OVER THE next week and a half, Republican senators may try one last time to repeal and replace Obamacare. The latest bill, from Sens. Bill Cassidy (La.), Lindsey O. Graham (S.C.), Dean Heller (Nev.) and Ron Johnson (Wis.), is about as execrable as the others that GOP lawmakers previously failed to approve. The process by which Republicans would pass it would be as sloppy and partisan as the one to which senators such as John McCain (R-Ariz.) objected earlier in the summer. The outcome would be no less destructive.
The big difference now is the clock; the procedural window for passing a health-care bill along straight party lines will disappear at the end of the month, spurring Republicans to try one last time. That is a sad excuse to rush through — without even an attempt at bipartisanship and without a complete Congressional Budget Office assessment — a half-baked bill that would harm millions. Senators who objected to repeal-and-replace efforts before have no principled reason to change their votes.
The Graham-Cassidy proposal would cancel Obamacare's major programs in 2020 and offer the states block grants instead. This plan at least does not include a massive upper-income tax cut, as previous GOP bills did, and it would seem to allow blue states to create and maintain universal or near-universal health coverage systems within their borders, even as red states went in a more conservative direction.
But the bill suffers from fatal flaws, even setting aside how red-state residents would suffer under the parsimonious health policies their governments would adopt. First, analysts project that it would scale back the money states would get over time, relative to what would have flowed their way under Obamacare. The Center on Budget and Policy Priorities, a center-left think tank, estimates the shortfall would total $41 billion by 2026. The bill's funding formula would, in general, shift money from blue states to red states. These factors would make it difficult for states that like their Obamacare to keep their Obamacare.
Second, the bill would seriously cut Medicaid, which covers the poor and near-poor, putting yet more burden on states to cover needy people — if states even try.
Third, the state block grants that would underpin the Graham-Cassidy system would end in 2027; that would breed uncertainty in the market, fear among patients and rancor on Capitol Hill.
Moreover, the bill would make it easier for states to erode important safeguards guaranteeing that sick people can obtain the care they need.
And that is the rosy scenario. There is a good chance that many states would fail to create brand-new health-care systems by 2020, in time to stave off the chaos that would occur after Obamacare's carefully regulated and subsidized health-care markets disappeared. Establishing such a system is hard under any circumstances. Doing so under a tight deadline, without the administrative, technical and other help that federal officials currently provide, would be very hard, the Urban Institute's Linda Blumberg pointed out.
Some Republicans want to pass this policy disaster before the end of the month, in less than two weeks. A last-minute committee hearing would be nothing more than a fig leaf disguising a reprehensibly partisan process in service of an unworthy bill.
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