By Jonathan D. Salant | NJ Advance Media for NJ.com
Having failed in their previous attempts to repeal the Affordable Care Act, President Donald Trump and Senate Republicans are itching to make one last try this week.
They're up against a Saturday deadline. That's the expiration date for a budget resolution allowing Senate Republicans to pass legislation with just 51 votes rather than 60.
That would require the support of at least eight Democratic senators, and House and Senate Republican leaders have spent the past nine months excluding the minority party from all debate about health care legislation.
Sen. Bill Cassidy, R-La., center, listens as Sen. Lindsey Graham, R-S.C., left, speaks, accompanied by Senate Majority Leader Mitch McConnell, R-Ky., on Capitol Hill. (AP Photo | Alex Brandon)
The latest effort, sponsored by U.S. Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., would take all the money that now goes for insurance subsidies and expanded Medicaid, cut $239 billion, and redistribute the rest to the states as block grants in such a way that those states that enrolled more residents (such as New Jersey) would get fewer federal dollars and others would get more.
The measure also would end traditional Medicaid by giving each state a fixed amount rather than cover costs based on need, and would expand Health Savings Accounts, which allow taxpayers to put away money tax-free to pay for medical expenses and primarily are used by upper-income Americans.
The sponsors offered a new version on Monday that they said would reduce the losses that states like New Jersey would face, but the figures released do not include the Medicaid cuts.
President Donald Trump speaks with reporters before boarding Air Force One at Morristown Airport. (Brendan Smialowski | AFP/Getty Images)
Trump has embraced the repeal efforts even though they broke his campaign promises to not cut Medicaid and to not take insurance away from anyone. He has claimed that the current law is failing, an assertion refuted by the Congressional Budget Office and outside experts.
“Eventually we’ll win, whether it’s now or later,” Trump told reporters after spending the weekend at his Bedminster golf club.
But it's a tough sell, and it would still smack New Jersey hard. Here's how it breaks down, by the numbers:
0: States that would be 'big winners,' despite what Trump said
None of the states Trump touted as "big winners" under the Republican repeal bill he's backing actually came out ahead in the initial proposal.
Alaska would lose $275 million, Arizona $4.5 billion, Maine $54 billion and Kentucky $6.3 billion, according to the Kaiser Family Foundation, which studies health care.
A last-minute adjustment proposed Monday would give more money to Alaska and Maine in order to win support from U.S. Sens. Lisa Murkowski, R-Alaska and Susan Collins, R-Maine, who have opposed all of the previous Republican repeal efforts.
Senate Finance Committee Chairman Orrin Hatch, R-Utah. (AP Photo | Rick Bowmer)
1: Hearings on new bill
The Senate Finance Committee, which has jurisdiction over health care, held a hearing Monday on the latest Republican health care bill.
In the nine months of debate over repealing the Affordable Care Act, that was the only scheduled committee hearing in either the House or Senate.
2: N.J. senators opposed to Obamacare repeal
Both U.S. senators from New Jersey, Democrats Cory Booker and Robert Menendez, oppose the latest Republican repeal legislation.
Booker called the measure "even more harmful to Americans than its cruel and craven predecessors."
Menendez said he would skip his trial in Newark so he could travel to Washington and vote against against the measure. "This bill is still a mean-spirited, right-wing assault on the health and security of American families," he said.
3: Senate Republican defectors who could kill it
With 52 Republican senators, Senate Majority Leader Mitch McConnell, R-Ky., can afford just two defectors and still pass legislation. So far, Collins and U.S. Sens. John McCain, R-Ariz., and Rand Paul, R-Ky., have said they will vote no. A fourth lawmaker, Murkowski has opposed every other effort this year to repeal the Affordable Care Act. If no one changes their position, the bill is dead.
3: Reasons why millions of Americans will lose coverage
A Congressional Budget Office report issued Monday said millions of Americans "with comprehensive health insurance that covers high-cost medical events" would no longer have coverage for three reasons:
First, cuts in Medicaid funding would drive down enrollment. Second, individuals would no longer be able to afford coverage because subsidies would be reduced. Third, many Americans no longer would buy insurance because they would no longer be required to.
