Those efforts failed. But now Trump and Republicans are back with one final effort to repeal Obamacare. And in so doing, they will try to sell a proposal that would cut hundreds of billions of dollars in health spending on poor and working people — by peddling all sorts of creative lies about how those cuts wouldn’t actually end up hurting the many millions who would lose coverage as a result.
Anyone else notice a pattern here? This time, however, it just might work. But for that to happen, a handful of moderate GOP senators would have to support the bill in a way that would reveal their previous vociferous moral objections to GOP repeal efforts as entirely hollow.
The Post reports that Senate Republicans are planning a major push this week to see whether they can get 50 votes for the repeal bill created by Sens. Bill Cassidy (R-La.) and Lindsey O. Graham (R-S.C.). Politico reports that Trump and the White House will try to build support for it.
The Graham-Cassidy bill would get rid of the Medicaid expansion and subsidies for lower-income people starting in 2020 and replace them with block grants to the states, which could use that money to cover people in a variety of other ways. But as an analysis by the liberal Center on Budget and Policy Priorities shows, the result would be very deep cuts to the Affordable Care Act’s historic coverage expansion.
There are two reasons for this. CBPP concludes that the overall spending on the block grants would add up to hundreds of billions of dollars less between 2020 and 2026 than would be spent on Medicaid and subsidies under current law. As Jonathan Cohn puts it: “Cassidy-Graham would shrink the federal investment in health care programs dramatically.”
Second, because of Graham-Cassidy’s funding formula, it would redistribute funds from states that have expanded Medicaid to ones that haven’t, penalizing the states that have tried to make the law work for them. This would end up costing a lot of Republican states that expanded Medicaid. As Axios points out, the three Republican senators who helped sink the “skinny repeal” bill last time — Susan Collins (Maine), Lisa Murkowski (Alaska) and John McCain (Ariz.) — all come from states that would lose out under the bill.
You’d think that voting for Graham-Cassidy should also be a very heavy lift for other Republican moderates from states that expanded Medicaid, such as Shelley Moore Capito (W.Va.) and Rob Portman (Ohio). Their states, too, would lose out.
What’s more, most of these senators, including Collins, Murkowski, Capito and Portman, originally expressed strong moral opposition to the original GOP repeal bills precisely because of their deep Medicaid cuts. And now we are going to find out whether they meant what they said. Once the big push for Graham-Cassidy starts, you’ll hear the same old nonsense about how no one will lose out under the bill; how everyone will have “access” to coverage; and how the states will now have more “flexibility” to better address their coverage needs.
Indeed, that last talking point is already being employed. But as Cohn notes, what this really means is that states could redirect their block grant money away from covering poor people, and toward other goals, and the bottom line is that substantially cutting spending means that people — a lot of people — will lose coverage.
The grand health-care debate of 2017 revealed a meaningful divide between Republicans who want government to spend money to expand coverage to people who are too poor and sick to afford it, and those who want to roll back most or all of that spending. That divide was papered over for years, as Republicans could call for repeal without it actually happening. But once repeal loomed as a reality, a few Republicans revealed themselves to be unwilling to go through with it, precisely because that rollback of spending would have inflicted an unacceptable outcome on millions who stood to lose coverage.
Once the Congressional Budget Office weighs in on Graham-Cassidy, we will have a clearer sense of the magnitude of the coverage loss this latest effort would bring about. And we will once again find out whether those Republicans who claimed to oppose such an outcome meant what they said.
* MUELLER INTENSIFIES FOCUS ON TRUMP TEAM’S LYING: The New York Times reports that Trump’s lawyers, White House counsel Donald McGahn and outside counsel Ty Cobb, are feuding over how cooperative to be amid special counsel Robert S. Mueller III’s probe. Note:
Mr. McGahn himself is a likely witness. Mr. Mueller wants to interview him about [FBI director James] Comey’s dismissal and the White House’s handling of questions about a June 2016 meeting between Donald Trump Jr. and a Russian lawyer said to be offering incriminating information about Hillary Clinton. Mr. McGahn is willing to … answer questions, but his lawyer, Bill Burck, has asked Mr. Cobb to tell him whether the president wants to assert either attorney-client or executive privilege, according to lawyers close to the case.
