The next 11 days are critical for health care advocates who are looking to safeguard the Affordable Care Act (ACA), as September 30 marks the deadline for passing an ACA repeal bill with just 50 votes, according to typical Senate rules. But the next two weeks will also be a test of whether lawmakers care about these rules and precedents in the first place.

After repeated failed attempts to repeal and replace the ACA, Republican lawmakers are yet again rushing through a health bill without waiting to get a comprehensive Congressional Budget Office (CBO) score or hold hearings on the contents of the legislation.

But GOP lawmakers are taking steps to make it appear as if their current repeal-and-replace effort is not sidestepping regular order — potentially in an attempt to win over key lawmakers like Sen. John McCain (R-AZ).

“Some of John McCain’s Senate colleagues are trying to get him to back on his word and abandon his principles,” noted New York Times columnist David Leonhardt on Tuesday.


McCain — with the help of his colleagues Susan Collins (R-ME) and Lisa Murkowski (R-AK) — killed the last iteration of the GOP’s ACA repeal-and-replace bill, rejecting the way Senate Republicans tried to fast-track their legislation.

McCain has repeatedly demanded “regular order,” a vague-sounding phrase that refers to standard congressional procedures and process. When McCain returned to the Senate after a leave of absence to undergo brain surgery in July, he pleaded with colleagues to return to regular order.

“Why don’t we try the old way of legislating in the Senate, the way our rules and customs encourage us to act,” McCain said. “If this process ends in failure, which seems likely, then let’s return to regular order.”

McCain reiterated the importance of process in August and then again in September.

Now, looking to garner support from McCain, his Republican colleagues have scheduled one hearing that would unpack the Cassidy-Graham bill — legislation that undercuts consumer protections more so than any other GOP health bill.


The hearing, which will held by the Senate Committee on Finance, is scheduled for Monday, September 25. A second hearing hosted by the Senate Committee on Homeland Security and Government Affairs — which has limited-to-no health care jurisdiction — was scheduled for the following Tuesday, but has since been cancelled.

It’s not yet clear who will testify before senators on the potential impacts of the proposal, and it’s also hard to imagine they will have all the information they need about the legislation’s impact.

Next week’s hearing will proceed without a comprehensive analysis from the CBO, which announced Monday that it will only be able to provide a “preliminary assessment” given the limited timeframe — a deadline that’s self-imposed by the Senate because it’s unlikely senators will be able to get enough support for the Cassidy-Graham to pass the bill with anything but a simple majority.

It’s hard to definitively say what health care coverage will look like under a Cassidy-Graham bill. Under the proposal, the ACA’s individual marketplace and Medicaid program is largely left to the states to decide. The bill repeals the ACA subsidies and Medicaid expansion, and in return states are afforded “flexibility” packaged as temporary block grants. The bill shortchanges the Medicaid program overall, which provides health care for low-income people, seniors, and people with disabilities.

Without a CBO analysis, think tanks have taken it upon themselves to explain to the public what the Cassidy-Graham bill would mean for them. The Center on Budget and Policy Priorities concluded that the proposed block grant structure would provide $239 billion less in funding between 2020 and 2026 than projected federal spending under current law; the cuts disproportionately hurt states that expanded Medicaid eligibility under the ACA. The Center for American Progress, meanwhile, projected that insurance premiums would significantly increase for people with pre-existing conditions. (Disclosure: ThinkProgress is an editorially independent site housed at the Center for American Progress.)

The aforementioned think tanks are liberal-leaning, which makes comprehensive independent analysis from the CBO that much more critical. Independent health care consulting firm Avalere Health said they would release its own analysis Wednesday.

Big Graham-Cassidy issue: whose numbers are credible in showing the redistribution of dollars between states? That Rs believe? — Rodney Whitlock (@RodneyMLS) September 18, 2017

Think tanks and health care groups have largely examined the bill from the perspective of the consumers. CBO would have measured the effects on the federal deficit, but is currently unable to produce this in time for senators to vote. As pointed out by Republican strategist Steve Schmidt, voting on a bill that affects one-sixth of the economy without a cost estimate is “antithetical to conservatism.”

Alternatively, there is a health bill that is making its way through Congress under regular order.

The Senate’s Health, Education, Labor and Pensions (HELP) Committee has been working on a ACA stabilization bill to strengthen the law and improve its state-level marketplaces; the bill’s drafting process has been applauded by Sens. Collins and Murkowski. The HELP committee has so far held 4 committee hearings on this bill.


Now that Senate Republicans are trying to rush through the Cassidy-Graham bill, however, the Republican leading this bipartisan legislation — HELP Committee Chairman Lamar Alexander (R-TN) — is reportedly feeling pressure from GOP leadership to kill the efforts.

A Senate Democratic aide privy to negotiations told ThinkProgress they are still hopeful that the committee can produce a bill. “We are not going to sit on this bill,” the aide told ThinkProgress.

Alexander said his team would try to produce the bill by the third week of September. The faster the HELP committee finalizes legislation, the better off the ACA will be; September 27 is the last day insurance companies can pull out of the marketplace while September 30 is the last day Republicans can pass an ACA repeal bill with just 50 votes.