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Help us get the word out about open enrollment!

We can’t let Trump sabotage ACA enrollment!

Despite all the attempts by Congress and Donald Trump to repeal and replace the Affordable Care Act, the ACA remains the law of the land. The fifth ACA Open Enrollment period (OE5) will begin on November 1. But, sadly, many people are confused or think the ACA has been repealed.  After all, the Trump Administration cut the advertising budget for OE5 by a whopping 90% and has slashed funding for navigators who can help people enroll.
Raising Women’s Voices is working with Community Catalyst and other national non-profits to fight back and make sure people know OE5 is happening. Open enrollment starts Nov. 1 and, in most states, goes only until Dec. 15 this year. We need your help to get the word out!
This week, we are launching a campaign to let people know that they can still enroll this fall, or renew their coverage. We have prepared social media badges for use on Facebook and Twitter (like the one shown above) and flyers that can be printed out and distributed at outreach events. You can find all of our materials (and more created by Health Literacy Media) in a google drive established by Community Catalyst (click the button below):

We have four key messages for people who need health insurance:

1. Yes! You can sign up for health insurance this year.  But the open enrollment period is shorter than in previous years in most states, so don’t wait to sign up. We are encouraging uninsured people to go on the website right now to learn how to apply and be ready when Open Enrollment starts on Nov. 1. 
 2. Most people who apply for coverage through the marketplace will still get financial help.  Yes, some of the premiums for health plans are going to be higher this year, in part because of the Trump sabotage efforts. However, the amount of federal premium tax credit subsidies available through ACA marketplaces will rise along with the price of the plans. So, people who receive subsidies to help cover insurance costs may not have to pay more for premiums.

3. You may qualify for free or low-cost health insurance.  Trump and Republicans in Congress failed to eliminate Medicaid expansion or traditional Medicaid coverage in their repeal and replace bills over the summer. So people who are worried they cannot afford health insurance may still qualify for Medicaid in their state.
4. Free local enrollment help is still available. While some federally-funded navigators have had their budgets slashed or eliminated, others have received enough funding to offer help. Moreover, certified application counselors (such as staff at hospitals and community health centers) have not relied on federal funding and so will continue to help people enroll. We are encouraging groups to list local enrollment assistors when posting this and similar badges on Facebook.
Because of our experience working with diverse women, LGBTQ people and families who are disproportionately affected by health care inequities, Raising Women’s Voices was asked by Community Catalyst to create materials for five specific audiences: African-Americans, LGBTQ people and our families, the Latinx community, immigrants and low-income people. We produced all of the badges for the Latinx community in both English and Spanish, with the aid of the Caracol Translation Cooperative. Health Literacy Media created similar materials for general audiences, young adults and Asian-Americans. The printable flyers are available in PowerPoint with space for local groups to add their contact information and logos. Funding for this work has been generously provided by the Robert Wood Johnson Foundation, through Community Catalyst. 
Six RWV Regional Coordinators in targeted outreach effort!
Raising Women’s Voices could not have created meaningful outreach and education materials for this initiative without the active participation of these six regional coordinators:
  • The Afiya Center, Dallas, TX
  • Feminist Women’s Health Center, Atlanta, GA
  • Lesbian Health Initiative/Montrose Center, Houston, TX
  • New Mexico Religious Coalition for Reproductive Choice, NM
  • Trans Queer Pueblo, Phoenix, AZ
  • Women with a Vision, New Orleans, LA
These regional coordinators were invited to participate in the OE5 Outreach and Education project because the states in which they are based have higher rates of un-insurance and lower rates of Medicaid enrollment. They serve on an advisory committee to Raising Women’s Voices, giving advice on our messaging. They are also committed to distributing the materials we created in the coming weeks through their social media platforms, at community events, and at gatherings they organize.

