Here’s why the new GOP Obamacare-replacement bill might actually pass in Congress

  • The Graham-Cassidy Obamacare replacement bill improves greatly on the GOP bills introduced this summer.
  • Its best details include eliminating crony capitalist subsidies to big health insurers.
  • This bill might actually pass in Congress.
  • But the bill's fate still seems to hang on the personalities of a handful of senators, especially John McCain.

There's just one thing to say about the new GOP Obamacare-replacement bill introduced by Senators Lindsay Graham and Bill Cassidy: That's more like it!

Finally, we have a bill that isn't beholden to protecting the health-insurance companies, allows the states to focus resources where they're really needed, and allow for more choices.
And this one might actually pass.

Gee, it's amazing how much good the Senate can do once Mitch McConnell is forced to step a little bit away from the process.

The first and most obvious sign of McConnell's reduced input in the Graham-Cassidy bill is the fact that it eliminates the counterproductive and corrupt direct subsidies to private health insurers supposedly meant to keep premium costs down. (Premium costs of course went up under Obamacare anyway.) But when McConnell was taking the lead crafting his Obamacare-replacement bill earlier this year, he reportedly did most of the work in close consultation with those same insurance companies and their lobbyists and hardly consulted his fellow Republicans in the Senate. That was not only ethically questionable, it played a major role in dooming that bill to failure from the start. McConnell is still backing this new effort, but his influence over its details is much, much lighter.

If Graham-Cassidy becomes law, those direct federal subsidies to the insurers will go away and it will be up to the individual states if they want to use some portion of federal block grants to pay health insurance companies some of what they're demanding to stay in their own health insurance business. In short, this would be a satisfying start to pulling the plug on an egregious example of crony capitalism.

But it gets better. Graham-Cassidy also challenges the big insurance lobbying powers by allowing states to eliminate the costly "essential benefit" requirements that made it much harder for smaller insurers to compete under Obamacare. Younger and healthier Americans who have been perfect customers for lower cost "major medical" plans haven't been able to buy them since the ACA went into effect. And not enough of them signed up for approved Obamacare plans to keep many local exchanges afloat.

"McCain could be the deciding vote again, and those who believe his previous vote against the Obamacare repeal bill was really about his personal distaste for President Donald Trump are watching closely."

The block grants will also allow the states to set up their own risk pools to cover that very small percentage of the U.S. population that account for so much of the nation's health care costs. Remember, the sickest 5 percent of Americans are responsible for more than 50 percent of our annual health-care spending, according to the Agency for Healthcare Research and Quality. The ACA tried to put those most costly patients into the general risk pool and hoped that requiring everyone to sign up for Obamacare plans would defray that cost. It didn't. Risk pools aren't perfect, since nothing short of major medical breakthroughs can put a dent in the costs patients with chronic and serious diseases face. But they do put a much better lid on costs than the Obamacare method that spread those expenses to everyone more directly.

Another welcome part of Graham-Cassidy is its move to end the ill-advised Obamacare Medicaid expansion. The Medicaid expansion made the ACA much more of a new entitlement program and less of a new insurance law. And this expansion has simply not been justified based on economics. Sure, we're not back to the robust GDP levels of the late 1990s. But thanks to the expansion, a whopping 74.5 million Americans are currently on Medicaid according to the latest government reports. That is almost double the 39 million Americans who were on Medicaid just as recently as 2007. Is America twice as poor as it was 10 years ago? Of course not.

And lest you think that expanding Medicaid is the right thing to do despite the macroeconomic numbers, remember that this policy has crowded out the truly poor who already were having some growing difficulties in many parts of the country finding doctors and other health care facilities that accept Medicaid patients. If this new bill allows the states to focus more on the truly poor, it might be worth passing it for that part alone.
Now for the trillion-dollar question: Will this new bill pass?

Remember that the GOP can only afford two defections to set up Vice President Mike Pence to cast a tie-breaking 51-50 vote. Right now, Republican Senator Rand Paul is one of those defectors because he says it keeps too much of Obamacare in place. Maine Senator Susan Collins has not committed one way or another, but her track record of bucking GOP trends and her state's reliance on keeping the Medicaid expansion for as long as possible make her a likely vote against it, too.

That leaves us with Senator John McCain of Arizona, whose vote against the GOP Obamacare effort this summer killed that bill. McCain could be the deciding vote again, and those who believe his previous vote against the Obamacare repeal bill was really about his personal distaste for President Donald Trump are watching closely. That's because Senator Graham and McCain are close friends and even often appear as a tandem in interviews on cable news programs. McCain also said he might "reluctantly" vote for the bill if his state governor endorses it. Arizona Governor Doug Ducey did just that Monday, but McCain is still non-committal. Trying to guess McCain's next move is confounding a lot of the experts again.

That's too bad, because the Graham-Cassidy bill is a significant improvement over what the GOP was kicking around just a couple of months ago. And it's a rare example of a group of politicians actually learning quickly from their mistakes. This isn't just a GOP bill worth Republican votes, it's a measure worth trying for the entire country.

Commentary by Jake Novak, senior columnist. Follow him on Twitter @jakejakeny.

For more insight from CNBC contributors, follow @CNBCopinion on Twitter.

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