John McCain spent most of the last week muttering his demands that health-care legislation be approved through “regular order,” before shocking Washington Friday with an announcement that he would not support Lindsey Graham and Bill Cassidy’s latest attempt to repeal Obamacare. Graham and Cassidy have revised their bill once again, and the updated version merely serves to confirm McCain’s position: the process through which Republicans are attempting to pass a massive reordering of the American health-care system is an utter dereliction of public responsibility.
Like several previous repeal plans, Graham-Cassidy is designed around the belief that speed can outrun analysis. The latest version, which leaked out Sunday night, contains a series of revisions designed to placate Senate holdouts. The funding is tweaked to favor a handful of states whose Republican senators have indicated opposition. There is a $500 million payoff specifically tailored for Alaska:
Graham-Cassidy includes a $500 million bribe to states with waivers that cover reinsurance – which is to say, Alaska. This isn’t subtle. pic.twitter.com/flhEYQhOYm
— Nicholas Bagley (@nicholas_bagley) September 25, 2017
There is also, amusingly, a $750 million payment exclusively for Louisiana, home state of the bill’s major sponsor, Bill Cassidy:
States that expanded Medicaid after Dec 2015 get extra $$$
Louisiana — i.e., Cassidy’s state — expanded Jan 2016 https://t.co/BitPz9ehyG pic.twitter.com/D3MVqqWmOu
— Jonathan Cohn (@CitizenCohn) September 25, 2017
The most sweeping changes are a comprehensive deregulation of state insurance markets. Insurance plans would now be even more liberated to charge higher prices to sick people, and to cap payments to families. The official waiver process for deregulation would be eliminated, and in its place would be a weaker requirement that states merely submit an explanation for how their state’s looser or nonexistent regulations would allow “adequate and affordable” insurance for all. It’s more like a grade-school essay contest than a well-designed regulatory regimen. The net effect would be to eviscerate the protections for people with expensive medical costs, once again leaving them to bear the burden of their own costs alone, without cross-subsidies from healthy people.
Graham and Cassidy deny this, of course. The bad faith of their last-minute push is comprehensive. They propose to rewrite every insurance market in the country in ways experts are grasping to comprehend, and to rush this massive complex change into law in a matter of days. The Trump administration is circulating ludicrously inaccurate numbers purporting to show that certain states would gain under the new formula. (Of course, Graham-Cassidy also allows the Executive branch to rewrite the funding formula as it sees fit, so any deal struck now can be revised later on.)
Cassidy committed an act of near-candor when he explained why any Congressional Budget Office analysis of the bill would be worthless. The proposal is mutating so rapidly, he told ABC News, that any study of its impact will be instantly moot.
— ABC News Politics (@ABCPolitics) September 24, 2017
Cassidy meant this comment as a dismissal of the value of CBO’s analysis. But it is actually a confession about his own method. His purpose is to keep alive various incompatible promises to different Republicans senators. Some (like Lisa Murkowski) want more spending, and others (like Rand Paul) want less. The party leadership has consistently followed the strategy of last-minute legislative changes that allows them to emphasize different features to different members of Congress, hoping to secure their agreement before any outside experts can recognize what is going on, and before stakeholders can mobilize in response.
They have continued to follow this reckless strategy because, while a handful of Republicans have blocked them, the vast majority of the party has acceded, leaving them tantalizingly close. Their willingness to unleash sweeping and potentially catastrophic change, with little understanding of its precise workings, is a testament to the ideological mania for repeal that has not been dislodged. As the deadline for the latest repeal approaches, the Republican government is continuing to reveal its unfitness to govern.