The GOP is setting aside a lot of stuff that needs to get done so it can take one last whack at killing Obamacare, this time through the awful Graham-Cassidy bill, which would convert federal healthcare spending for the Affordable Care Act and Medicaid into block grants to the state, while also making those grants much smaller than the amounts currently spent on both programs. Then the states will magically be more efficient in setting up 50 different healthcare systems, so the cuts won’t matter and everyone will be covered, maybe. At least until 2026 when the block grant funding goes away altogether. It’s “flexibility” and it’s “federalism,” and also it’s bullshit.
We’ve ‘splainered why Graham-Cassidy is a clusterfuck that would even hurt people with employer-paid insurance, and we’ll also keep pointing you to these more detailed pieces at Vox and WaPo, so lets’ get right into the latest developments.
First off, you’ll be glad to know that the consensus of health policy experts is that Jimmy Kimmel is right and co-sponsor Bill Cassidy is a lying liar about the bill’s impact — on people with pre-existing conditions, and on the healthcare system in general. Also, Kimmel got pretty shirty with Cassidy and Graham, who dismissed him as only a dumb comedian, and called Brian Kilmeade a “phony little creep,” which may be the nicest thing anyone’s said about Kilmeade lately.
Oh, but there are bigger fish to fry. One of the key parts of Graham-Cassidy, those very rules that would allow states to waive protections for people with preexisting conditions and to cut essential health benefits like prescription coverage, maternity benefits, mental health care, and even ER/hospital visits, may actually not pass muster with the Senate parliamentarian, Elizabeth MacDonough, according to a piece by U of Chicago Law professor Daniel Hermer. In order to pass the bill with just 50 votes and a tie-breaker by Mike Pence, the whole thing has to meet the conditions of the so-called “Byrd Rule” for budget reconciliation measures. That means it can’t contain any provision that “produces changes in outlays or revenues that are merely incidental to the non-budgetary components of the provision.” Hermer notes Graham-Cassidy includes several provisions that the parliamentarian rejected in the Senate’s previous attempt at strangling Obamacare, the “Better Care Reconciliation Act” (BCRA), like banning funding of Planned Parenthood (probably included to attract “pro lifers” even though the provision would be doomed), and rules that weren’t really about the budget but that regulated health care, like the imposition of a six-month waiting period to buy insurance if people were uninsured for over two months; a rule allowing insurers to charge older enrollees five time as much as younger ones; and the provisions that allowed states to tell insurers they can charge any price for folks with preexisting conditions and wouldn’t have to cover all essential medical benefits.
If the parliamentarian rules them out, losing the provisions eliminating essential health benefits and protections for preexisting conditions could kill support from more than a couple of GOP senators, says Greg Sargent at WaPo, since then the block grants would cut federal health spending but would leave ACA regulations in place, requiring states to do what the ACA does, but with far less money. That would eliminate the “flexibility” that’s supposedly the whole point of Graham-Cassidy. As Hermer explained in an email to WaPo:
Without the waiver provision, Graham-Cassidy is a totally different bill. It doesn’t provide states with flexibility, but it still takes away a lot of money. This would change the terms of the debate entirely — and would do so just a few days before the senators cast their final votes.
So there’s the possibly hopeful news, not that the parliamentarian’s ruling slowed down McConnell and crew back in July. But it might peel away some of the GOP “moderates” (no such thing) who would love to kill Obamacare if they can crow about “flexibility.”
Don’t bet your prescription or ob-gyn benefits on that, though. As CNN and Vox both note, there’s really one big factor appealing to Republicans this week and next: It’s their last chance to keep rightwingers happy and say the voted to “repeal and replace” Obamacare. Plenty of them — like the Leader of the Free World — don’t give two runny shits what’s in the bill, and would be happy to ignore the parliamentarian’s ruling if it goes the wrong way. They just want a win, no matter the cost, no matter how many people lose insurance, no matter how many babies max out their lifetime coverage caps before they reach kindergarten (oh, we’re not allowed to mention babies because that’s emotionally manipulative, and besides, we support abortion rights).
Vox ran an enlightening set of interviews with Republicans on why they’re supporting Graham-Cassidy. Some seem to have at least a wishful-thinking understanding of the bill, like Oklahoma’s Jim Inhofe, who explained that huge budget cuts wouldn’t hurt anyone, since “the efficiencies that come with transferring the funding to the states can very well make up the difference between what the federal thing would be.” And if not? “Well, nothing protects everyone.”
And then there’s super-smart Kansas Senator Pat Roberts, who thinks all Indian doctors know each other (or should). He didn’t even seem to understand reporter Jeff Stein’s question, “What problems will this solve in the health care system?”
Pat Roberts: [Graham-Cassidy] is the last stage out of Dodge City. I’m from Dodge City. So it’s the last stage out to do anything. Restoring decision-making back to the states is always a good idea, but this is not the best possible bill — this is the best bill possible under the circumstances.
If we do nothing, I think it has a tremendous impact on the 2018 elections. And whether or not Republicans still maintain control and we have the gavel.
Jeff Stein But why does this bill make things better for Americans? How does it help?
Pat Roberts: Pardon me?
Jeff Stein: Why does this make things better? What is this doing?
Pat Roberts: Look, we’re in the back seat of a convertible being driven by Thelma and Louise, and we’re headed toward the canyon. That’s a movie that you’ve probably never seen —
Jeff Stein: I do know Thelma & Louise, sir.
Pat Roberts: So we have to get out of the car, and you have to have a car to get into, and this is the only car there is.
Gotta pass it. It’s the last train out of Dodge (where Roberts didn’t actually have a home during his last election, in 2014), so no matter how crappy it is, the bell’s ringing. It only makes sense to throw as many people as possible under the wheels. How many people? Oh, only about 32 million, according to the Commonworth Fund.