Every congressional attempt to reform national health coverage requires at least one clumsy attempt to bribe a reluctant member of the majority. Everyone remembers the “Cornhusker Kickback” from the last days of the ObamaCare process, yes? That was Harry Reid’s bid to get Ben Nelson to back the Senate bill by shoveling an extra $100 million in Medicaid funding at Nebraska. Conservatives (and some Democrats) howled with outrage and the provision was dropped. Nelson ended up voting yes anyway, gifting us with the albatross that still hangs limply around America’s neck.
Fast-forward seven years and the GOP’s trying to shed that albatross by offering a kickback to one of its own. Lisa Murkowski cast one of the three Republican no votes that sank “skinny repeal” in the Senate in July; she’s also a holdout on the Graham-Cassidy bill that’s coming up for a vote next week. Graham-Cassidy would blow up much of the basic infrastructure of ObamaCare — no more mandate, no more tax credits for premiums, no more cost-sharing subsidies, no more federal rules about “essential health benefits” (if a state wants to waive them), no more federal funding for Medicaid. The states would be given much greater power over regulating insurers plus block grants to fund health care for poorer residents. Is Murkowski, one of the most powerful centrists in the Senate, going to go along with a reform that will inevitably leave her accused of tanking Medicaid for lower-income Alaskans and leaving middle-class constituents with no help from Uncle Sam in paying for insurance on the individual market? Probably not, no. Unless…
We need a name for this that’s as catchy as “Cornhusker Kickback.” “Alaska Purchase” is fine but it doesn’t have the same alliterative ring. A Twitter pal suggests “Kodiak Kickback,” which I kind of like. The “Polar Payoff” and the “Permafrost Payola” are good too. Anyway, Alaskans are making out like bandits compared to the rest of the country — if Murkowski takes the deal:
“This draft includes 3 separate provisions benefitting Alaska.
1. Alaska (along with Hawaii) will continue to receive Obamacare’s premium tax credits while they are repealed for all other states. It appears this exemption will not affect Alaska receiving its state allotment under the new block grant in addition to the premium tax credits.
2. Delays implementation of the Medicaid per capita caps for Alaska and Hawaii for years in which the policy would reduce their funding below what they would have received in 2020 plus CPI-M [Consumer Price Index for Medical Care].
3. Provides for an increased federal Medicaid matching rate (FMAP) for both Alaska and Hawaii.”
More Medicaid money *and* Alaskans continue to get some sugar back from the IRS to help pay for their insurance that the rest of the country, apart from Hawaii, would not. “In essence,” writes Peter Suderman, “they would be attempting to bribe Murkowski to vote to repeal Obamacare by letting her state keep Obamacare.” How’s that for PR for the GOP’s new bill? Their new system is such an improvement over the old that they couldn’t pass without guaranteeing Alaska that it could … keep the old one.
Murkowski’s sure to go for it, right? Maybe not. This isn’t the first time this year a “Kodiak Kickback” has been whispered about. She didn’t like the idea when it was broached in June:
Senator Lisa Murkowski of Alaska, one of the key moderate holdouts, said leaders shouldn’t expect to be able to buy off her vote with an Alaska-specific solution.
“This is like a really big deal to get this right for the country,” Murkowski told reporters. “Let’s just say that they do something that’s so Alaska-specific just to quote, ‘get me.’ Then you have a nationwide system that doesn’t work. That then comes crashing down and Alaska’s not able to kind of keep it together on its own.”
I don’t know why she’s worried about Alaska struggling to maintain its own unique state system. If Graham-Cassidy passes and then comes crashing down a few years from now, we all know what’s going to replace it.
I also don’t know why the other handful of Republican “maybe” votes whom McConnell desperately needs to get to 50 yays don’t hold out for similar deals. If you’re from a red state then you’re stuck voting for whatever comes to the floor because that’s the way Trump wants it and whatever Trump wants, your voters want. If you’re from a purplish state like Alaska, though, you have every incentive to cover your ass by squeezing some similar concessions on premiums and Medicaid funding out of McConnell, Graham, and Cassidy, especially if it seems likely that the bill will in fact pass. Susan Collins may have a special reason to vote no regardless because she’s reportedly looking at running for governor and may have calculated that Mainers will hate Graham-Cassidy enough to damage her chances even if she gets a legislative bribe for them too. But what about McCain, or Cory Gardner? Both purple-staters, both fairly centrist-y. McCain might not care since he’s almost certainly in his final term in the Senate but Gardner’s got a long career ahead of him potentially. If Murkowski gets a deal, what does he tell Coloradans when they ask why they didn’t get one too?
Exit question: Think this might come up on Monday night?
— Mark Preston (@PrestonCNN) September 21, 2017