Graham and Cassidy go into overdrive to win Murkowski vote

Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) are going into overdrive to win over Alaska Sen. Lisa Murkowski (R), a pivotal vote for their bill to dismantle ObamaCare and give states more authority over health care.

The two have seen Murkowski, one of three Republicans to sink the GOP’s last repeal bill, as a critical vote for some time.

Graham told a meeting of conservative activists last week that special accommodations would have to be made in the bill for Alaska to win over Murkowski. The senator asked the groups to understand and to not make a stink if concessions were made.

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The Graham-Cassidy proposal would convert ObamaCare’s insurer subsidies and funds for Medicaid expansion into block grants that would be given to states to design their own programs.

Right now it looks like an uphill battle to change Murkowski’s mind.

“I’d say the chances are less than 30 percent. Alaska doesn’t do very well in this bill. Her governor is lukewarm on it and her insurance commissioner is not for it,” one Senate GOP aide added.

Graham and Cassidy met with Murkowski on Wednesday in the office of fellow Alaska Sen. Dan Sullivan (R).

The face-to-face negotiations took a break Thursday as Graham traveled back to South Carolina and Murkowski flew back to Alaska, according to their offices. 

Karina Petersen, a spokeswoman for Murkowski, said her boss is still vetting the bill and studying data from the Centers for Medicare and Medicaid Services and the Department of Health and Human Services.

Alaska has higher health-care costs than other states because of its vast size and isolated geography.

Lori Wing-Heier, the director of Alaska’s Division of Insurance, testified before the Senate earlier this month that the state has some of the highest health-care costs in the nation because of its low population.

Under Graham-Cassidy, Alaska would see a $1 billion reduction in funding compared to current law for years 2020 through 2026, or about $1,350 per resident, according to a new study by Avalere, a consulting firm founded by a former Clinton administration official. 

A study by the Center on Budget and Policy Priorities, a left-leaning think tank, projected a $255 million reduction in federal funding for Alaska in 2026 alone, a number made more daunting by the state’s small population of 742,000.

The Independent Journal Review reported Thursday that a new draft of Graham-Cassidy would allow Alaska, as well as Hawaii, to keep ObamaCare’s premium tax credits in addition to receiving block grants.

But Murkowski’s spokeswoman said she was not aware of any revised bill language being shared with her office.

Graham on Wednesday downplayed the notion that Alaska would fare better than other states in the bill but nevertheless acknowledged that something would have to be done to accommodate the state’s high costs.

“What we’re going to do is not deny Alaska the uniqueness of Alaska, but that’s it,” he said, according to The Washington Post.

The strategy could prove risky, however, as conservatives may balk at any language that might be seen as a special giveaway to Alaska.

One conservative Republican aide said extra funding for the state “possibly” could be a problem. 

Graham’s office did not respond Thursday to a question about special aid for Alaska.

With Sen. Rand Paul (R-Ky.) opposed to the bill and Sen. Susan Collins (R-Maine) seen as a likely no, Republicans can’t afford to lose another GOP vote.

Yet winning Murkowski won’t guarantee passage either.

Cassidy’s office is also working with Sen. Mike Lee (R-Utah), another conservative who has raised concern about waivers for states.

Lee was encouraged earlier this week by the progress of the talks.

Other Republicans have raised concerns or said they need more time to study the bill.

Sen. John McCain (R-Ariz.) has repeatedly told reporters that legislation as complicated as health-care reform should go through the regular order of committee hearings and markups.

The Senate Finance Committee is scheduled to hold a last-minute hearing on the legislation Monday, but it’s doing so on a rushed schedule because lawmakers are racing to vote before Sept. 30, when special budgetary rules that will allow it to pass with a simple majority, instead of 60 votes, expire.

Conservative Sen. Ted Cruz (R-Texas) has raised concerns over whether the bill goes far enough to exempt states from ObamaCare’s insurance market regulations, which he believes have sent premiums soaring.

Asked this week if the bill’s insurance waivers go far enough, Cruz responded, “Not at the moment.”

Cruz, however, added that he is working with colleagues to “expand the regulatory freedom and lower premiums so that families who are struggling will be able to afford health insurance.”

Other Republicans say they need more time to make up their minds.

Sullivan, who shares some of Murkowski’s concerns about the potential impact on Alaska’s pricey insurance market, and Sen. Shelley Moore Capito (R), whose home state of West Virginia has benefited from ObamaCare’s Medicaid expansion, say they are still reviewing the bill.

Senate Republican aides say McConnell has gotten fully behind Graham-Cassidy over the past week.

He told Republican senators at a lunch meeting Tuesday that this is their last chance to repeal ObamaCare in the current Congress because of the special budgetary rules’ Sept. 30 deadline.

But while McConnell and his leadership team are engaged, they are not as fully in control of the negotiations as in July, when McConnell worked with Senate Finance Committee Chairman Orrin Hatch (R-Utah), Senate Budget Committee Chairman Mike Enzi (R-Wyo.) and Senate Health Committee Chairman Lamar Alexander (R-Tenn.) to draft the health-care bill Senate Republicans were pushing at the time.

In July, McConnell’s office was in control of almost every decision, and he handled much of the negotiation with wavering senators.

Now, Graham, Cassidy and their partner, former Pennsylvania Sen. Rick Santorum (R), are taking the point.

“It’s their bill; they’re the best ones to sell it,” said a senior GOP aide.

McConnell met with Murkowski and McCain on Monday to feel them out.

The GOP leader also met with Graham and Cassidy prior to their meeting with Murkowski on Wednesday.