCain opposes Graham-Cassidy, in possible death blow to Obamacare repeal, by Dylan, Scott, https://www.vox.com/policy-and-politics/2017/9/22/16351494/john-mccain-graham-cassidy-obamacare-repeal

As HuffPost’s Jonathan Cohn explains, the bill, sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), leaves most decisions on health insurance to states, as it converts federal money to state grants. States could dismantle key provisions of the Affordable Care Act, such as the requirement that people with preexisting conditions are not denied coverage. Without that requirement, insurers could charge higher insurance premiums based on patients’ medical status.” (A)

“In releasing a revised version of their legislation to repeal and replace the Affordable Care Act (ACA), Senators Bill Cassidy and Lindsey Graham, along with co-sponsors Dean Heller and Ron Johnson, claimed that their bill isn’t a “partisan” approach and doesn’t include “draconian cuts.” In reality, however, the Cassidy-Graham bill would have the same harmful consequences as those prior bills. IT WOULD CAUSE MANY MILLIONS OF PEOPLE TO LOSE COVERAGE, RADICALLY RESTRUCTURE AND DEEPLY CUT MEDICAID, AND INCREASE OUT-OF-POCKET COSTS FOR INDIVIDUAL MARKET CONSUMERS. It would cause many millions of people to lose coverage, radically restructure and deeply cut Medicaid, eliminate or weaken protections for people with pre-existing conditions, and increase out-of-pocket costs for individual market consumers.” (B)

“One GOP senator on Thursday, however, seemed to suggest that the new bill could leave sick Americans worse off. Sen. Jeff Flake of Arizona, a Republican supporter of the Graham-Cassidy bill, said on MSNBC’s “Morning Joe” Thursday that the new plan could allow states to undermine protections for people with preexisting condition. He argued, however, that that wouldn’t end up happening.
“There are provisions in there, I’ve heard it said, that would allow a race to the bottom and states to deny coverage or allow insurance companies to deny coverage [based] on preexisting conditions,” Flake said. “If they’re able to, de jure, de facto, they won’t be able to.”” (C)

“Senators Lindsey Graham and Bill Cassidy, the sponsors of the Graham-Cassidy repeal bill, claim that their bill is different—that it simply shifts health care decisions to the states. This is false. Just like the failed repeal bills that came before it, Graham-Cassidy would result in millions of Americans losing health coverage. And in crucial respects, it’s the most harmful version of repeal yet….
Although Graham and Cassidy claim that this will increase flexibility for states, in reality it will do the opposite. Slashing federal funding will force states to cut eligibility or benefits based on budgetary limits.” (D)

“Graham-Cassidy doesn’t let states waive the part of the Affordable Care Act that says insurers have to cover sick people. But it does allow states to opt out of several other ACA rules that can cause people with pre-existing conditions to pay more for their health care. Those provisions include:
The ban on charging sick people higher premiums than healthy people. The requirement that insurers cover “essential health benefits,” including prescription drugs. People who need expensive drugs might not have access to a plan that covers those drugs, requiring them to pay out of pocket. Services that aren’t “essential” benefits aren’t subject to the ACA’s ban on annual and lifetime limits.
The bill also would also loosen rules about how much insurers can raise their premiums because of a customer’s age. (Older people are more likely to have pre-existing conditions.” (E)

“On Tuesday I wrote that the chances for Senate Republicans’ last stab at Obamacare repeal, Graham-Cassdidy, “may well hang on what offer Republican leaders are willing to make on Alaska’s behalf in the next week” in order to secure Sen. Lisa Murkowski’s pivotal vote. A couple of reports Thursday afternoon show us how that offer may be shaping up. To put it as generously as possible, it’s not subtle…
Independent Journal Review, citing a “Republican Senate aide,” reports what would be the most incredible package of carve-outs known to mankind. It would allow Alaska—and Hawaii, tossed in as a poor effort for political and legal cover—to keep Obamacare in the Obamacare repeal bill. And then some.” (F)

“The bill would allow states to opt to waive Obamacare rules requiring basic health benefits, essentially cutting protections for sick people in an effort to keep premiums from rising. The waivers allow states to charge more for health insurance offered to people with pre-existing conditions—including cancer, heart disease, Alzheimer’s (or dementia), cerebral palsy and even pregnancy, among other medical factors that could have resulted in denied coverage prior to Obamacare—while continuing to receive federal block grant funding.
Experts say the bill could raise health care costs for those with pre-existing conditions to a point where insurance would be virtually unaffordable for millions of people.” (G)