Take action! Help spread the word!
You can help!
Click the button above to choose the messages you want to share on your social media. Print out flyers and fact sheets and share them within your community. We need strong mobilization in every state this fall to overcome Trump’s sabotage of the ACA.



More ACA Sabotage From Trump

Executive order is latest attempt to undermine the ACA
Donald Trump issued an executive order today attacking some of the Affordable Care Act’s (ACA) key consumer protections for people buying health insurance on the small business and individual markets. While the executive order itself doesn’t do much, it directs federal agencies to implement disruptive changes to the ACA designed to push younger, healthier people into unregulated “junk” insurance. The order is part of a much bigger push by Trump to sow chaos in ACA markets and build momentum for full repeal.

This is just the latest step in a long line of steps to sabotage the ACA and drive up the costs of insurance for women, families, and anyone with a pre-existing condition. The Protect Our Care coalition, of which Raising Women’s Voices is a member, released this video earlier today explaining how Trump is actively working to sabotage our health care and fulfill his promise to let the ACA “be a disaster.”
Trump’s Department of Health and Human Services (HHS) is cutting nationwide advertising for the 2018 open enrollment period by 90 percent. In addition, HHS announced it was cutting the amount spent on in-person outreach through the federal navigator program by 41 percent—and abruptly stopped funding navigators altogether for 30 days—saving some of the deepest cuts for the most successful navigators.
For example, one of our RWV regional coordinators, Enroll Michigan, was deeply cut despite praise from federal officials for “years of outstanding work as a navigator grantee and leader of your community.” Executive Director Dizzy L. Warren (pictured at left) was quoted in the New York Timeshighlighting the scope of the problem: “Our funds were drastically reduced, but the government did not reduce our responsibilities.” And “we have not received an explanation of why our funds were cut,” she said.
RWV Regional coordinator Planned Parenthood of the Heartland, the largest navigator group in Iowa, was also quoted in the Times after after their grant was cut by 85 percent: “The government claims this funding is tied to performance measures,” said President Suzanna de Baca. “But we met or exceeded nearly all our goals, so a cut of more than 80 percent appears to be completely arbitrary.”
Trump order allows “junk” insurance 

What is “junk” insurance and why is it bad for us? Under current law, short-term health insurance plans intended to cover very short gaps in coverage don’t have to comply with the ACA’s consumer protections. But, they are limited to three months and they don’t satisfy the ACA’s individual mandate to have health insurance coverage.  By contrast, Trump’s order directs the federal government to re-write the rules to allow year-long “junk” insurance policies to satisfy the mandate.
Much like proposals pushed bycongressional conservatives this summer, these plans would not be required to cover essential health benefits like maternity or mental health care. They could discriminate against people with pre-existing conditions, charge limitless out-of-pocket expenses and reinstate annual and lifetime coverage caps. The ”junk” plans would not be required to spend a minimum percentage of our premiums on actually providing health care, instead of CEO salaries or advertising.
With lower monthly premiums, “junk” plans would appeal to younger, healthier people who don’t expect to get sick, have an accident, or need much insurance throughout the year. Referencing an earlier, similar proposal, insurance companies warned, “This would allow the new plans to ‘cherry pick’ only healthy people from the existing market, making coverage unaffordable for the millions of people who need or want comprehensive coverage, including, for example, coverage for prescription drugs and mental health services. … In fact, it creates two systems of insurance for healthy and sick people.
What else would the Trump order do to disrupt the ACA marketplaces?

In a second part of the executive order, Trump directs federal agencies to dramatically expand association health plans with similarly disruptive results. Pre-ACA, national trade associations like the Farm Bureau or the US Chamber of Commerce could pick a state with the worst coverage and use those rules to offer insurance nationwide. So, for example,they could offer coverage that complies with Mississippi’s consumer protections to small businesses in Massachusettsregardless of Massachusetts state law. Under current rules, small businesses can still band together to form association health plans for their members, but they have operate within states (not across state lines). Mostly importantly, they have to abide by ACA coverage requirements for small businesses. For example, they have to cover essential health benefits like maternity care.  
Under the changes Trump is proposing, association health plans would be exempt from a host of ACA consumer protections and would once again be able to operate under the rules of any state they choose – most likely one with the least coverage protections. The small businesses with the youngest, healthiest people would face strong incentives to exit the ACA’s small business marketplaces and buy a cheaper, skimpier association plan, raising prices for all of the small businesses that remained. 

