Sens. Billy Cassidy (R-LA) and Lindsey Graham (R-SC) hope to pass their Obamacare “repeal and replace” bill by the end of the month, but have encountered opposition from a few in their own party. Sens. John McCain (AZ) and Rand Paul (KY) have already said no while Sens. Susan Collins (ME) and Lisa Murkowski (AK) remain on the fence. Even Sen. Ted Cruz (R-TX) has said “that he’s not yet on board with the legislation.”

This has led to a few changes to the bill, which includes boosts for Arizona, Alaska, Kentucky, and Maine as a way to entice these senators to vote yes.

The Republicans only hold a majority in the Senate by two seats, which means it can only afford two defections. Paul and McCain have flat out said no. That left the Republicans with a 50-50 vote, but then Cruz also said that as of right now “they don’t have my vote.” He also doesn’t “think they have [Utah Republican Senator] Mike Lee’s either.”

Still, without clear from support from Murkowski and Collins, they made changes. From Axios:

What’s different: According to Graham and Cassidy’s analysis, the revised bill would direct more money to Alaska, Arizona, Kentucky and Maine, compared with earlier versions. But it would still reduce overall federal funding to those states — whose Republican senators are, for now, opposed to the bill or undecided.

  • Although the state-by-state numbers being circulated show these states faring well, the Kaiser Family Foundation’s Larry Levitt called them “pretty misleading,” as they don’t take into account the per-person cap on federal Medicaid funding. They also add state savings to the block grants under the bill, but don’t include them in the current law baseline, meaning the comparison isn’t apples to apples.

The revisions also ramped up some of the regulatory rollbacks needed to help win conservative votes. Sen. Ted Cruz said earlier today that he’s not yet on board with the legislation.

Here are the regulatory changes:

  • Allows “multiple risk pools,” which could separate sick and healthy people and thus drive up premiums for people with pre-existing conditions.
  • Allows states to change the federal cap on out-of-pocket costs for enrollees.
  • Allows states to decide how much insurers can charge people with pre-existing conditions, the benefits plans must offer and how cost-sharing is structured.
  • States only have to describe their plans; they don’t have to submit waivers of insurance rules.
  • “If there was any question about Graham-Cassidy’s removal of federal protections for pre-existing conditions, this new draft is quite clear,” Levitt tweeted.

The Washington Post reported that Alaska would receive “3 percent more funding between 2020 and 2026 than under current law, and Maine would get 43 percent more funding during that time period.” CNBC discussed the changes to Arizona and Kentucky:

Arizona would gain $4.2 billion under the new draft calculations, roughly 14 percent, compared with a loss of $19 billion under the original plan. Maine stood to lose $2 billion between 2020-2027, but under the revised draft would gain nearly $1.5 billion. Kentucky would go from losing roughly $11 billion compared with Obamacare, to gaining $1.1 billion or 4 percent.

The Hill notes that despite these changes, the Graham-Cassidy bill “is largely the same as the earlier version:”

It still converts ObamaCare’s subsidies and Medicaid expansion dollars into a block grant for states.

It also allows states to waive ObamaCare protections against people with pre-existing conditions getting charged more, an area at the center of controversy around the bill.

None of these senators have commented on this new bill.

Opposition

Collins appeared on CNN’s “State of the Union” on Sunday morning and told host Jake Tapper that “[I]t’s very difficult for me to envision a scenario where I would end up voting for this bill.” She also said that she’s waiting for the CBO score to come out, which should happen today. Collins expressed concern for protections of those with pre-existing conditions and the costs of premiums and deductibles.

Murkowski’s staff told the media on Friday that the senator is still undecided. Paul has called this bill Obamacare lite. From The Washington Post:

Paul said in a Sunday interview that he broadly opposes a keystone of the Cassidy-Graham plan: turning funding for the ACA into block grants for states.

“The problem I have with block grants is that looks like I’ve affirmatively said I’m okay with 90 percent of Obamacare as long as we reshuffle it and give it to Republican states,” he said. “That’s a horrible message.”

Paul said he is willing to listen to suggestions about how that element of the bill could be constricted. “Would I talk to them if they said they wanted to make the block grants half as much? I might,” he said.

Last Friday, McCain said he could vote for the bill. CNN reported:

“I cannot in good conscience vote for the Graham-Cassidy proposal,” the Arizona Republican said in a statement. “I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will effect insurance premiums, and how many people will be helped or hurt by it. Without a full CBO score, which won’t be available by the end of the month, we won’t have reliable answers to any of those questions.”

Cruz made his remarks at the Texas Tribune Festival in Austin, TX. From CNN:

“Right now, they don’t have my vote, and I don’t think they have Mike Lee’s either,” Cruz said, referring to the Utah Republican, at the annual Texas Tribune Festival in Austin, according to the Tribune. “Now I want to be a ‘yes,’ I want to get there because I think Obamacare is a disaster … but the price to getting there, I believe, is focusing on consumer freedom.”

Cruz continued, “If you want prices to go down — Econ 101, you want prices to go down, you want more choices, more options, more competition, and prices fall,” he said. “What does Obamacare do? Fewer choices, less options, less competition, prices rise. If you want people to have access to health insurance, you want prices to fall.”