The Republican effort to repeal and replace the Affordable Care Act (ACA) is a case study in the Lazarus syndrome – the spontaneous resuscitation of a patient after death. After suffering what many considered to be a fatal blow on the Senate floor back in July, the Republican ACA repeal and replace effort roared back to life last week. After many fruitless weeks of pushing their proposal at the White House and among their colleagues, Senators Lindsay Graham (R-SC) and Bill Cassidy (R-LA) hurtled into the spotlight last week, becoming the GOP’s final hope for repealing and replacing the ACA. Since the odds of Senate passage are looking dimmer by the minute, I won’t get too much into the nuts and bolts of the Graham-Cassidy plan here, but if you want to learn more there are helpful summaries HERE and HERE. But given that this effort seems to consistently find new life, I think it’s important to consider what odds the proposal would face in the House, should it ever make it out of the upper chamber.  The process in the Senate has been fraught with plenty of hurdles, many of which have played out over the past several days. But what are the odds in the House? Speaker Ryan has expressed his support for the proposal and pledged to bring it up for a vote should the Senate pass it. So what would Speaker Ryan face if he brought this proposal to his members?

What feels like ages ago, there were 20 Republicans who voted against the House-passed iteration of repeal and replace, the American Health Care Act (AHCA). Though there were some who voted no because they felt the bill didn’t go far enough, the majority of those 20 were moderate Republicans from blue states who voted no due to concerns about coverage losses and cuts to Medicaid.

According to the Center on Budget and Policy Priorities, California, Oregon, and New York are a few of the states set to lose the most federal funding under Graham-Cassidy. Every Republican in the California delegation voted for the AHCA. Greg Walden, Chairman of the House Energy and Commerce Committee and Congressman from Oregon voted for the AHCA. Seven of the nine Republicans from New York voted for the AHCA. But now, with their states facing potential funding losses in the billions, will they be able to stay in the no column?

And on the other hand, will all the original 20 no votes remain? Congressman Will Hurd of Texas and Congresswoman Barbara Comstock of Virginia both voted no the first time around, but unlike many of their colleagues, their states are likely to see increases in federal funding under Graham-Cassidy. Will that be enough to convince them to vote yes?

The AHCA passed the House by a razor thin margin of just four votes. The Graham-Cassidy bill has introduced a whole new host of considerations for Members to weigh. Will this Hail Mary pass end in a touchdown or go up in flames? Stay tuned, it’s going to be a busy week.


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Molly McDonnell is a Principal at Winning Strategies Washington, a DC-based government relations firm. Molly spent several years on Capitol Hill working for a member of the Energy & Commerce Committee with a focus on health care.

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