One under-discussed impact of the pre-ACA small business insurance market was how it depressed employment opportunities for women. A small business looking at a highly qualified female candidate and a less qualified male candidate would face a strong financial incentive to pick the male candidate simply because it would mean lower insurance premiums. In industries dominated by women—like home health care—small businesses simply provided no insurance at all. There is every reason to think that the Trump proposal would reinstate barriers to hiring women, particularly older women or those with pre-existing conditions.
But even for women who end up being covered by an association plan, there’s no guarantee that they’ll actually be covered as promised. As the Washington Post notes, “25 years ago, federal watchdogs concluded that [similar] plans ripped off hundreds of thousands of Americans by refusing to pay their medical claims while violating state insurance laws and even criminal statutes.”
If fully implemented the way the Trump order envisions, these two changes (individually and combined) could destabilize ACA marketplaces by setting up a “death spiral” in comprehensive coverage. Some younger and healthier people would opt for cheaper, junk plans (or have their employer choose it for them) making the market for comprehensive coverage slightly older and sicker. That would drive up premiums which would price out the next tier of healthy people, including those who wanted comprehensive coverage but could no longer afford it. And that, in turn, would leave ACA markets as a de facto high risk pool with only the very sickest still trying to afford comprehensive coverage.



We won’t stand for Trump’s attack on birth control!

Expanded religious and moral exemptions will hurt women
Today, the Trump Administration released two new rules to weaken the Affordable Care Act (ACA)’s contraception coverage, effective immediatelyEmployers will be able to deny their employees birth control coverage because of the employer’s moral objections to birth control. In addition, the rules allow more employers to cite religious objections for denying the coverage. Raising Women’s Voices rejects this latest and most devastating anti-science and anti-women attack on our reproductive health and freedom.
What can we do to fight back? Already, our colleagues at the ACLU have filed a lawsuit challenging the new rules, and more court challenges are likely. What else? First, we can call on employers to stand up for their employees and publicly declare they will continue to provide contraceptive coverage. Second, all of us who are employees can demand that our employers affirm they will continue contraceptive coverage. And we all can call out the Trump administration on social media, using the hashtag #HandsOffMyBC.
Raising Women’s Voices will also be preparing comments on the rules, which are due by December 5. Even though the rules went into effect today, they are interim final rules on which the Trump administration is accepting comments. We must speak up!
What has the contraceptive coverage rule meant for women and their families? Under Obama-era regulations implementing the ACA, 62.4 million women have insurance coverage for their birth control free from out-of-pocket costs.  The percentage of womenwith insurance through their employers who were paying out-of-pocket expenses for birth control pills fell from 1 out of every 4 women before passage of the ACA to just 1 out of every 28 women in 2014. And in 2013 alone, women saved $1.4 billions in co-pays and deductibles on birth control pills.
Why is contraceptive coverage vulnerable to administrative attack even while ACA repeal efforts have stalled? While the ACA made some women’s preventive health protections explicit in the law, it expanded coverage for a broader range of measures by tasking the Department of Health and Human Services (HHS) to draw up a list of “additional preventive care and screenings not described” elsewhere in the bill. Under the Obama Administration, HHS issued a list of preventive measures that included contraceptive counseling and all 18 FDA-approved contraceptive methods.
But the story didn’t end there. In response to objections from religiously affiliated employers, the Obama Administration issued an “accommodation” for non-profits and later, closely-held for-profits who object to contraception on religious grounds. While not ideal, the accommodation was a compromise that gave women access to seamless birth control coverage at no cost while also allowing employers with religious objections to avoid paying for it themselves. Fights over the accommodation famously played out over the course of two Supreme Court battles to determine whether religiously-affiliated employers must provide coverage.
With today’s announcement, the Trump Administration has thrown the existing Obama administration religious employer accommodation out the window. Instead of an accommodation that protects employers’ religious views and women’s access to vital health care, the new rules simply allow almost any employer to strip birth control coverage from their employees for either moral or religious objections to contraception. Universities can also deny birth control coverage in student health plans for religious or moral reasons. In addition, insurance companies can deny coverage for religious or moral reasons as long as the employer agrees.
Which leads us to the question, why did the administration issue two rules?Because while the 1993 Religious Freedom Restoration Act serves as the basis for right-wing objections based on “sincerely held religious beliefs”—the crux of those two Supreme Court cases—there is no legal basis for broadening that standard to include “moral” objections. The Trump Administration is creating a new standard, seemingly out of whole cloth. Furthermore, by issuing the rules as “interim final rules,” which are effective immediately before public comment is sought, there’s a strong legal case to be made that the administration is breaking the law.
It’s possible and perhaps likely that the courts could block the rule from taking effect, particularly while HHS conducts its planned after-the-fact comment period through December 5. But while legal challenges make their way through the courts, women’s coverage is at risk now.



