Senate Republicans are trying to revive the momentum to overhaul the Affordable Care Act with the Cassidy-Graham proposal. Here are five things to know about the plan and the rush to pass it. (Jenny Starrs/The Washington Post)
Opinion writer

It is difficult to decide which is the worst aspect of the Republicans’ latest try at repealing Obamacare: the irresponsibility, the cruelty or the lies.

And it is impossible to ignore that the climax of this battle will take place under the shadow of President Trump’s shameful, racially charged attacks on prominent African American athletes. Once again, Trump has demonstrated his lack of seriousness about the responsibilities of his office, his autocratic habit of demonizing dissent, and his willingness to play racial politics to divide and distract.

Trump has reason to distract because the repeal effort he has championed was dealt a near-fatal blow when Sen. John McCain (R-Ariz.) announced Friday that he would vote against the catastrophically flawed proposal to scrap the Affordable Care Act from Sens. Lindsey O. Graham (R-S.C.) and Bill Cassidy (R-La.). McCain stuck to the principles he outlined when he voted against July’s repeal bill , even though Graham is his best friend in the Senate and despite the pressure from Trump and GOP congressional leaders.

There is only one reason the Senate even considered a vote this week: The GOP base, and particularly the party’s donor class, wants repeal. So never mind what happens to Americans with modest incomes who have cancer, diabetes or heart trouble. Politics matters more than giving serious thought to a bill that would upend one-sixth of our economy.

That’s why this bill was not subjected to any serious analysis or debate. Republicans scheduled a quickie, last-minute hearing this week for show. Because Trump and his party want “a win,” they’re willing to wreak havoc on the insurance markets, state governments and people’s lives to get it.

Any serious deliberative process would have forced the GOP to grapple with a statement from the bipartisan National Association of Medicaid Directors on Cassidy-Graham’s approach of marrying block grants to severe cuts. The association called the bill “the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history.”

“Any effort of this magnitude,” the Medicaid directors added, “needs thorough discussion, examination and analysis, and should not be rushed through without proper deliberation.” Exactly.

There has always been something deeply wrong about our country’s failure to provide health insurance for all our citizens, which all other wealthy industrialized nations do. It’s not okay for people to face bankruptcy simply because they are doing everything they can to stay alive. Obamacare was a cautious, market-friendly attempt to make the system a bit kinder.

Since the Republicans launched this year’s repeal offensive, many Americans who thought of the Affordable Care Act as a vague sort of failure have heard the compelling stories of those with preexisting conditions and serious illnesses who are far better off today because of the law. A Washington Post-ABC News poll released Friday showed Americans preferred Obamacare to Cassidy-Graham by 56 percent to 33 percent.

Many who believed Trump and other Republicans when they promised to pass something better than Obamacare now know that this pledge was a sham. What the GOP really wants is to spend a lot less government money helping people get health care. But Republicans can’t admit this because it sounds heartless.

So instead, they lie outright about what their bill does. Slate’s Jamelle Bouie provided one of the best compendiums of falsehoods being offered on behalf of this bill. Jimmy Kimmel called out Cassidy for failing to live up to what the senator himself called the “the Jimmy Kimmel test.” Kimmel described this as a pledge that “no family should be denied medical care, emergency or otherwise, because they can’t afford it.” Cassidy, Kimmel charged last week, “lied right to my face.”

Trump insisted in a tweet: “I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does!” Actually, it lets states undermine this coverage.

And if Obamacare is so bad, why are Republicans reportedly trying to buy the vote of Sen. Lisa Murkowski (R-Alaska) with a special provision that would, in effect, allow Alaska to keep the Affordable Care Act pretty much as is? Why not give every state this option by killing Cassidy-Graham altogether?

One can hope that McCain’s brave decision and the doubts expressed Sunday by other Republican senators have done exactly that. But the GOP repeal effort never seems to die, so this week remains a testing time.

It’s a test of whether the movement that saved the ACA this summer can rally once more. It’s a test for Republicans who claim to take health-care policy seriously. And it’s a test for a president who prefers ripping the country apart to governing.

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