WASHINGTON — A week that Senate Republicans had hoped would mobilize conservatives and shore up support for their measure to repeal the Affordable Care Act instead ended with eroding enthusiasm, as usually reliable Republican senators from red states blanched at its impact on rural communities.
With Congress set to return on Monday after a week’s recess, Republican lawmakers are increasingly aware that their seven-year promise to dismantle President Barack Obama’s largest policy achievement is deeply imperiled. Senator John Hoeven, Republican of North Dakota, signaled this week that he would not vote for the bill as written, following negative remarks from other senators with large poor and rural populations. That was the 10th defection.
Three other Republican senators, Bob Corker of Tennessee, Charles E. Grassley of Iowa and John Boozman of Arkansas, have withheld their support, although they have not declared their opposition, and others have largely remained silent.
Mr. Grassley told voters on Friday that he was unsure if he would vote for the Senate Republican bill in its current form, according to The Des Moines Register. “I don’t even know if we’re going to get a bill up,” said Mr. Grassley, an expert on health policy and taxes who has been in Congress for more than 40 years.
In small counties, rural hospitals and other health care providers are often the largest employers, and after years of railing against Mr. Obama’s law, Republican senators are now grappling with the impact of its possible demise.
“I am a product of rural Kansas,” Senator Jerry Moran, Republican of Kansas, told constituents this week. “I understand the value of a hospital in your community, of a physician in your town, of a pharmacy on Main Street.”
Senator Jerry Moran on Thursday faced constituents in Palco, Kan., who were upset that the health law might be repealed. Credit Chad Pilster for The New York Times
Well short of the 50 votes needed to pass his bill, Senator Mitch McConnell of Kentucky, the majority leader, repeated his fears this week that his party may be stuck tweaking the Affordable Care Act with Democrats. He raised the prospects of a bipartisan fallback last week on the driveway of the White House, and again on Thursday in Glasgow, Ky.
If Republicans cannot pass a bill on their own, they may need to work with Democrats on short-term measures to stabilize insurance markets that, by their account, are on the verge of collapse in many states.
Paul Ryan: Not My Problem 22 Million Will CHOOSE To Lose Healthcare
Now that it is pretty clear that R's dont have the ability to do anything on their own, which is because they never did the work, lately because thy were sure that Trump would lose, if the D's were decent people they would offer to pitch in and work on keeping the collapsing of OBamaCare from hurting the nation more than it must.
I dont expect it, because when was the last time these assholes put the best interests of the nation above their fantasies of winning elections the next time?
As Republicans lawmakers frantically attempt to piece together a passable health bill to repeal and replace Obamacare, the American people continue to declare that they overwhelmingly prefer the current law to its Republican alternatives.
According to a new Fox News poll, only 27 percent of the American public views the Senate’s health care bill favorably — with a mere 11 percent strongly approving of it — confirming a growing trend of unpopularity for the Better Care Reconciliation Act.
Meanwhile, the Affordable Care Act, which Republicans are so adamant about repealing, is increasing in popularity, with a 52 percent approval rating. Ever since Republicans ramped up their efforts to repeal Obamacare, the ACA has become more popular than before.
Over the past months, former President Barack Obama’s signature health care legislation has consistently registered higher approval ratings from the American public than President Donald Trump, House Speaker Paul Ryan (R-WI), and Senate Majority Leader Mitch McConnell (R-KY). Only 36 percent of Americans approve of the way Trump has handled the health care debate, the same Fox News poll found.
In a way, it’s no surprise: The Republican-led government has been mired in Trump’s scandals and legislative stalemates. On health care, the Republican alternatives to Obamacare have consisted of two bills that would cost more than 20 million people their health insurance, according to estimates by the Congressional Budget Office.
It’s a bad sign for Republican lawmakers, many of whom have spent the past seven years campaigning on repealing Obamacare but have struggled to find a proposal that could a) pass Congress and b) be welcomed by the American public.
The Senate bill in its current form doesn’t have enough support among Senate Republicans to pass Congress’s upper chamber. Sen. Ted Cruz (R-TX) has proposed some changes that could possibly thread the needle between warring factions of the party, but they still include massive cuts to Medicaid, which have proven to play unfavorably with the American public.
The Democrats are watching closely; with hopes to regain control of the House of Representatives in 2018, congressional candidates have already begun framing their attacks around the growing health care fight.
(CNN) — Two more Republican senators announced Monday that they would oppose a procedural step to advance GOP leadership's health care bill, preventing Senate Majority Leader Mitch McConnell from moving forward with plans to repeal and replace Obamacare.
Sens. Mike Lee of Utah and Jerry Moran of Kansas separately announced their opposition to the revised health bill, and will vote no on the motion that would allow it to go to the floor.
McConnell could only afford to lose two senators and still advance the legislation, and as of last week, he'd already lost Sens. Susan Collins of Maine and Rand Paul of Kentucky.
