COVINGTON, La. — Sen. Bill Cassidy got cheers on late-night television for calling for an Obamacare replacement plan that would pass what he calls "the Jimmy Kimmel test" — that is, cover children like the comedian’s son recently born with a congenital heart defect.
But the first-term senator and physician is not seeing that support from his GOP colleagues.
“He knows of what he speaks,” said Sen. John Cornyn of Texas, the Senate’s No. 2 Republican. “But we’ve got to find a way to get behind a consensus bill.”
Cassidy is undeterred. To hear him tell it, he’s the one in Congress fighting to keep President Donald Trump’s promises to his base. On the campaign trail, Cassidy argues that Trump consistently promised a health plan that would reduce premiums, eliminate mandates, ensure continuous coverage and protect people with pre-existing conditions. Any GOP plan, he says, needs to meet that bar.
“I’ve been pretty out front and pretty bold and pretty national and pretty local, saying I want our bill to pass because our bill fulfills President Trump’s pledge to the voter,” Cassidy told 220 people packed into a town hall outside New Orleans last week. “Also, by the way, I think it is good public policy and I think is good for the American people.”
Sen. Lindsey Graham (R-S.C.) called Cassidy a “real intellectual driver on our side” and said it’s unlikely the Louisiana senator would simply fall in line at the end of the process and vote for whatever GOP leaders demand. Graham has co-sponsored Cassidy’s bill even though it stands little chance at this juncture.
“I don’t think he’ll vote for a bill that he doesn’t believe in,” Graham said.
Cassidy demurs when asked whether he would support a GOP plan that he feels doesn’t meet that Trump pledge.
“I hesitate to answer that because I want to see” the bill, he told POLITICO. “I may feel like it crosses that bar and someone else may think not.”
In many ways, Cassidy’s whole professional life has led up to this moment. A gastroenterologist who cared for uninsured Louisianans in the state’s charity hospital system, Cassidy stands out for his passionate advocacy for the people he once treated, even as he ran against Obamacare during his Senate campaign.
He was the first senator out of the gate to introduce an Obamacare replacement bill with moderate Republican Sen. Susan Collins of Maine that would allow states to set up the health plan of their choice — including keeping Obamacare. To date, only five Republicans have signed onto a proposal that most other Republicans regard as too liberal and Democrats as too conservative.
But should Majority Leader Mitch McConnell be unable to corral 50 votes for a more narrowly partisan bill, Cassidy hopes his bill could become a bipartisan starting point.
“There are parts of it I like,” Sen. John Neely Kennedy, Cassidy’s GOP colleague from Louisiana, said of his proposal. “I don’t like the idea of allowing states to remain on Obamacare if Obamacare is failing.”
Sen. Chris Murphy (D-Conn.) derided the Cassidy-Collins effort as “window dressing” for what will ultimately be an all-Republican bill written by the 13-person working group that excludes Cassidy.
Cassidy says he wasn’t offended by his exclusion from McConnell’s working group — and he’s attending the meetings anyway. As someone who probably has more firsthand experience with Medicaid than any other Republican senator, he says he is determined to influence the debate, even if he has to muscle his way in.
Certainly, he’s doing everything he can to keep his own proposals in the public eye. When Kimmel’s tearful plea for health coverage for children went viral last month, Cassidy called for any Obamacare repeal plan to pass the “Jimmy Kimmel test” — a quip that got him booked on the talk show and that he’s regularly taken to the Senate floor.
Formerly a low-profile and somewhat anonymous senator, Cassidy is now dogged by packs of reporters and offers candid takes on the CBO’s score for the House’s health care bill (an “eye-popper,” he says). At one point, he rolled up his shirtsleeves and walked reporters through the intricacies of his health plan on a whiteboard.
He also handed his fellow Republicans a seven-page handout showing the strong correlation between the states Trump won and the parts of the country most in need of health care and health insurance. He created a spreadsheet of how much money each state would lose if Obamacare’s Medicaid expansion funding were eliminated.
And he’s pushing Republicans to revamp the Medicaid program, now an entitlement, to a set payment for every enrollee — an idea he first proposed in 2013.
He’s also seeking to automatically enroll people in a health plan with a chance to opt out — a proposal some other Republicans say is too similar to the unpopular individual mandate.
Cassidy is not alone in advocating for a health care bill that would require Democratic cooperation, and several Republican senators have stated they are uncomfortable with using the budget reconciliation process to sweep away Obamacare on a party-line vote in an effort to avoid a Democratic filibuster. But Republicans say that they cannot pursue work with Democrats until their GOP-only efforts fail first.
“I don’t like that we’re doing this through reconciliation,” said Collins. “I understand why we are because we’ve had no cooperation from the other side of the aisle, but I just think that makes it extremely difficult to come up with a comprehensive approach.”
Sen. Mike Rounds (R-S.D.), a supporter of the Cassidy-Collins bill, said that Democrats won’t cooperate unless the GOP’s party-line effort fails. But he said he was confident that Cassidy’s legislation would get consideration and that he has the most realistic view of how to move away from Obamacare: by propping up the individual markets with subsidies to keep insurance affordable for several years.
“He understands that you can’t just simply look at them and say … ‘We’re just going to let you fend for yourself,’” Rounds said of Cassidy. “I call it the Obamacare hangover. It’s the time period after Obamacare where we’re going to have added costs but we’re going to have to help them.”
Cassidy is sometimes sensitive to his colleagues’ opinions of him. In 2014, after being called "weird" by Louisiana Democratic Rep. Cedric Richmond, he sought a meeting with Richmond to bury the hatchet. These days, he expresses irritation at Democrats for refusing to work with him, calling them “incredibly passive” for a group of “alpha males and alpha females.”
In a May interview, he excoriated Minority Leader Chuck Schumer for rallying his troops to ignore the GOP until they admit they can’t repeal Obamacare.
“Schumer says: ‘Well, you need to play by my rules. And so therefore, I’m going to write off the needs of those millions in New York,’” Cassidy said. “It’s just the craziest thing in the world.”
Meanwhile, with the GOP’s razor-thin Senate margin, many lawmakers don’t believe a health care bill can pass without Cassidy’s support.
Fueling concerns that he might oppose a GOP repeal bill is his alliance with Collins, the most moderate Senate Republican and the most likely to break with her party.
Collins jokingly told reporters recently that the duo would only do joint interviews.
“Because we’re Cassidy-Collins,” she said. “It’s my first name now.”
Cassidy recognizes this as his moment. As a lawmaker, “you want to contribute ideas, and I know I am contributing ideas,” he said in an interview after his town hall meeting last week.
He acknowledged that not all of his ideas have taken off yet and he doesn’t have the clout that comes with a committee chairmanship or decades in the Senate.
So instead, he’s going to talk about his proposal until he’s blue in the face.
“Sometimes,” he said, “ideas have to be socialized.”