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Washington — The authors of the latest GOP health care repeal effort defended their bill in a hearing before the Senate Finance Committee on Monday afternoon, even as the legislation appeared doomed.

“We are going to send this money back to the states. You can’t spend it on roads and bridges. You gotta spend it on health care,” Republican Sen. Lindsey Graham of South Carolina told the panel Monday.

“You’re going to have flexibility, but you’re also going to have accountability. And for the first time in health care, somebody’s going to listen to you.”

Protesters, many in wheelchairs, chanted as the hearing got underway in a Senate office building Monday: “No cuts to Medicaid! Save our liberty!”

Committee Chairman Orrin Hatch of Utah briefly recessed the hearing as police carried or wheeled the demonstrators out of the hearing room.

Several Republicans on Monday continued to express doubt or opposition to the bill, despite revisions intended to gain their support for the legislation, sponsored by Graham and Louisiana Sen. Bill Cassidy, a physician.

Sens. John McCain of Arizona and Rand Paul of Kentucky don’t plan to support the bill, and moderate Sens. Susan Collins of Maine and Lisa Murkowski of Alaska have concerns. Senate GOP leaders can only lose two votes and still pass the legislation. They face a looming deadline to pass the bill by month’s end.

Sen. Debbie Stabenow, the Lansing Democrat, has called the legislation a last-minute “sneak attack” on the federal health care law, the Affordable Care Act, better known as Obamacare.

Stabenow, the ranking Democrat on the Senate Finance Subcommittee on Health, on Monday highlighted a new report from Standard & Poors that the legislation could cost 580,000 jobs in 2027.

Stabenow also cited an analysis of the initial bill by the consulting firm Avalere Health that estimated Michigan would lose 35 percent of its federal funding for health care, or $140 billion, by the time the legislation is fully phased in in 2036.

That is compared with the $56 billion state budget signed recently by Gov. Rick Snyder, Stabenow noted.

“There is no way that we will not see people’s health care, nursing home, children’s care cut as a result of this bill,” she said at the hearing.

Stabenow has also expressed frustration that the repeal debate this week bumped plans for the Senate to consider a bipartisan deal to extend funding for the federal health insurance program for low-income children, as well as for community health centers – both of which expire Sept. 30.

The Graham-Cassidy proposal would end the Affordable Care Act’s subsidies for private insurance and eliminate the Medicaid expansion for low-income Americans adopted by 31 states, including Michigan.

States would instead receive lump-sum payments to create their own health programs. In his testimony, Cassidy argued that states could use the block grant money to continue their Medicaid expansion programs for low-income earners.

The legislation repeals the mandate that individuals obtain health insurance coverage and that larger employers provide access to coverage, but Graham said states may reinstate those mandates if they wish.

“We leave the taxes in place, $1.2 trillion, and we block-grant it out to the states in a formula that I think is fair,” Graham said.

Stabenow doubted that Congress would extend the block grants after they expire in 2027 because of to the expected $190 billion cost for the next year at the same level of funding. By comparison, the entire budget for Health and Human Services is $164 billion.

“You couldn’t pay for that block grant. It’s not believable. It’s just not credible,” she said.

The revised plan would make it easier for states to waive some federal insurance regulations, but Cassidy insisted that critics of this provision misunderstand the text.

“We preserve protections like mental health parity, guaranteed issue, prohibit charging women more, no lifetime caps,” Cassidy testified.

“States applying for waivers must prove that Americans with pre-existing conditions have access to affordable, adequate coverage. Period. The end. And you define affordable as ‘able to afford.’”

But Stabenow said the bill would jeopardize protections for women seeking maternity care, which was a “major debate” in the Senate when it was adopted as one of the “essential health benefits” that insurers must cover under the ACA.

Republican Gov. Rick Snyder said over the weekend he is still reviewing the GOP Senate plan but is concerned by outside analyses suggesting it could be bad for Michigan.

The Congressional Budget Office released Monday a preliminary analysis of the original Graham-Cassidy proposal that found that there would be “millions” less of people with comprehensive health insurance covering “high-cost medical events.”

“That number could vary widely depending on how states implemented the legislation, although the direction of the effect is clear,” according to the analysis.

The lower number of the insured would result from federal funding cuts in Medicaid, reduced subsidies and the repeal of the coverage mandate that included rising penalties for those who didn’t buy insurance, according to the CBO.

Staff writer Jonathan Oosting contributed

mburke@detroitnews.com

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