Congressional Republicans are rushing to overhaul the U.S. health-care system by passing a bill that is based on dishonest claims, avoids the usual professional analysis, and makes a mockery of serious legislative process.
The Senate is scheduled to vote this week on a proposal by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana to repeal and replace much of the Affordable Care Act passed by a Democratic Congress in 2009. Earlier Republican efforts failed, but this time, using more than a little sleight of hand, party leaders and the White House think they may pull it off.
The plan is to approve the legislation with only Republican votes in the Senate, with limited debate and before the Congressional Budget Office has time to analyze the costs and impact, then to rush the same bill through the House and send it to President Donald Trump. Haste is necessary because the procedural window will close at the end of September for passage with only Republican votes.
There have been no hearings on the bill despite its massive impact on the U.S. economy and health-care system.
Graham and Cassidy have sold this hastily assembled measure as a bipartisan compromise that, rather than cutting coverage, merely gives the funds and flexibility to the states to determine their own health-care policies.
None of that holds up. The bill is purely partisan — it’s being rushed through for the simple reason that it lacks any Democratic support.
Graham, in press conferences, has hailed the plan as a middle-ground compromise between Obamacare and the coverage-slashing Republican proposals that collapsed in July.
That’s nonsense. It’s crafted to appeal to Republican voters and lawmakers by cutting Medicaid spending in states where Democrats dominate and increasing it where Republicans hold sway. Graham claimed to Breitbart News that the measure “will score very well” with the CBO even though he’s hurrying to avoid CBO scrutiny because it almost certainly won’t.
The sponsors suggest that their plan wouldn’t really cut healthcare funding, instead replacing Obamacare subsidies and Medicaid expansion with block grants to states. Sorry, guys: It does cut funding dramatically.
Avalare Health, a respected, nonpartisan consulting and analytical firm, estimated this week that federal spending would be cut $215 billion over 10 years from Affordable Care Act projections. Without congressional action, that would turn into trillions over two decades, Avalare estimates.
The Louisiana health secretary, Rebekah Gee, wrote to Cassidy this week to outline the devastating effect his proposal would have on his home state.
It “gravely threatens health-care access and coverage for our state,” she wrote, especially for the poor, those with disabilities and the elderly. She noted that in addition to cutbacks in the Affordable Care Act, Graham-Cassidy imposes a cap on other Medicaid spending which would ultimately result in deep reductions. Cassidy questioned her numbers; he’s the one who won’t wait for the CBO analysis.
The block grants to states would expire in 2026. Sponsors say that rather than causing draconian cuts then, the grants simply can be extended. But Graham and Cassidy specifically chose not to extend them beyond 10 years.
Supporters also contend that the bill does not undo the Obamacare prohibition against discrimination in health insurance aimed at people with preexisting medical conditions. That’s more nonsense. It permits states to waive this requirement; where they do, it will make coverage unaffordable for millions of people with chronic diseases and disabilities. It also guts current guarantees of coverage for mental health treatment.
The Graham-Cassidy bill is opposed by the American Medical Association, the pediatrics and family-physician associations, the nurses’ group, the Children’s Hospital Association and most advocacy groups for people suffering from major diseases, like the American Cancer Society. They all understand what the bill would do.
Still, there is at least an even chance that the Graham-Cassidy bill will pass Congress and be sent to the White House. When the dire consequences ensue, backers will claim it’s all because of Obamacare, another lie.
Hunt is a Bloomberg View columnist. He was the executive editor of Bloomberg News, before which he was a reporter, bureau chief and executive Washington editor at the Wall Street Journal.