Want to know what the wild card is in the GOP's dead-sprint to a vote is? The P-word. Yep, the parliamentarian, who's sort of a like a congressional referee, still has to rule on which parts of the Graham-Cassidy repeal bill are valid based on the whether they are directly related to the budget. It was the Senate parliamentarian, for instance, that told Republicans they only had until September 30 to repeal health care with a simple majority.
But now the parliamentarian will be weighing in on the Graham-Cassidy bill's most critical element: whether states can waive the Obamacare provision that requires insurers to cover certain essential health benefits (EHBs) and prevents them from jacking up prices for people who have pre-existing conditions. It's the bill's entire reason for being. When Sen. Lindsey Graham says they are trying to give "flexibility" back to the states, what he means is the federal government would give states the power to allow insurers to limit their coverage and price gouge people with pre-existing conditions in order to make overall coverage cheaper. But guess what? That provision might not even be allowable, which would completely upend the nature of the bill. The Washington Post's Greg Sargent writes:
Some health policy analysts think there’s a decent chance that the parliamentarian will strike those deregulatory features under the Byrd Rule, because they don’t have a direct budgetary component. Daniel Hemel of the University of Chicago, for instance, points out that a very similar feature was struck from a previous GOP repeal bill and thinks it should — and very well may — happen again. [...]
I asked Hemel what the consequences of this would be, and he emailed:
“Without the waiver provision, Graham-Cassidy is a totally different bill. It doesn’t provide states with flexibility, but it still takes away a lot of money. This would change the terms of the debate entirely — and would do so just a few days before the senators cast their final votes.” [...]
Nicholas Bagley of the University of Michigan agrees and adds that this would mean that a primary selling point for the bill would vanish: It would no longer meaningfully offer the states “flexibility” and would no longer constitute the “federalism” that supporters have extolled.
If this were to happen, the bill would become a virtual monster in the eyes of Republicans—keeping all of Obamacare's protections in place while simultaneously failing to lower costs and yet still sucking billions of federal dollars away from the states. Honestly, it's hard to imagine who would vote for that and there's a good chance we would never know because it's equally as hard to imagine Mitch McConnell bringing it to the floor.