The Graham-Cassidy bill to murder Obamacare isn’t actually dead yet, and the bill’s supporters keep fiddling around with the numbers to try and make it slightly more palatable to Republican senators who might conceivably be convinced to pass the damned thing this week. Politico has acquired a copy of the most recent draft of the bill, which shifts some Medicaid spending around to supposedly make the bill a bit more appealing to Senators Lisa Murkowski of Alaska, Rand Paul of Kentucky, and possibly to Arizona’s John McCain, who said Friday he would vote against the bill. The new version even has goodies for Maine, although Susan Collins said Sunday morning she found it “very difficult” to see how she could be persuaded to vote for the bill. But that was Friday’s version of the bill, so let’s not assume McCain will hold to his “no” pledge. Besides, the Senate will hold a single hearing on the bill today, which maybe McCain will decide is enough “regular order” for him.
So what’s new in this new crappy version of the already-crappy bill that would turn funding for the Affordable Care Act and Medicaid into block grants to the states (with great big cuts from current funding levels) while also having the completely intended side effect of throwing out any protections for pre-existing conditions, along with bans on caps on coverage? Politico ‘splainers:
Under the revised measure, the bill’s authors now project increases in federal funding for Arizona (14 percent), Kentucky (4 percent) and Alaska (3 percent), which would have seen declines in funding under the previous version, according to a leaked analysis from Trump’s health department. In particular, Murkowski’s home state would uniquely benefit from Sec. 129, which allows the state with the highest separate poverty guideline — Alaska — to receive a 25 percent hike in federal matching funds for Medicaid.
Funny, though: It turns out that the new version doesn’t include any new money for Medicaid block grants. The total is still a cut of $175 billion by 2026, capped by state population, and rolls back Medicaid expansion. But this time out, the distribution has been rejiggered to appeal to those wavering senators, while still cutting the block grant to states that expanded Medicaid. Just one problem with that, as Politico notes:
Alaska, Arizona, Kentucky and West Virginia would still receive less funding under Graham-Cassidy compared with Obamacare, according to Topher Spiro, a health analyst with the left-leaning Center for American Progress. In Twitter postings, he said the bill’s authors were accounting for money states saved as a result of ending Obamacare’s Medicaid expansion to low-income adults, which is overwhelmingly funded by the federal government but requires states to pay a fraction of the cost.
Topher Spiro explains the statistics fuckery in this Twitter thread:
States will “save” a lot on Medicaid — if they cut spending on Medicaid to match the federal cuts that will already leave more people without medical care. So that’s some great “savings,” huh?
The latest revision also includes some tweaks intended to win over Ted Cruz and Mike Lee, who haven’t actually come out against the bill but who murmured over the weekend that maybe it’s not quite cruel enough:
The revised bill also includes provisions that would give states more freedom to eliminate federal insurance regulations, as Cruz and Lee have requested. For instance, states could lift existing caps on out-of-pocket costs, which currently prevent insurers from offering bare-bones insurance policies. As a result, people could potentially buy health plans featuring cheaper premiums but higher out-of-pocket costs, which are more attractive to healthier customers.
Hooray! Junk insurance for everyone! And Jimmy Kimmel’s baby could exhaust his lifetime maximum before he’s in kindergarten.
Shorter Version: The “new” Graham-Cassidy is every bit as bad as the previous one, and we’d like to hope that Lisa Murkowski and Susan Collins will be smart enough to see that that even with the shuffling-around of shrinking healthcare dollars, their states would still be worse off — and other states would see enormous cuts. The Brookings Institution estimated last week that 32 million people would lose insurance if this mess becomes law, and the changes released last night would only change slightly where they’d lose their insurance. And there’s nothing in this version to overcome the opposition of pretty much the entire healthcare system, which released this letter Saturday:
That’s quite an impressive array of opposition: the American Medical Association, American Academy of Family Physicians, American Hospital Association, Federation of American Hospitals, America’s Health Insurance Plans, and the BlueCross BlueShield Association — not exactly a bunch of lefties, although if you want some lefties you could add in Planned Parenthood, plus nonpartisan patient and research advocacy groups like the AARP, American Cancer Society, the Children’s Hospital Association, the Alzheimer’s Association, and the National Association of Medicaid Directors. Among many others.
Unfortunately for patients, doctors, hospitals, and researchers, the most important voices in health care, big Republican donors, want their damn tax cuts, so the rest of us have to be very, very loud. Get to the phones, folks. We have one more week of pressuring senators to vote against this trainwreck — and then next year, they can start trying to kill Obamacare all over again.