You stopped Trumpcare! Again!

Calls, rallies, social media and more made the difference!
You called your senators, posted on social media, joined rallies and reached out to the news media. It made all the difference! Yesterday, Senate Republicans announced that they will not be voting this week on the Graham-Cassidy bill, which was the last remaining Trumpcare bill!

We knew this was the worst attempt yet to repeal the Affordable Care Act (ACA) and slash Medicaid. The bill was opposed by an unusual coalition of doctors, hospitals, and insurance companies who warned that it would “cause patients and consumers to lose important protections,” “undermine safeguards for those with pre-existing conditions,” “make coverage more expensive,” and force “millions of patients to lose their coverage and go without much-needed care.” S&P concluded that the bill would lead to “580,000 lost jobs and $240 billion in lost economic activity by 2027, ensuring that the GDP growth remains stuck in low gear of around 2% at best in the next decade.” In its preliminary score—the full score won’t be available for weeks—CBO found that “millions” of people would lose their health insurance.
We outlined the devastating consequences for women in our RWV newsletters and blog, and in a guest blog for Community Catalyst.
Across the nation, Raising Women’s Voices regional coordinators and supporters worked hard to get the word out!
In Wisconsin, our regional coordinator, Wisconsin Alliance for Women’s Health, participated in the Wisconsin Health Matters’ six-hour-long speak-out-a-thon to help raise awareness of what was at stake in the latest ACA repeal bill. This online event featured advocates sharing how a variety of communities -- including women, children, the disabled, the aging, cancer patients and survivors of domestic violence and sexual assault – would be negatively affected.  Under the bill, at least 414,000 Wisconsinites would have lost coverage by 2027 and Wisconsin would have seen a $29 billion cut in Medicaid over two decades. "It was amazing! The six hours flew by and we reached over 4,000 people through Facebook. Over 40 people shared our event on Facebook!" said Sara Finger, Founder & Executive Director, Wisconsin Alliance for Women's Health (shown at right in photo).

