Bill Cassidy

Sen. Bill Cassidy, R-La., right, arrives as Congress prepares to vote on the biggest reshaping of the U.S. tax code in three decades, on Capitol Hill, Tuesday, Dec. 19, 2017, in Washington. (AP Photo/Andrew Harnik) ORG XMIT: DCAH124

Andrew Harnik

WASHINGTON — For much of 2017, Louisiana Sen. Bill Cassidy plugged away at possible replacements for the Affordable Care Act, helping shape a series of policy proposals designed to undo former President Barack Obama’s signature legislative achievement.

Even as Republican efforts to repeal the ACA foundered in dramatic fashion over the summer, Cassidy and his staff kept working, eventually rolling out a block-grant proposal with South Carolina Republican Sen. Lindsey Graham that briefly gained momentum in September before, too, falling short on votes.

Though Cassidy’s efforts failed to make it into law, those pushes dramatically raised the Baton Rouge physician’s national profile and minted him as one of the GOP’s go-to lawmakers on health care issues.

The bitter battles over health care — which for months made crowds of protesters a fixture in the Capitol hallways and provoked vociferous opposition from Democrats — have left many of Cassidy’s colleagues reluctant to take another crack at dramatically overhauling the country’s health insurance system.

With Alabama Democrat Doug Jones now in the chamber, Republicans hold an even slimmer Senate majority. Meanwhile, a major GOP victory on taxes — including the repeal of the Affordable Care Act’s penalty for not having health insurance — has some of his Senate colleagues talking about moving on from contentious battles and onto narrower goals.

But Cassidy remains interested in another push. Just before Christmas, Cassidy sat down with Vice President Mike Pence and the Graham-Cassidy bill’s cosponsors — Graham, Sen. Dean Heller of Nevada and Sen. Ron Johnson of Wisconsin — to plot a potential path forward on a similar approach. Johnson and Cassidy said Monday that those meetings are ongoing.

“If there is another effort to repeal and replace, it will center around a block-grant approach similar to Graham-Cassidy,” Cassidy told The Advocate in a late-December interview.

“I didn’t run for office to hold the office,” Cassidy said. “I ran for office to try to do something good for the people of Louisiana and my fellow Americans.”

Cassidy and his co-authors acknowledged the tricky math to pass any bill through the sharply divided Senate. Republicans can only afford to lose one GOP vote and still pass legislation on a party-line vote.

Johnson said the group of GOP senators are tweaking the bill's formulas, designed to divvy up federal Obamacare health funding into block grants for states, in an effort to bring enough fellow Republicans on board. Opposition from Republican Sens. Rand Paul of Kentucky, Susan Collins of Maine and John McCain of Arizona doomed the earlier push.

Senate Republican leaders have sounded skeptical notes when asked about the possibility of another Obamacare repeal-and-replace effort in 2018, especially with midterm elections looming in the fall. Majority Leader Mitch McConnell, R-Kentucky, told NPR in December that other issues will likely dominate the discussion in 2018.

“We obviously were unable to completely repeal and replace with a 52-48 Senate,” McConnell said. “We’ll have to take a look at what that looks like with a 51-49 Senate. But I think we’ll probably move on to other issues.”

"Sometimes events dictate," Cassidy said Monday. "You’ve got to be ready when the time comes and, when the time comes, you go forward."

Cassidy, who worked for years as a doctor in Louisiana’s charity hospital system before launching a political career, arrived in the U.S. Senate in January 2015 after knocking off incumbent Sen. Mary Landrieu, a Democrat, in a hard-fought campaign.

Cassidy maintained a relatively low national profile over his first two years in the Senate, where power and influence are usually built over decades.

But the wonky senator's push for a conservative overhaul of the nation's health care system rocketed Cassidy to far greater visibility, eventually emerging as one of the most prominent faces of the ultimately unsuccessful efforts to repeal the ACA.

At the beginning of last year, he strategically shuffled his committee assignments, securing a seat on the Senate's Finance Committee, which oversees taxes and insurance issues. The job, paired with his spot on the Health Committee, put Cassidy in key positions to have a voice on healthcare.

Beginning with his work on a 2016 law addressing mental health care with Sen. Chris Murphy, D-Connecticut, Cassidy said his office has developed a reputation for “working hard on policy” and taking details of proposed legislation extremely seriously.

Cassidy weighed in on the repeal debate early in 2017 with a proposal, drafted along with moderate Republican Sen. Susan Collins of Maine, that would’ve left much of the Affordable Care Act in place in most states while allowing others to roll back much of the law.

Cassidy made a friendly May appearance on comedian Jimmy Kimmel's late-night talk show to tout his "Jimmy Kimmel Test" to include protections for those with pre-existing conditions in any Republican health-care bill.

Months later, Kimmel spent several straight shows using his opening monologues to attack Cassidy and savage the Graham-Cassidy bill for allegedly breaking those promises. Cassidy fired back that Kimmel didn't understand the proposal.

The Graham-Cassidy bill gained steam in September but unraveled days before an October 1 deadline to pass it with a simple majority. Cassidy called himself “disappointed,” but admitted defeat only for the moment, vowing to press on with similar policy proposals he contends would allow states to work toward more affordable health-care coverage for residents in ways the ACA won’t allow.

Opponents of the Graham-Cassidy bill included a range of stakeholders in the health-care system — doctors’ groups, insurance companies and hospital associations — as well as activists and a united Democratic caucus on the Hill. Many of those groups expressed alarm over caps the bill would’ve put on future Medicaid spending.

Jan Moller, executive director of the Louisiana Budget Project, which lobbied hard against the Graham-Cassidy proposal, said the legislation's low ratings in public-opinion polls and congressional Republicans’ repeated failure to repeal the Affordable Care Act should’ve sent a message to leave the law alone.

Cassidy’s “signature legislative initiative would’ve taken away health coverage from many thousands of his most vulnerable constituents, driven up costs for others and left Louisiana worse off,” Moller said. “Hopefully, Sen. Cassidy will use his considerable intelligence and clout to find a bipartisan solution to the health care problems we still face in this country."

Not long after the health care defeat last fall, Cassidy's office needed to immediately get positioned on the Republican effort to rewrite the nation's tax code. A number of lobbyists and outside interest groups credit Cassidy with playing a critical role in putting several Louisiana-friendly provisions into the legislation that became law.

Using his seat on the bill-writing Finance Committee, Cassidy inserted provisions giving victims of the 2016 Louisiana floods significant tax breaks, a measure that Louisiana's congressional delegation had long fought for, but had not been able to get through.

He also helped push through a hike in the cap on the amount of federal offshore oil revenue potentially flowing to Louisiana to fund coastal restoration work under the 2006 Gulf of Mexico Energy Security Act.

Historic preservation and redevelopment groups, meanwhile, have pointed to Cassidy as the most important figure in saving tax credits for redeveloping historical properties, which have been widely utilized by Louisiana builders and helped fuel a post-Katrina downtown building boom in New Orleans.

The National Trust for Historic Preservation's president singled Cassidy out for praise in saving the credits, which earlier drafts of the GOP bill would've eliminated. Jack Davis, interim director of the Preservation Resource Center of New Orleans, called the credits the "life blood of a key part of the economy."

Follow Bryn Stole on Twitter, @BrynStole.