The last-ditch Senate Republican effort to repeal and replace the Affordable Care Act has zeroed in on a single target: Alaska Republican Sen. Lisa Murkowski, who cast one of three decisive no votes in July.
Her colleagues Sens. Rand Paul of Kentucky and Susan Collins of Maine have been written off as no votes by the bill’s backers. If Murkowski joins them and votes no again, the bill, which cuts federal health care spending and devolves power to the states, falls short of the 50 votes it needs.
Murkowski has given no indication that she has reconsidered her opposition, and on Tuesday, Alaska’s governor, Bill Walker, announced he was against the new bill. Later that day, while speaking with reporters, Murkowski quoted Walker’s statement, adding that she is not yet announcing her own position.
If all that isn’t enough to give an indication of how she’ll vote this time around, take a look at a conversation she had with a class of high school interns just last month. Murkowski, who tends to hold her cards close to her vest, didn’t announce her decision last time before the vote, either. But that doesn’t mean she hadn’t made up her mind.
In the Q&A with her outgoing interns, she allowed each to ask her a question. The back and forth was recorded and posted to YouTube. As of this writing, it has been viewed 523 times and was referenced in a profile of Murkowski written in August by Jennifer Bendery of HuffPost.
One intern, Kobe Rizk, asked Murkowski to name an issue she had “made a visible difference on and how.”
Murkowski immediately referred back to her vote against repealing the Affordable Care Act. The nay vote had been cast amid tremendous pressure — which Murkowski described later to CNN as “repercussion from party, a tweet from the president, backlash from your leadership” — and even a threat that Alaska could lose federal funding for energy projects.
For backers of Graham-Cassidy, who still claim to have hope she will come around, Murkowski’s answer to the intern could not bode worse for their bill. Her core argument is that health care reform should be done in a bipartisan way, that the process should be transparent and go through the proper committees, and it should not be rushed by an arbitrary deadline just to get something done.
None of that is true for Graham-Cassidy.
“Health care reform is not something that we want to just get behind us, trying to cobble together sufficient votes to just get something. The substance of it matters. And I heard that daily from Alaskans. And so it’s OK to take a little more time to get there, and that’s where I think we have made a difference,” she said. “I think that the role I played in ensuring that we do take the time to get this right was an important one.”
“We put that on pause,” Murkowski said, coining a euphemism for the hammer her vote brought to the last bill, “while we now shift to an approach that allows for an open and transparent committee process, one that allows for bipartisan participation, a full vetting of ideas, and I think something that will allow us to move forward with consensus positions in an area that is extraordinarily important.”
Were Murkowski to vote for Graham-Cassidy, it would short circuit everything she said she was trying to accomplish. She said she understands the stakes for the party. “I know it’s been disappointing because there has been so much hard work that’s gone into all aspects of trying to find the different approaches and I respect that,” Murkowski told the interns. “But if we haven’t reached consensus yet, it’s OK to acknowledge that we haven’t, and let’s keep working to find that path. But I have long felt that it is important to make sure that we’re listening to all the voices when we’re talking about something as critical as health care. And having that committee process, having a bipartisan approach, I think is important. We’ll have an opportunity to do just that.”
Indeed, if Murkowski has her way — and her vote would ensure that she does — the Senate will have the opportunity to move forward with a bipartisan approach. Asked earlier in the conversation by another intern what she hoped her legacy would be, she said that she hoped people understood she cared about Alaska and the people there.
“I would hope that legacy is, ‘She really cares for us.’ Because that’s what gets me up every day,” Murkowski said. “I hope that Alaskans will recognize that I do it because I love Alaska and her people.”
Meanwhile, the bill’s co-sponsors, Sens. Lindsey Graham, R-S.C. and Bill Cassidy, R-La., have been doing what they can to win over Alaskans by goosing the funding formula to help the state out. But even with that boost, the bill cuts federal funding so drastically that Alaska still winds up with less money than it gets now. That was why Walker, Alaska’s governor, announced his opposition on Tuesday.
The increased flexibility at the state level was a plus, Walker said, but the math trumped ideology. Murkowski explained that Walker had told her, “If I get half as much money, flexibility doesn’t help me.”
The Intercept asked Graham if he was disappointed in Walker’s announcement and whether he had spoken with him beforehand. It quickly became clear this was the first time he was hearing about it. “When did he make that announcement?” he asked.
“I don’t know the governor of Alaska. Here’s what I would tell him: If you think you don’t like this bill, just watch what you’ve got comin’, pal,” he said, referring to upcoming employer mandate penalties in Obamacare.
Graham-Cassidy has been kicking around for several weeks now, but in the last week Democrats have sounded the alarm, after Graham and Cassidy boasted about being close to having the votes to pass it.
Sen. John McCain, R-Ariz., who killed the last effort along with Collins and Murkowski, has yet to commit either way, but is close friends with Graham, and backers are confident he could come around.
But Collins, while she won’t outright say she’s opposed yet, is considered unobtainable. This week, she did volunteer that the bill would cost Maine $1 billion in Medicaid money. “That’s obviously of great concern,” she said.
Paul has repeatedly said he’s a hard no, nailing himself to that opposition every way he can think of. “I’m for repealing Obamacare. Apparently that’s a quaint notion,” he said, calling Graham-Cassidy insufficient.
Paul had previously said he was opposed to the Senate’s last attempt at repeal, yet subsequently voted for it, raising questions among Democrats as to just how firm his no is this time. But the two scenarios are wildly different: In July, Paul was promised the “skinny repeal” bill would not become law and instead would go to a conference committee, giving him another chance to oppose it when it came back. So he was merely voting to keep the process moving forward. This time, the bill on the floor is the bill that would become law, so his opposition is thought to be more solid.
Collins, for her part, is deeply disturbed that the Congressional Budget Office won’t be fully analyzing the bill. When The Intercept told her the CBO wouldn’t be studying its effect on the number of uninsured or the cost of premiums, she laughed. “Really? It will be interesting to see what they do have if they don’t have those two, because that’s pretty major,” she said. “That’s problematic. It’s part of the problem with short-circuiting the process.”
Following the last decisive vote, Collins and Murkowski sat down together with CNN’s Dana Bash for an interview. Murkowski said she wouldn’t soon forget a conversation she had after that vote with McCain. “We had one of those conversations you’ll think of years down the road. He said people might not appreciate what has happened right now as being a positive,” she said. “But the time will prove that having a pause, having a time out for us to do better, is going to be good for the country.”
Those are the words of the Republican Party’s only hope for repeal.
Update: Sept. 21, 2017
Independent Journal Review is reporting that Graham and Cassidy are offering major renovations to the bill in order to blunt its impact on Alaska. Before the story published, The Intercept had asked Murkowski spokesperson, Karina Peterson, if talks were ongoing with Graham, with the potential that a deal could bring around both Murkowski and Alaska’s governor. “That doesn’t sound accurate. Senator Murkowski is in the process of vetting the bill and determining its impacts to Alaska, simple as that,” she said.
Cutting an Alaska-specific deal would cut against what Murkowski has previously said about such carve-outs.