Graham, Cassidy pull out the stops in race to uproot ObamaCare

Republicans' attempt this week to repeal and replace ObamaCare in the Senate is supposed to be their last shot.

Maybe.

The effort looks bleak right now as the Senate careens toward a Sept. 30 deadline to try to rip out the 2010 health care law and replace it with a plan engineered by GOP Sens. Lindsey Graham, South Carolina, and Bill Cassidy, Louisiana.

They retooled their blueprint over the weekend by bolstering funding for Alaska and Maine to court the states’ respective GOP senators, Lisa Murkowski and Susan Collins, who each have expressed skepticism about the bill but aren’t hard noes yet.

The legislation largely sends health care dollars to states as “block grants,” permitting states to use the money as they see fit.

It’s doubtful the Senate will this week have a complete analysis of the legislation from the Congressional Budget Office.

Graham-Cassidy supporters argue the nonpartisan CBO already “scored” many provisions in their legislation -- just not together. However, some partial analysis is expected Monday that could merely be a letter about the bill without tables and detailed dissection.

Supporters will argue that’s enough economic-impact analysis to hold a full vote before the Sept. 30 deadline to pass the bill with a simple, 51-vote majority. Critics argue the process is too incomplete to vote on such major legislation.

Then there is the math.

The Senate breakdown is 52 Republicans and 48 senators who caucus with the Democrats.

GOP Sens. Rand Paul, Kentucky, and John McCain, Arizona, said last week that they won’t vote for the bill. That meant the bill was on life support with a potential maximum of 50 GOP yeas. The thought was that Vice President Pence could break a possible tie. Then Sen. Ted Cruz, R-Texas, on Sunday announced his opposition.

“They don’t have my vote,” said Cruz, who suggested fellow Republican Sen. Mike Lee will also vote no.

Excluding Murkowski, Collins and Lee, there are 51 nays on the bill. That’s makes the bill an immovable object unless something dramatic changes.

Expect GOP leaders and White House officials to administer a full-court press this week as the parliamentary carriage carting the health care bill turns into a pumpkin at 11:59:59 p.m. ET on Sept. 30.

Here’s where things get tricky.

With only 52 Senate Republicans, GOP leaders knew they didn’t have a chance of neutering a Democratic filibuster on any repeal and replace effort. Under most conditions, it takes 60 yeas to shut off a filibuster.

But once a year, the Senate can sidestep filibuster rules and consider legislation under a process called “budget reconciliation.” Budget reconciliation limits debate to 20 hours and requires only 51 votes to pass a bill.

Budget reconciliation packages are ostensibly good for only one fiscal year. The government’s fiscal year runs out Saturday night, or Sept. 30, and so does the reconciliation measure for health care. Thus, this week’s health care sprint.

It’s unclear whether Senate Majority Leader Mitch McConnell, R-Ky., would forge ahead this week with the Graham-Cassidy plan as a major amendment to the budget reconciliation effort the Senate debated in July.

Debate time on this particular reconciliation package expired, though senators could agree to some limited debate if everyone is on board.

Endless amendments -- in addition to Graham/Cassidy -- are in order.

That could launch a “vote-a-rama” in the Senate. A vote-a-rama is where the Senate votes for hours on end on a lengthy slate of amendments during budget reconciliation.

Democrats could try to clog the works with so many amendments that the clock expires Saturday night. Democrats could also submit amendments so lengthy that it takes the Senate clerks hours to orally read each one before the chamber.

In reality, the deadline here is sometime late on Sept. 28 or in the wee hours of Sept. 29. The holiest day in Judaism -- Yom Kippur -- begins at sundown on Sept. 29 and runs until after sundown on Sept. 30. Jewish senators won’t be available for Senate work during that period.

Still, House and Senate Republicans could always craft a budget reconciliation package for tax reform with provisions that also allow for a repeal and replacement of ObamaCare. After all, tax reform is next in line and a budget reconciliation vehicle is essential for that goal, too. Such a ploy would mean that Sept. 30 isn’t the absolute deadline for repealing and replacing ObamaCare.

If the future of the health care bill is cloudy in the Senate, it’s even murkier in the House.

Let’s say for a moment the Senate does approve Graham-Cassidy. The House and Senate aren’t in alignment as both bodies adopted different health care bills. That means if the Senate package returns to the House, the House could be stuck with a take-it-or-leave-it proposition.

The House narrowly approved its own version of health care in May. Graham-Cassidy is a different animal. Would California’s 14 House Republicans vote yea?

How about GOPers from New York, New Jersey or Ohio? Graham says House Speaker Paul Ryan, R-Wis., was confident his members would muscle through the Senate’s health care bill. But that could require a Herculean effort.

It’s possible the House may change a Senate-approved bill. An altered bill must return to the Senate.

Any changes to the Senate bill by the House would be subject to a filibuster. An amended bill would require 60 votes to halt a filibuster. That’s never going to happen under these circumstances. But if this bill has any chance of becoming law, House Republicans will likely have to accept whatever the Senate sends over.