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Here we go again.
A new plan to repeal and replace major parts of Obamacare is set to be unveiled by two Republican senators, who face a looming deadline and a less-enthused President Donald Trump as they try to get that plan passed into law.
Among other things, the bill would allocate federal dollars to individual states to craft their own health-care systems as they see fit, instead of being compelled to follow Obamacare rules and regulations for health plans.
The Graham-Cassidy bill also would try to resolve a major sticking point about Medicaid funding that had led some GOP senators to oppose earlier repeal bills, dooming them to failure this summer.
Graham and Cassidy do not have a lot of time to win approval of their bill.
Senate Republicans have been trying to use a procedural mechanism known as budget reconciliation to pass a repeal-and-replace bill for the Affordable Care Act.
That method would allow the bill to be passed by just 51 votes, as opposed to the 60 votes that would normally be required, and which in any case would be impossible to achieve in the face of universal Democratic opposition to repeal.
However, on Sept. 1, the Senate Parliamentarian ruled that the budget reconciliation resolution that Republicans were using to win passage of an Obamacare repeal will expire Sept. 30.
Despite holding a 52-seat majority in the Senate — and a potentially tie-breaking vote from Vice President Mike Pence — the GOP caucus to date has failed to cobble together enough votes to pass a repeal bill.
NBC News noted that the Graham-Cassidy package would seek to achieve parity in federal funding among states that expanded their Medicaid programs under Obamacare, and those that did not.
While that may please several senators from expansion states who opposed earlier bills because they would cut funds granted such states, there is no guarantee they would then be enticed into voting for the Graham-Cassidy bill.
And the bill, because of its component parts, is likely to receive the same kind of analysis from the Congressional Budget Office that prior repeal bills did. Those bills were projected to lead to 22 million more uninsured Americans by 2026. As a result, the bills were broadly unpopular with the public and many interest groups.
Trump, who had loudly advocated for Obamacare repeal, several days ago appeared to suggest on Twitter that the repeal effort was dead, and that Republicans in Congress should not imperil his proposal for tax reform by spending any more time on repeal.
The new bill would repeal, retroactively to 2016, the financial penalty on individuals for failing to have some kind of health insurance coverage, and also repeals retroactively to that same year the penalty on large employers for failing to offer affordable health coverage to workers.
It also would allow states to repeal Obamacare rules that, among other things, currently bar insurers from charging people with pre-existing health conditions higher premiums than the rates charged healthy people.