SCOTTSDALE, ARIZ.—Though RISE West took place on the other side of the country, the healthcare policy drama unfolding in the nation’s capital loomed large at the industry conference.
In fact, two separate keynote presentations—one on Monday and one on Tuesday—centered on the current political landscape.
Krista Drobac, a partner at the Washington, D.C.-based consulting firm Sirona Strategies, noted that when she spoke at RISE Nashville in March, House Republicans unveiled the American Health Care Act. Now, as she presented at another RISE event, a last-ditch Affordable Care Act repeal-and-replace bill put forth by Sen. Bill Cassidy, R-La., and Sen. Lindsey Graham, R-S.C., was improbably gaining steam.
“Everybody sort of dismissed it, dismissed it, and now it’s got momentum,” she said of the bill.
Even so, Drobac was highly skeptical that the bill could actually end up becoming law. For one, Sen. John McCain—who cast the deciding vote that killed the Senate’s previous ACA repeal push—has not yet said he’d support the measure. Some governors are also opposed, and they have become powerful forces in the debate over the ACA’s future.
What’s more, Drobac said she’d be surprised if the conservative Freedom Caucus in the House agreed to pass the bill as is, which would be necessary since the Sept. 30 deadline for budget-reconciliation instructions means it can’t go back to the Senate for revisions.
“The chances of it becoming law become slimmer after it goes to the House,” she said of the Graham-Cassidy bill.
However, Grace-Marie Turner, president of the nonprofit Galen Institute, noted in her keynote on Tueday that the bill has won the support of one very important governor: Arizona’s Doug Ducey. His stance suggests to Turner that McCain could be convinced to flip on the Graham-Cassidy bill.
Turner also noted that House members’ input was taken into account in the development of the Graham-Cassidy bill, so that could mean it will have an easier path to passage there than some would expect. In addition, Vice President Mike Pence flew back to the Capitol on Tuesday to attend the GOP’s weekly policy lunch, which suggests to her that the Trump administration believes the latest ACA repeal bill “has legs.”
Even so, Turner was frank about the difficulty of prognosticating about the measure’s future. “What are the chances this is going to happen? I don’t know,” she said.
Beyond Graham-Cassidy
Turner pointed out that once the window closes for passing budget-reconciliation measures, healthcare policymaking could still continue. For example, she suggested that that less-controversial measures like medical liability reform and making tax credits available for COBRA plans could get the 60 votes needed to overcome a filibuster in the Senate.
Talks have broken down over a bipartisan ACA stabilization bill by Sen. Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash. But even if Graham-Cassidy fails and those negotiations resume, the future is still murky, according to Drobac. If the Senate Health, Education, Labor and Pensions Committee is ultimately able to reach an accord, Drobac predicted it will include two years of funding for cost-sharing reduction payments in exchange for greater flexibility in 1332 waivers.
That said, similar to the Graham-Cassidy bill, such a measure might hit a wall in the House.
“The chances of this actually becoming law are probably pretty slim,” Drobac said.
Both she and Turner, meanwhile, were highly skeptical about the merits of Sen. Bernie Sanders’ newly unveiled Medicare-for-all bill, which has garnered the support of several high-profile Democrats.
One of the biggest issues, Turner noted, is how the federal government would pay for it. Plus, she argued that “Medicare not the right platform to get to universal coverage.
For her part, Drobac warned attendees not to dismiss single-payer as impossible, considering many once thought the same of Republicans’ promises to repeal the ACA. But expanding on that parallel, she worried Democrats were making the same mistake as their colleagues across the aisle—pursuing a partisan healthcare policy agenda that is doomed to fail.
“Let’s just skip the debate and move on to something that can work,” Drobac said.