American politics is always a math problem. If you have a group of x people, you need (x/2) + 1 votes to win the most votes. That holds true for most elections pitting two candidates against each other, and it holds true for passing legislation.
In the case of Cassidy-Graham, the clumsily named bill that is the latest and last iteration of Republican efforts to gut the Affordable Care Act, also known as Obamacare, the x is 100 — the number of votes in the Senate. Thanks to two quirks of the process, the legislation would pass with just (x/2) votes, with the +1 being added by VPOTUS-ex-machina Mike Pence. (The other quirk is that, under the rules that only apply until Sept. 30, the bill can’t be filibustered.)
Because there are 52 Republican senators and since there is one firm no and three maybes among that group, those maybes have an outsize influence over the fate of the legislation. And since that legislation has an outsize influence over the future of the country — it’s estimated that a sixth of the economy is linked to our health-care system — those senators have a lot of power.
How much power? Let’s consider Alaska, where Sen. Lisa Murkowski has refused to say with certainty how she’d vote (as is normally the case for her).
As written, Cassidy-Graham would cut health-care spending in Alaska by 2026 by some substantial amount: 8 percent according to the Kaiser Family Foundation or 11 percent per the consulting firm Avalere. Murkowski’s vote is so important to the process that AARP, which opposes the bill, put together a special report looking only at the effect of the legislation on that state.
“New AARP Public Policy Institute projections find that the per enrollee cap proposal in [the bill] will cut between $4.5 billion and $11 billion from total (federal and state) Medicaid spending in Alaska over the 20-year period between 2017 and 2036,” it reads — clearly hoping that Murkowski would read those words and decide to cast a no vote.
On Thursday afternoon, a report said that the advocates of the bill had returned fire. The Independent Journal Review’s Haley Byrd reported that a Republican Senate aide described a deal-sweetener that had been crafted for Murkowski. Under its terms, Alaska and Hawaii would get to keep the tax credits that keep insurance costs affordable under Obamacare, though the rest of the country would lose them. The deal would also delay implementation of the Medicaid caps that are a major driver of cuts in Medicaid spending over the long term. What’s more, Hawaii and Alaska would also get an increased Medicaid matching rate — that is, a higher percentage of the Medicaid costs that the government would reimburse.
(The inclusion of Hawaii in that deal suggests that perhaps it’s meant to address the long-standing partnership between the nation’s newest states, in which they tried to maintain a voting alliance that would protect their mutual interests. In 2015, Murkowski argued that such an agreement should be a mutual goal of the states.)
If that report is correct, the implications are staggering. To win a critical vote, Alaska (and Hawaii) might be spared many of the negative effects of the legislation. Because the Senate allocates its members by state and not population, that means two-thirds of 1 percent of the country could receive benefits that result in the other 99.33 percent of the country losing theirs.
Why? Because the Senate doesn’t work on (x/2) + 1 where x is the population of the United States. Neither does the House, of course, though it’s closer, and neither does the electoral college.
Again: There’s no guarantee that this deal would actually be offered or that Murkowski would take it. In June, when she was being similarly wooed, Murkowski told reporters: “Let’s just say that they do something that’s so Alaska-specific just to quote, ‘get me.’ Then you have a nationwide system that doesn’t work. That then comes crashing down and Alaska’s not able to kind of keep it together on its own.”
But it could be offered and it could sway Murkowski and that could give the Republicans 50 votes and the House could then pass it and President Trump could then sign it and then Alaska could be operating under much the same system as it does today while 48 other states scramble to respond to the new system.
That’s not really how the math is supposed to work.