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Opinion Deja vu on Trumpcare

Sen. Lindsey O. Graham (R-S.C.) spoke about his proposal for health-care reform at a news conference on Sept. 13. (Video: Reuters)
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If you thought the Senate already beat back a bill that would slash federal support for the health-care exchanges, end Medicaid as we know it, undermine the minimum set of benefits insurers must offer and remove the guarantee on coverage for those with preexisting conditions, you’re right. You thought Sen. John McCain (R-Ariz.) rejected a bill that was entirely partisan and rammed through without regular order? Right again. You thought the Senate disparaged the House for voting on its own health-care bill without a complete score from the Congressional Budget Office? You’re three for three.

So why is a bill with all those infirmities and a few more getting teed up for a vote before the clock strikes midnight on Sept, 30, ending the fiscal year and the Senate’s chance to do this by reconciliation?

Cassidy-Graham is such a poor piece of legislation that its sponsors have resorted to citing misleading statistics to justify their effort. The Center on Budget and Policy Priorities found:

In rolling out their revised bill to repeal the Affordable Care Act (ACA), Senators Bill Cassidy and Lindsey Graham released estimates purporting to show that most states would see large funding gains under their proposal. But these estimates do not compare states’ funding under the proposal to what states would receive under current law, the relevant comparison. Instead, they show how each state’s funding under the proposed block grant would change over time. In reality, the Cassidy-Graham plan would cut federal funding for coverage programs by about $80 billion in 2026 compared to current law, leading to cuts in most states, and would cut federal funding by about $300 billion in 2027, with funding cuts in all states. … By 2027, every state would see large, damaging cuts in federal funding.

The bill’s sponsors are also trying to hide the ball on its “per capita cap” on federal funding of Medicaid, leaving this substantial change out of the bill’s projections.  In fact, with the caps, the Medicaid cut “would rise from an already deep $80 billion in 2026 to about $300 billion in 2027, with commensurate increases in cuts for individual states.”

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There is no logical reason then that Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and McCain would suddenly decide they are fine with massive Medicaid cuts and a partisan rush to judgment. But yet, Graham (R-S.C.), Cassidy (R-La.) and Ron Johnson (R-Wis.) are trying it again, maybe hoping their three colleagues are fickle and will go for it this time. It does not even have the sop of billions for opioid abuse treatment that got Sens. Shelley Moore Capito (R-W.Va.) and Rob Portman (R-Ohio) to go along with the “skinny repeal” last time. (Imagine Portman having to explain why he sold opioid abuse patients down the river.)

Senate Minority Leader Charles E. Schumer (D-N.Y.) went to the floor on Monday with special focus on these very senators:

My colleagues should know the effect of the bill, they don’t. CBO has told us that they cannot give us a full score, but simply note whether it meets the budget reconciliation. It’ll say, ‘it’ll cut a billion dollars.” That’s all it will say. We won’t know how many citizens are hurt. But Center for Budget and Policy Priorities whose numbers are very, very reliable has done a calculation. I would ask my colleagues to pay attention. I’ve just picked out some states; there are more. Arizona would lose $1.6 billion in federal funding; Alaska would lose $255 million in federal funding; Maine would lose $115 million in federal funding; West Virginia would lose $554 million in federal funding; Colorado would lose $823 million in federal funding; Ohio, a state most wracked by the opioid epidemic, would lose over $2.5 billion in health care funding; and Iowa would lose $525 million in federal funding.

He also pointed out that voting for this would undercut the sole bipartisan effort underway at the time. “Senator Alexander, Senator Murray have had hearings, they’ve had discussion. They’re negotiating it this moment,” Schumer said. He added, “It’s not to rush a bill through in the dark of night without even knowledge of how it affects people, because now CBO has said they cannot measure how many people would lose coverage and how people would be affected until a few weeks because this is a block grant, it takes a long time to weigh it.” (CBO said it will have some kind of preliminary score next week, but the bill’s impact on coverage will take weeks to develop.)

McCain wasn’t fooled. On Monday, he decried the process again. “It’s better but it’s not what the Senate is supposed to be doing. … Is it better to be guilty of murder or train robbery? … I’m not the one that waited nine months … it’s not my problem that we only have those few days.” I suppose the three co-sponsors think McCain doesn’t mean what he says.

Collins also released a statement. “I have a number of concerns with the Graham-Cassidy proposal, including the fundamental changes to the Medicaid program, the effect on premiums for older Americans, and the fact that the bill could allow insurers to charge higher premiums for people with pre-existing conditions,” she said. She vowed to examine carefully the CBO analysis. She doesn’t seem likely to be snookered into supporting this bill either.

Returning to our original question — why is the Senate even toying with this? One explanation is that scared of Trump’s foray with Democrats, the Republicans are trying to get back in his good graces with one more try at health care. (But if they fail again, doesn’t that get Trump all worked up again?) It might also be that Republicans imagine this is actually a “hard” vote for red-state Democrats and want them to vote again. Senate and House tax plan negotiators may also have discovered that they cannot square the numbers for big tax cuts without the added revenue from cutting Medicaid. (Yes, they contemplate big cuts to Medicaid that will help pay for tax cuts for the rich and for corporations.) Then again, they may imagine their colleagues who opposed the previous version of Trumpcare are so dense and insincere that they’ll cave to the Trumpian base this time around. (If the latter, we don’t yet know whether they are right.)

Whatever the motive, it is the worst sort of legislation — thoughtless, partisan, cynical and injurious to the most vulnerable in our society. Cassidy is a doctor by trade — did he not learn Hippocrates’s medical directive “First, do no harm”? Maybe the GOP as a whole should start adopting that principle.