“When Iowa reporters asked Sen. Chuck Grassley on Wednesday about the attempt to repeal and replace Obamacare, his answer was remarkable and revealing.
“You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” the Iowa Republican said. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.” (H)

“The bill is structured as a sort of slow-motion repeal of the health law’s main coverage programs. Though the bill establishes the new state block grant program for a decade, all of the program’s money expires after 2026. That makes it different from the Obamacare overhaul bill passed by the House and a previous bill considered by the Senate, which would have made modifications and cuts to those programs, but preserved them in perpetuity. The expiration of the health law’s programs alone would probably mean that about 23 million fewer Americans would have health coverage, if compared with current law, according to an estimate the Congressional Budget Office made in regard to a previous repeal bill.” (I)

(A) Trump Is Misrepresenting What’s In The Health Care Bill He Wants To Pass, by Marina Fang, http://www.huffingtonpost.com/entry/trump-graham-cassidy-health-care-bill_us_59c3a74ee4b0c90504fbdcd7
(B) Like Other ACA Repeal Bills, Cassidy-Graham Plan Would Add Millions to Uninsured, Destabilize Individual Market, by JACOB LEIBENLUFT EDWIN PARK MATT BROADDUS AVIVA ARON-DINE, https://www.cbpp.org/research/health/like-other-aca-repeal-bills-cassidy-graham-plan-would-add-millions-to-uninsured
(C) GOP senator admits new healthcare bill could harm people with preexisting conditions, but says it won’t happen, by Bob Bryan, https://finance.yahoo.com/news/gop-senator-admits-healthcare-bill-160014682.html
(D) Graham-Cassidy Is the Worst Obamacare Repeal Bill Yet, by Thomas Huelskoetter, http://fortune.com/2017/09/20/graham-cassidy-health-care-bill-obamacare-repeal/
(E) What Graham-Cassidy means for pre-existing conditions, by Caitlin Owens, https://www.axios.com/what-graham-cassidy-really-means-for-pre-existing-conditions-2487720743.html
(F) Report: GOP Is Trying to Buy Murkowski’s Obamacare Repeal Vote by Letting Alaska Keep Obamacare, by Jim Newell, http://www.slate.com/blogs/the_slatest/2017/09/21/murkowski_buyoff_watch_senate_gop_may_just_let_alaska_keep_obamacare.html
(G) TRUMP FALSELY CLAIMS AMERICANS WITH PRE-EXISTING CONDITIONS ARE GUARANTEED COVERAGE UNDER NEW HEALTH BILL, by CHRIS RIOTTA, http://www.newsweek.com/donald-trump-pre-existing-conditions-health-care-graham-cassidy-false-669001
(H) How one Chuck Grassley quote sums up the entire GOP repeal and replace effort, by Chris Cillizza, http://www.cnn.com/2017/09/21/politics/grassley-trump-health-care/index.html
(I) How the Latest Obamacare Repeal Plan Would Work, by REED ABELSON and MARGOT SANGER-KATZ, https://www.nytimes.com/2017/09/20/upshot/obamacare-repeal-bill-offers-both-enormous-flexibility-and-uncertainty.html

“Eleven governors, including five Republicans and a pivotal Alaskan independent, urged the Senate on Tuesday to reject a last-ditch push to dismantle the Affordable Care Act.
But Republican leaders pressed toward a showdown vote. And they choked off separate bipartisan efforts to shore up health insurance markets under the Affordable Care Act, hoping to give Republican senators no alternative but to vote for repeal.
The latest repeal bill, drafted by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, would undo much of the Affordable Care Act and send tens of billions of federal dollars to the states with vast discretion over how to spend the money.” (A)

“On Tuesday evening, Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, said that he was ending bipartisan negotiations for a bill to stabilize health insurance markets and make a few changes to the Affordable Care Act, because after four hearings and involved negotiations, his group had “not found the necessary consensus among Republicans and Democrats.” The unexpected decision appears aimed at shoring up support for the Senate GOP’s last-ditch plan to repeal ObamaCare, sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), by removing any alternative legislation….Alexander said that especially since Graham-Cassidy gained steam, appetite within his party for his bill was very low. “I know how to get bipartisan results, but I’m not a magician,” he said. (B)

