Republicans hammered Democrats seven and a-half years ago for larding Obamacare with state-specific payoffs and sweeteners to secure the last few votes for passage. Who can forget the “Cornhusker Kickback,” which funneled $45 million to Nebraska to nail the support of former Sen. Ben Nelson?
But the revised Senate Obamacare repeal bill shows Republicans engaged in the same pattern of horse trading as they try to win 50 ayes to advance an unpopular bill.
Leaders are likely to cook up even more deals to entice uncommitted senators. As conservative health policy expert Chris Jacobs points out at The Federalist, Majority Leader Mitch McConnell still has about $200 billion that he can spend on holdouts without breaking Senate budget rules he’s using to try to pass the legislation. The Trump administration is pitching a proposal to Nevada as a way to bring Republican Gov. Brian Sandoval and Sen. Dean Heller on board that aims to move Medicaid expansion enrollees into the private insurance market where they could use subsidies to help pay for premiums.
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Alaska — The most blatant attempted buyoff is aimed at Alaska’s Lisa Murkowski, who has been decidedly unenthusiastic about potential coverage losses in the state. In what’s been dubbed the “Polar Payoff,” the revised legislation stipulates that any state with premiums that are at least 75 percent higher than the national average must receive at least 1 percent of state stability funding. There’s only one state that meets that threshold: Alaska. With $182 billion designated for stabilization efforts in the revised bill, that translates to at least $1.82 billion for Alaska. …
“Buffalo Bribe” — This provision was originally stuck in the House bill at the behest of Rep. Chris Collins of New York, who has long been angered by the way his state forces county governments to contribute to its Medicaid program. It would penalize states that do this by reducing their federal payments by whatever amount local governments are required to pay. The provision resurfaced in the Senate bill, but it’s not clear at whose behest. …
Florida — The bill would exempt some spending from the Medicaid per capita cap in the event of a public health emergency. That was a priority for Sen. Marco Rubio of Florida, whose home state has been fighting the Zika virus outbreak. The bill also makes a change in the funding formula for hospitals that see a large number of poor and uninsured patients, using the number of uninsured instead of the number of Medicaid enrollees to calculate payments. That will particularly benefit states like Florida that didn’t expand Medicaid and have higher uninsured rates.
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