The Republican Health Care Zombie Is Back

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Chris Gash

Republican lawmakers have wasted much of the year trying to repeal the Affordable Care Act, a move that would deprive millions of people of health insurance. They’re back at it. Like a bad sequel to a terrible movie, a proposal whose main architects are Bill Cassidy of Louisiana and Lindsey Graham of South Carolina would in many ways be worse than bills that came before. It would punish states like California and New York that have done the most to increase access to health care and set in motion cuts to Medicaid, the federal-state program that provides insurance to nearly 70 million people, many of whom are disabled and elderly.

This is not an idle threat. President Trump wants this bill passed by the end of next week, before the expiration of a budget rule that allows the chamber to pass a health care bill with only 50 votes (and a tiebreaker from the vice president). It’s unclear whether the votes are there, but the bill’s chances increased on Monday when Gov. Doug Ducey of Arizona said he supported it. His endorsement is important because it could convince Senator John McCain, who cast the decisive vote against repealing the A.C.A. in July, to vote for this version.

It is hard to overstate the cruelty of the Graham-Cassidy bill. It would eliminate the mandate that even healthy people buy health insurance, end the subsidies that help people purchase coverage and stop the expansion of Medicaid. It would offer states block grants they could use to help people get insurance but would leave people at the mercy of individual state legislatures and, over all, would provide $239 billion less than what the federal government would spend under current law between 2020 and 2026, according to the Center on Budget and Policy Priorities.

Worse, the formula for determining state grants would penalize the 31 states that expanded Medicaid under the A.C.A. so as to provide more money to the 19 states that did not. This is a cynical attempt to win votes by taking money from generous states that are more likely to be governed by Democrats and giving some of it to representatives of stingier states that are more likely to elect Republicans. The block grants would disappear entirely in 2027, and it is by no means certain, given the pitched partisan battles over health care in recent years, that Congress would be inclined to reauthorize them.

Graham-Cassidy would further cripple Medicaid by putting a per-person cap on what the federal government spends on the program. Under current law, federal spending increases automatically to keep up with the rise in medical costs; a per-capita cap would leave governors, who are ultimately in charge of administering Medicaid, in the unenviable position of denying care to poor and older Americans.

The rush job proposed by Mr. Cassidy and Mr. Graham and endorsed by the president is deeply unfair and leaves other lawmakers with little time to understand what’s in the bill or its true costs. The Congressional Budget Office says it will not be able to determine the full impact of the legislation, including its effect on premiums and the number of people who have insurance, for several weeks.

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