John McCain


Howard Fischer, Capitol Media Services

When last we visited the Affordable Care Act (aka, Obamacare) in mid-August, U.S. Sen. John McCain had cast the deciding vote against repealing it, placing it in political and financial limbo. At the time, we endorsed efforts by a bipartisan group of governors to stabilize the individual insurance market and work on the fund to pay for the most costly, chronic cases that were causing many insurers to leave the exchanges.

Fast forward a month, and the governors, working with Republican Sen. Lamar Alexander of Tennessee and Democrat Patty Murray of Washington, reported bipartisan progress.

But with the clock winding down to Sept. 30 on the ability of Republicans in the Senate to deal with Obamacare with a simple majority vote, GOP leaders pulled the plug on the bipartisan plan, leaving no other option but to kill it or face the wrath of conservative voters.

So this week, they have trotted out pretty much the same bill that McCain voted to kill, saying he wanted full hearings and amendments plus the approval of Gov. Doug Ducey. Under the bill proposed in August, Arizona’s single adult and working poor Medicaid patients – more than 400,000 – stood to lose their coverage, as did patients with pre-existing conditions if they could not afford sharply higher premiums. (Under Obamacare, these patients could neither be denied coverage nor charged more.)

The new bill this week guts the protections for the poor and chronically ill in Obamacare but says each state, if it chooses, could reinstate those rules, along with requiring even healthy adults to purchase insurance – a mandate that was helping to pay for Obamacare.

Ducey, while not commenting on whether he favored preserving those protections, switched to supporting repeal, apparently believing a block grant to his state would allow state lawmakers and officials to craft coverage more responsive to local markets and health conditions.

The problem, as the AMA and other health groups have pointed out, is that without mandatory enrollment, there won’t be enough money to cover the poor and ill unless the state forks over billions of dollars itself (Obamacare has been essentially free to the states so far). The bill also eliminates Medicaid expansion subsidies, something that allowed Arizona to add those 400,000 patients above with the help of a hospital bed tax that will disappear if Obamacare subsidies go away. Also covered were more of the working poor earning up to 133 percent of poverty. And without the federally supported exchanges, the individual insurance market is likely to revert to its pre-Obamacare enormous premium hikes based on pre-existing or chronic health problems.

How much would Arizona have to pay if it chose to make up all of the subsidies under Obamacare that are covering those patients?

The Center on Budget and Policy Priorities says the latest Senate bill would mean the loss of $80 billion nationally by 2026, including a $1.6 billion loss for Arizona.

And if that federal law expires as proposed in 2027 and the block grants go away entirely, the same organization puts the price tag for Arizona at $6.9 billion out of $8.6 billion in current federal dollars.

McCain has remained coy about how he will vote, although those counting noses say there may already be at least three no votes among Republicans without him. In any case, we endorse his call for hearings and waiting for the release of preliminary Congressional Budget Office figures on the bill’s impact before taking the vote. Republicans have already waited seven years to come up with a viable repeal and replace bill for Obamacare. What’s 10 more days?


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