Topeka The U.S. Senate is preparing for a vote this coming week on yet another bill to repeal and replace the Affordable Care Act, also known as Obamacare, and once again, Republican Kansas Sen. Jerry Moran is finding himself the target of intense political pressure on both sides.
Unlike his colleague, Sen. Pat Roberts of Kansas, who has supported every measure so far to overhaul the federal health care law, Moran has been less predictable. He surprised many by coming out against the first repeal-and-replace bill in July, but he supported a second version of the bill later that month, even though it eventually failed anyway.
"We know thousands of Kansans are reaching out to him to express their opposition to the bill," David Jordan, leader of the Alliance for a Healthy Kansas, said during a telephone interview.
Meanwhile, Kelly Arnold, chairman of the Kansas Republican Party, said the party, along with other independent groups, have been using social media urging Republican voters to contact Moran and encourage him to vote yes on the bill.
As he did in the previous two debates, however, Moran so far has remained on the fence, not saying how he intends to vote.
“Sen. Moran continues to have conversations with Kansans and his colleagues regarding Graham-Cassidy and reconciliation,” a spokeswoman in his office said in an email, referring to the bill named after its chief sponsors in the Senate, Republicans Lindsey Graham of South Carolina and Bill Cassidy of Louisiana.
By many accounts, the Graham-Cassidy bill would go even further than the two earlier bills in repealing major portions of Obamacare and overhauling the Medicaid system.
Among other things, it would eliminate Medicaid expansion that was allowed under Obamacare along with the tax credits and cost sharing subsidies that enabled moderate-income individuals to buy private insurance in the online exchange markets.
In place of those programs, states would receive block grants from the federal government which they could use to set up their own programs for the years 2020-2027. Those block grants, however, would be substantially less than what the federal government is paying currently, and the block grants would be completely eliminated starting in 2027.
It would also eliminate both the individual mandate to carry insurance and the mandate that large employers provide affordable health coverage to their full-time employees as part of their benefits packages.
The effect of that would be a major blow to states that took advantage of Medicaid expansion. States like Kansas, which did not expand Medicaid, would take a smaller hit.
According to an analysis by the Kaiser Family Foundation, for states like Kansas that did not expand their Medicaid programs, the block grants would bring a slight increase in Medicaid funding through 2027, but the state would also be responsible for using that money to create some other kind of coverage plan.
A different analysis by Avalere Health says Kansas would lose about $2 billion in Medicaid funding through 2026. That number would then mushroom to $11 billion over the following 10 years after the block grant is eliminated.
The Kansas Hospital Association is among the major health care groups in Kansas urging the state's senators to vote against the bill.
Among that group's main concerns, KHA spokeswoman Cindy Samuelson said in an email, are that it would result in a loss of coverage for many Kansans and erode key protections under current law for patients and consumers by allowing states to eliminate "some or all of the essential health benefits and allow insurers to charge individuals with pre-existing conditions any amount in premiums, effectively pricing many individuals out of coverage."
"We will continue to urge our senators to address the challenges facing our health care system, protect health coverage and oppose the Graham-Cassidy-Heller-Johnson bill," Samuelson said.
Republicans are in a rush to pass a bill before the end of the federal fiscal year on Saturday, Sept. 30, because after that, they can no longer use the budget reconciliation process to overhaul Obamacare, a process that only requires a simple majority to pass. Instead, they would have to use the regular legislative process, which, in the Senate, requires a three-fifths majority, or 60 votes, to advance a bill to the floor for a final vote.
Moran's vote could be key. Republicans hold only 52 seats in the Senate, plus Vice President Mike Pence's tie-breaking vote, if necessary. As of Friday, Republican Sens. Rand Paul of Kentucky and John McCain of Arizona had announced they definitely would oppose the bill, and Sen. Susan Collins of Maine was "leaning" against it.
In an interview with the website Vox.com last week, Roberts said there would be political consequences for Republicans in 2018 if they don't pass a bill, and he called the Graham-Cassidy bill, "the last stage out of Dodge City."
"I’m from Dodge City. So it’s the last stage out to do anything," Roberts, who was actually born in Topeka and grew up in Holton, was quoted as saying. "Restoring decision-making back to the states is always a good idea, but this is not the best possible bill — this is the best bill possible under the circumstances."