“.. Like a bad sequel to a terrible movie, a proposal whose main architects are Bill Cassidy of Louisiana and Lindsey Graham of South Carolina would in many ways be worse than bills that came before it..
It is hard to overstate the cruelty of the Graham-Cassidy bill. It would eliminate the mandate that even healthy people buy health insurance, end the subsidies that help people purchase coverage and stop the expansion of Medicaid. It would offer states block grants they could use to help people get insurance but would leave people at the mercy of individual state legislatures and, over all, would provide $239 billion less than what the federal government would spend under current law between 2020 and 2026, according to the Center on Budget and Policy Priorities. (C)

“…With a deadline of Sept. 30 looming for use of the reconciliation rules to pass a bill, the Congressional Budget Office announced that it would rush analysis of the current overhaul bill, called Graham-Cassidy after its two primary sponsors, by the beginning of next week. That analysis would include an assessment of whether the bill would increase deficits over the long term, which is necessary for reconciliation. But it wouldn’t go much further.
“CBO will provide as much qualitative information as possible about the effects of the legislation,” its announcement read, “however CBO will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks.” (D)

“Gov. Chris Christie said on Wednesday that he opposes the latest Senate plan to repeal and replace Obamacare, deeming it “too injurious” to New Jersey. “I oppose Graham-Cassidy because it is too injurious to the people of New Jersey,” …I’m certainly not going to support a bill that takes nearly $4 billion from people in the state.” New Jersey could lose around $3.9 billion in federal Medicaid funds by 2026, according to an estimate from the Center for Budget and Policy Priorities.
Christie, an early and ardent supporter of President Donald Trump, stressed that he remains “philosophically” opposed to Obamacare but “took advantage” of Medicaid expansion for the benefit of his state residents….The Republican governor said he agreed with the “concept of block grants” but felt that Graham and Cassidy were “tying themselves into knots trying to help the states that didn’t expand.”” (E)

Health insurers will receive this month’s payments from the Trump administration reimbursing them for reducing copayments and deductibles for millions of low-income customers, the White House said Tuesday, once more shelving a standoff with insurers over the contested funds. (F)

“Graham said Tuesday he has made an alliance with “Darth Vader” — referring to former Trump advisor Steven K. Bannon — for support to see the bill to passage. Bannon, who was portrayed as the villain on NBC’s “Saturday Night Live,” is back to running the website Breitbart, which is influential among conservatives, after being pushed out of the White House.
“I have got Alan Greenspan, Jeb Bush and Steve Bannon” behind this bill, Graham said. “If anyone can do better, I’d like to meet them.”” (G)

(A) Republican Leaders Defy Bipartisan Opposition to Health Law Repeal, by ROBERT PEAR and THOMAS KAPLAN, https://www.nytimes.com/2017/09/19/us/politics/obamacare-act-fix-collapses-repeal-trump.html?_r=0
(B) Senate Republicans pull out of bipartisan health-care talks as Graham-Cassidy picks up steam, http://theweek.com/speedreads/725690/senate-republicans-pull-bipartisan-healthcare-talks-grahamcassidy-picks-steam
(C) The Republican Health Care Zombie Is Back, https://www.nytimes.com/2017/09/19/opinion/editorials/republican-healthcare-graham-cassidy.html
(D) Reminder: It’s very unusual to vote on a health-care bill before Congress knows what it will do, by Philip Bump, https://www.washingtonpost.com/news/politics/wp/2017/09/19/reminder-its-very-unusual-to-vote-on-a-health-care-bill-before-congress-knows-what-it-will-do/?utm_term=.7f33e17cf9b4
(E) Christie says he opposes Graham-Cassidy bill, by KATIE JENNINGS, http://www.politico.com/states/new-jersey/story/2017/09/20/christie-says-he-opposes-graham-cassidy-obamacare-replacement-bill-114611
(F) Trump Administration Makes ACA’s Health-Insurer Payments for September, by Louise Radnofsky, https://www.wsj.com/articles/trump-administration-makes-acas-health-insurer-payments-for-september-1505855468
(G) Trump is all in for GOP healthcare bill; sponsor Graham allies with ‘Darth Vader’ (a.k.a. Steve Bannon) for support, by Lisa Mascaro, http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-all-in-for-gop-healthcare-bill-1505841753-htmlstory.html