Our Charleston-based regional coordinator,WV FREE, participated in a press conference to draw attention to the threat the new Republican repeal plan would have posed to West Virginians. Under the Graham-Cassidy bill, West Virginia would have lost $1 billion in the next decade, and $27 billionover the next two decades. During that time,156,000 people, or one out of every twelve West Virginians, would have lost their health insurance.  WV FREE also attended a Medicaid summit, where they and their coalition partners discussed the future of Medicaid in West Virginia – a state that has hugely benefited from expansion under the ACA – and strategized about how to defend it from federal attacks like Graham-Cassidy. An example of one of their campaign material is pictured left.
Meanwhile, Maura Collinsgru, Health Care Program Director at New Jersey Citizen Action, the RWV coordinator for that state, spoke at a September 22 rally against the Graham-Cassidy bill held at Newark City Hall (pictured right). Graham-Cassidy would “undermine the progress we have made in achieving historically low rates of uninsured people,” Maura told the crowd. “Here in New Jersey, we have 900,000 people who have coverage directly as a result of the Affordable Care Act,” Maura said. See Maura’s full speech here.
Celebrate, but we must stay vigilant!
There are two important things we’ve learned this year:

First, the Trumpcare zombie never truly dies, which is why we are keeping this graphic on hand for future use.  
But second, grassroots action can keep pushing Trumpcare back into the grave. 
So, what’s likely to be our next challenge?On September 30, the 2017, fiscal year will die, killing the FY 2017 reconciliation package (which was the vehicle through which Graham-Cassidy could have been enacted with just 50 senators voting yes). But congressional Republicans are already plotting their next scheme to ram through ACA repeal in a partisan process by tying it to tax cuts for corporations and the wealthy.
Back in January, Republicans in Congress announced a plan to use an FY 2017 reconciliation package to kill the ACA by Easter, and then use another reconciliation package for FY 2018 to enact deep tax cuts by August. Now some Republicans want to combine the two strategies into one.
Reconciliation is the parliamentary tool that lets Senate Republicans bypass a Democratic filibuster. But it’s not an easy or immediate process. In order to authorize reconciliation, each chamber must pass an identical budget resolution. Budget resolutions aren’t spending bills and they never become law. Rather, they serve as blueprints for big picture decisions about taxes, spending, and the debt. In 2016, Republicans couldn’t pass one at all—which, ironically, is why they could attempt two resolutions this year.
As of now, the House Budget Committee has passed an FY 2018 resolution that would authorize a reconciliation package of deep tax cuts for corporations and the wealthy paid for by equally deep cuts to Medicare and Medicaid (on top of the ACA and Medicaid cuts that House Republicans assumed would be law by now).
The Senate Budget Committee is expected to vote on a resolution next week that would authorize deep tax cuts and increase the deficit by $1.5 trillion. But two Budget Committee members, Senators Lindsey Graham and Ron Johnson (of Graham-Cassidy-Heller-Johnson infamy), have said they will block any resolution that doesn’t also authorize another round of attacks on the ACA. To move forward, Republicans will need to resolve differences between the two houses and between those Republicans who aren’t ready to give up on the ACA fight and those who don’t want to jeopardize the tax cut bill with another toxic health care fight.
But even with the possibility that Congress will tackle another ACA repeal attempt sometime next year, there are some glimmers of hope that the bipartisan market stabilization package quashed during the rush to Graham-Cassidy could be picking up steam again. You may recall that in early September, the Senate Health, Education, Labor and Pensions (HELP) Committee held two weeks of hearings on a bipartisan plan to fund cost-sharing reductions and a national reinsurance program, taking testimony from governors and state health officials from both parties. HELP Committee Chairman Lamar Alexander (R-TN) was strong-armed into stopping the talkswhile his leadership whipped up support for Graham-Cassidy. But with that effort dead, Alexander announced yesterday that talks would be resuming.
Quick action on a stabilization package is important to ensure that enough insurers are participating in the marketplace when open enrollment opens Nov. 1! We were troubled by HHS action yesterday to extend the deadline from today until right before open enrollment for insurers to sign contracts to participate in the marketplace.
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Radical Trumpcare bill is gaining speed!