Trump himself had a hand in the statement that lied to the United States about that meeting. When your lawyers are lawyered up, you know things will get rocky.
* TRUMP’S UGLINESS IS DRIVING AWAY CUSTOMERS: The Post reports that Mar-a-Lago is on track to have its slowest season in nearly a decade:
Trump’s properties are attracting new customers who want something from him or his government. But they’re losing the kind of customers the business was originally built on: nonpolitical groups who just wanted to rent a room. … Before this year, many longtime Trump clients said they would return to use his clubs again — believing that quitting a Trump club would be a political act. Now, as Trump’s presidency has grown more polarizing, some customers say they see it as a political act to stay.
Trump’s use of the presidency to promote Mar-a-Lago is being outweighed by the degree to which his racism and ugliness are driving customers away. Sad!
* MAJORITY DOESN’T TRUST TRUMP ON NORTH KOREA: A new NPR-Ipsos poll finds that 51 percent of Americans don’t trust Trump to handle the North Korea threat, vs. 44 percent who do trust him. Note this:
The president has unilateral authority to launch a nuclear strike — a fact that surprises many Americans. Only about a quarter of the people surveyed know that Trump can order a strike on his own authority. Most incorrectly think he needs to get Congress’ approval.
One big campaign issue was whether Trump could be trusted to handle nukes. One wonders how that debate might have played out if more people understood the president’s authority over them.
* REPUBLICANS FEAR ‘SENATOR ROY MOORE’: Politico reports that Senate Republicans are dreading the possibility that religious-right candidate Roy Moore might actually beat establishment pick Luther Strange in the Sept. 26 Alabama Senate runoff:
Moore could cause GOP leaders grief by aligning himself with a conservative bloc of senators, or go rogue by placing holds on legislation and nominees, employing the enormous powers that individual senators possess. … Other Republicans worry that a Moore victory would embolden other conservative challenges to other incumbents.
If Moore wins, look for former Trump adviser Stephen K. Bannon to seize on that to argue that other challengers should also try to oust GOP senators.
* WILL COLLINS AND MURKOWSKI HOLD THE LINE ON REPEAL? Graham-Cassidy would end the Medicaid expansion and replace it with block grants to states, which would punish states that used the ACA to help their residents. E.J. Dionne Jr. explains what this should mean:
This should make the bill impossible for two brave Republicans, Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, who stood up against July’s repeal effort. Both have said they would not be complicit in undermining health-care coverage in their states.
And the bill would, in fact, undermine coverage in their states. The question is whether these two — and John McCain, who has insisted on a return to regular order — will remain consistent.
* HOW REPEAL COULD STILL PASS: Paul Krugman reminds us that it was public outrage and activism that blocked the last GOP repeal efforts, and notes:
The news cycle has moved on, taking public attention with it. Many progressives have already begun taking Obamacare’s achievements for granted, and are moving on from protest against right-wing schemes to dreams of single-payer. Unfortunately, that’s exactly the kind of environment in which swing senators, no longer in the spotlight, might be bribed or bullied into voting for a truly terrible bill.
And all Republicans need is one of the three who voted against repeal last time — or perhaps two, if Rand Paul votes no, as he has been threatening to do, though I wouldn’t count on that — to flip.
* HOW TRUMP’S ADVISERS ARE SCHOOLING HIM ON THE WORLD: The Associated Press has a fascinating look at how Secretary of State Rex Tillerson and Defense Secretary James Mattis privately schooled Trump on the need for American military engagement abroad:
To be successful, Mattis and Tillerson decided they should use talking points and commentary with which they believed Trump would be most familiar: the role that the military, intelligence officers and diplomats play in making the world safe for American businesses, like The Trump Organization, to operate and expand abroad. American troops provide stability, diplomats push rule of law and anti-corruption measures and the intelligence community provides context and analysis that drive the first two, the briefers explained.
No doubt studding these presentations with references to the greatness of Trump’s international business ventures would also help to hold his attention.