The CBO said it did not have enough time to completely analyze the proposal, meaning the Senate would be voting on legislation without knowing its full impacts.
6: Major health care groups who say it's bad
Six health care groups representing doctors, hospitals and insurers -- the American Medical Association, American Academy of Family Physicians, American Hospital Association, Federation of American Hospitals, America's Health Insurance Plans, and the Blue Cross Blue Shield Association -- released a letter opposing the latest Senate Republican repeal effort.
"Health care is too important to get wrong," the groups wrote. "Let’s take the time to get it right."
10: Current Obamacare health benefits that could end
Under the Affordable Care Act, all insurance policies must cover 10 essential health benefits, including hospitalization, prescription drugs, maternity care, mental health services, and treatment for addiction.
The Senate GOP bill would allow states to get waivers and enable insurers to offer policies that do not provide such coverage.
The new CBO report said coverage for people with pre-existing conditions would be much more expensive in some states and could even "become unavailable or more expensive for many more people than it would be under current law."
52: Percentage of Americans who don't like this bill
A majority of Americans, 52 percent, disapproved of the latest Republican repeal efforts, according to a CBS News poll. Just 20 percent supported the measure.
The survey of 1,202 adults was conducted Sept. 21-24 and had a margin of error of 3 percentage points.
In an ABC News/Washington Post poll, Americans preferred the existing health care law to the Graham-Cassidy repeal bill, 56 percent to 33 percent.
That survey of 1,002 U.S. adults was conducted Sept. 18-21 and had a margin of error of 3.5 percentage points.
218: Votes it would need in the House
Should the Senate pass Graham-Cassidy, the measure would go to the House. Lawmakers there would have to pass the bill unchanged, because any amendments would require a new Senate vote, and then 60 votes would be required.
House Republicans would need 218 votes, which is not guaranteed. They barely passed their initial repeal bill on the second try; a switch of only two votes would have killed legislation that the CBO said would have left 24 million fewer Americans insured
The last time, two votes for the House bill came from Reps. Rodney Frelinghuysen, R-11th Dist., who switched his position, and Tom MacArthur, R-3rd Dist.
Now they would be asked to support legislation that transfers billions of dollars in federal funds from New Jersey to other states.
900,000: N.J. residents who could lose health coverage
Around 900,000 New Jersey residents, including those now covered under the Medicaid expansion, could lose their health coverage under the Senate GOP repeal, according to New Jersey Policy Perspective, a progressive research group.
32 million: More Americans uninsured
As many as 32 million additional Americans would not have health insurance in 2026 under the Senate GOP repeal plan, according to the Commonwealth Fund, a foundation that supports efforts to increase health coverage. That includes up to 18 million people in 2019.
Gov. Chris Christie at the State House in Trenton. (Michael Mancuso | For NJ.com )
$6.5 billion: How much N.J. would lose through 2026
The Garden State would lose $6.5 billion from 2020 to 2026 under the Senate Republican repeal bill compared with existing law, according to the Kaiser Family Foundation. Only seven states would face a larger cut.
The revised bill would mitigate that somewhat, though figures provided by the legislation's sponsors did not include the reduction in Medicaid spending by the caps imposed on states.
$112 billion: How much N.J. would lose through 2036
A study by Avalere Health, a health care consulting firm, said New Jersey would lose $112 billion in federal funding from 2020, when the GOP law would take effect, to 2036, 10 years after the federal health care block grant ran out under the legislation.
Read more on Obamacare repeal
You won't believe how hard N.J. would be hit by new Republican Obamacare repeal
N.J. hospitals say new Republican Obamacare repeal 'would hurt millions of people'
There's a last-ditch Republican effort to repeal Obamacare, and it would still slam N.J.
Is Trump trying to sabotage Obamacare enrollment? N.J. lawmaker demands answers
N.J. insurers seek rate hikes as Trump actions threaten Obamacare
Jonathan D. Salant may be reached at jsalant@njadvancemedia.com. Follow him on Twitter @JDSalant or on Facebook. Find NJ.com Politics on Facebook.
Ad Choices