We’re back on high alert for the most radical Trumpcare bill yet!
Last week, we warned that Senate Republicans might make one last push to repeal the Affordable Care Act (ACA) and gut Medicaid before they run out of time. This week, we’re moving to red alert in response to reports that Republican leadership is gearing up for a vote the week of September 25, and a possible sham hearing before then.
Now is the time to call, write and rally to urge senators to reject this new threat! Tell them to instead support a bipartisan package to stabilize the insurance markets and fund the cost-sharing reductions that make coverage more affordable for many of us. You can call Congress toll-free at 844-898-1199.

The bill is known as Graham-Cassidy-Heller-Johnson for its sponsors—Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI). This legislation is being sold as a “compromise” and “non-partisan” solution, even though no Democrats support it. Not only is Graham-Cassidy not a compromise, it is the most radical proposal yet.  The bill goes far beyond Republicans’ campaign pledge to repeal the ACA, including Medicaid expansion. This measure also attacks long-standing traditional Medicaid.  
Republicans have only two weeks to ram through repeal with just 50 senators, plus the tie-breaker vote from Vice President Mike Pence. That’s because on September 30, when the current fiscal year ends, the special process known as “reconciliation” will turn back into a pumpkin and Republicans will once again need 60 votes to overcome a filibuster on any health care package.
Medicaid and the ACA
What’s at stake for women and families in the Medicaid portion of this latest Trumpcare bill? Traditional Medicaid, enacted in 1965, is sometimes described as “low-income and...” because to qualify, an individual must fit into a second category—such as low-income and pregnant, low-income and disabled, low-income andelderly.  Prior to the ACA, simply living below the poverty line wasn’t enough to qualify for coverage in most states, so millions of low- and middle-income adults had no access to health insurance.
The ACA, enacted in 2010, increased coverage in two ways. First, for those living below 138 percent of the federal poverty level, the ACA expanded Medicaid, giving low-income adults who didn’t otherwise qualify for Medicaid the same guarantee of high quality coverage. The ACA as written made the Medicaid expansion mandatory for all states, but in 2012 the Supreme Court made it optional. Nineteen states have refused to expand, leaving millions of their residents in a coverage gap. The intra-party battle in Congress this year has been heavily influenced by the dispute between the Republican governors who responsibly covered their constituents by expanding Medicaid and those who didn’t and now want to be rewarded by the party for fighting “Obamacare” at the expense of their constituents and state budgets.
The second way the ACA expanded coverage was by helping low- and moderate-income households living over the federal poverty line buy private health insurance in the individual market. The ACA subsidizes both premium expenses and out-of-pocket costs like co-pays and deductibles.
Under current law, everyone who is eligible for Medicaid or for financial help purchasing private coverage is entitled to it. That coverage guarantee means that the programs are flexible enough to respond to economic downturns, natural disasters, rising medical costs, and an aging population. By contrast, Graham-Cassidy would end these guarantees for both Medicaid and the ACA.

Graham-Cassidy Guts Traditional Medicaid
Graham-Cassidy would replace traditional Medicaid’s 50-year federal-state partnership with a cap-and-slash system designed to cover less and less each year. Under current law, Medicaid automatically adjusts when public health crises like those resulting from Hurricanes Harvey and Irma suddenly drive up per-person costs. But under Graham-Cassidy, once the federal per-person spending cap has been reached, federal funding cuts off. And natural disasters aren’t the only variables sure to raise costs.
The Center on Budget and Policy Priorities (CBPP)  warns that under a per capita cap, “federal funding [in traditional Medicaid] for seniors, people with disabilities and families with children would no longer automatically increase to account for higher costs such as prescription drug price spikes or rising costs resulting from an aging population. States would be responsible for 100 percent of all costs above the cap.”
So how does Graham-Cassidy expect states to cope with these huge cuts? By dropping coverage (like prescription drugs) and dropping people (like pregnant women) that they are currently required to cover.
Graham-Cassidy Repeals the ACA and Replaces It with … Nothing
Starting in 2020, Graham-Cassidy completely eliminates the ACA’s Medicaid expansion and subsidies for purchasing private insurance. As Cassidy himself tweeted, Graham-Cassidy “repeals entire architecture of Obamacare.”
In its place, the bill calculates how much money the federal government would have spent on ACA programs, cuts that by over one-third, and then redistributes the much smaller pot as block grants to the states with few strings attached. While the ACA includes consumer protections that prevent insurance companies from selling worthless “junk” insurance, rescinding coverage the moment someone gets sick, or discriminating against people with pre-existing conditions,Graham-Cassidy gives states free rein to reinstate all of the worst insurance practices of the bad old daysThat means insurance companies could once again charge non-smoking women more than smoking men, treat rape and domestic violence as pre-existing conditions, and reinstate annual and lifetime caps on coverage.
Even worse, there’s no requirement that states actually spend the money on providing coverage to low- and middle-income families. States would be free to spend the money on any purpose tangentially related to health care, and could design programs that discriminate against women, people of color, immigrants, LGBTQ people and other marginalized communities.
Initially, the 19 states that have thus far refused to expand Medicaid—leaving millions of their residents without care—will get an increase in ACA dollars by taking money away from the states that covered their residents. While the bill’s formula for distributing funds is complicated, it can be summed up in under 140 characters, as tweeted by conservative Senator Rand Paul (R-KY): “#GrahamCassidy … redistributes money from dem states to republican states.”
But even many of those Republican states will actually still face deep cuts once the per capita cap on traditional Medicaid is factored in. Analysis by CBPP finds that all but eight states will lose millions to billions of dollars under Graham-Cassidy in the years between 2020 and 2026.
But, no state will benefit for long. That’s because after 2026 under Graham-Cassidy, traditional Medicaid will be reduced by over one-third, while the ACA-turned-block grant funding will disappear altogether to be replaced with… nothing. That’s right, starting in 2027, the bill eliminates every last dollar spent on the ACA.
Finally, the bill once again attacks the ability of women and men to use Medicaid or other forms of government health insurance at Planned Parenthood for services like cancer screenings, STD treatments, family planning services like birth control, and more.

What’s Happens Next?

Senator John McCain (R-AZ), who dramatically voted against an ACA repeal in July out of concern that the bills hadn’t gone through “regular order”—including a bipartisan process of committee consideration—has said that he supports the bill (bill sponsor Graham is his best friend).  But he has hedged about whether he could support it in absence of a committee process. In response, bill co-sponsor Johnson told the press, “I’m chairman of Homeland Security. If either the Finance Committee or HELP committees [with jurisdiction] won’t hold a hearing, I’ll [set up] one this afternoon,” simply to check that box.

Under Senate rules, Graham-Cassidy will need a budget “score” from the Congressional Budget Office (CBO) and a “Byrd bath” from the Senate parliamentarian—the process of determining whether individual provisions qualify under the “Byrd rule,” which limits what can be included in a reconciliation package. Republican leaders are pushing for a partial CBO score by next week, one that shows the fiscal impact but not the number of people harmed by cuts to their care.
Should Republicans secure 50 votes on Graham-Cassidy or any other Trumpcare proposal, they will be able to pick up from where they left off in July, with all debate time expired and only the rapid-fire amendment process known as vote-a-rama left. In other words, some of the most consequential legislation in our nation’s history, affecting one-fifth of our economy, could get a vote after only 5 minutes of debate on the Senate floor.
If we can prevent the Senate from passing repeal legislation before September 30, we will have blocked their ability to pass Republican-only health care legislation for the foreseeable future. But if the Senate passes Graham-Cassidy, the House faces no similar time limit on their ability to pass the bill. They could—and likely would—move to immediately take up the Senate bill and pass it without changes, sending it to Donald Trump for signature. But they could also use the remaining 15 months of this Congress to pressure blue state Republicans to vote for the bill and stymying hope for a bipartisan package.
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