"We should not put our stamp of approval on bad policy. Furthermore, if we leave the federal government in control of everyday healthcare decisions, it is more likely that our healthcare system will devolve into a single-payer system, which would require a massive federal spending increase," Moran said in a statement. "We must now start fresh with an open legislative process to develop innovative solutions that provide greater personal choice, protections for pre-existing conditions, increased access and lower overall costs for Kansans.
Republicans trying to get the Better Care Reconciliation Act passed through the Senate could have their plans thwarted by the chamber's rules.
The Senate parliamentarian said Friday that major provisions of the Republican legislation would require 60 votes to advance, putting the already troubled legislation in further peril.
Passed in 1985, the Byrd rule says that any bill going through the budget reconciliation process — like the BCRA — can be blocked on the grounds that it contains an "extraneous matter" or something "merely incidental" to the federal budget.
The budget-reconciliation maneuver through which the GOP hopes to move the BCRA allows a bill that adjusts the federal budget to pass through the Senate with a simple 50-vote majority to avoid a filibuster. Any other legislation needs 60 votes to avoid a filibuster.
Key parts of the bill — including a plan to defund Planned Parenthood, restricting federal tax credits from being used for abortions, and a provision that would make people wait six months for health insurance if they have a lapse in coverage — all require 60 votes, according to the Senate parliamentarian. Republicans currently have 52 seats in the Senate.
"Should the Senate proceed to the bill, these provisions may be struck from the legislation absent 60 votes," the Senate budget office said.
Here are all the parts of the BCRA that could put the bill in jeopardy
•The plan to defund Planned Parenthood
•A provision that would restrict the use of tax credits for abortions.
•Getting rid of the essential health benefits for Medicaid in 2020.
•How the bill deals with cost-sharing subsidies
•The section that locks individuals out of the insurance marketplace for six months if they don't have continuous coverage.
•The medical loss ratio.
•The provision that allows states that haven't used all of their block grants for health coverage for non-health purposes.
•Changes to the Medicaid waiver system by prioritizing HCBS waivers.
•A provision that requires a report regarding CMS-64 and Transformed Medicaid Statistical Information System data
The White House-health care huddle came just hours before Trump savaged Senate Republicans in a series of Saturday tweets for failing to repeal Obamacare. If the Senate doesn't pass a bill soon, Trump warned, he may halt Obamacare payments subsidizing health plans for low-income individuals — an idea adamantly opposed by Republicans and Democrats alike.
Trump also appeared to take a personal shot at lawmakers, seemingly warning that he could revoke their own health benefits on the exchanges.
"If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!" Trump tweeted Saturday afternoon.
Trump seemed optimistic about moving forward on the bill on Friday after the shocking setback this week appeared to cripple his legislative agenda, according to a White House official. Yet several senior Republican Senate aides and allies of GOP leaders cautioned against any feelings of momentum coming from the White House on Saturday, particularly after Trump again instructed Majority Leader Mitch McConnell (R-Ky.) to change the Senate rules to a simple majority and gut the legislative filibuster.
McConnell has resisted such a suggestion publicly and has been pushing back against Trump privately, according to people familiar with their interactions. One person close to McConnell said Trump has asked McConnell personally to change the rules but said no.
During his Saturday tweet-storm, Trump blamed the arcane budget reconciliation rules that make it more difficult to fully repeal and replace Obamacare on party lines.
“The very outdated filibuster rule must go. Budget reconciliation is killing R's in Senate. Mitch M, go to 51 Votes NOW and WIN. IT'S TIME!” Trump said. “Republicans in the Senate will NEVER win if they don't go to a 51 vote majority NOW. They look like fools and are just wasting time.”
Senate rules don’t appear to be the problem. From the “skinny repeal” bill to a McConnell designed replacement bill to a so-called “clean” repeal bill, all GOP efforts failed to get 50 votes in the Senate this week. After the GOP’s failure to move forward on Friday, McConnell asked Senate Democrats for their ideas on healthcare and warned against bailing out insurance companies. Some Republican senators want to move on from the partisan effort and start looking at fixes to the law's insurance exchanges with Senate Democrats.
Sen. Bill Cassidy, R-La., has been touting a health care bill authored by him and Sen. Lindsey Graham, R-S.C. Below are four statements by Cassidy about the legislation and our analyses of them, based on conversations with health care experts.
Statement: "There will be more folks covered under this bill than the status quo, and it protects people with pre-existing conditions." — ABC News interview
Fact check: The Graham-Cassidy bill would scrap the individual mandate requiring people to buy health insurance — the crux of Obamacare, anathema to its opponents — meaning people would no longer be penalized for not having health coverage.
James Capretta, a fellow with the right-leaning American Enterprise Institute, told ABC News that the absence of the individual mandate means it would be "highly, highly unlikely" more people would be covered under Graham-Cassidy than under current law.
"Absent other changes, it's likely this kind of approach would encourage and provide an incentive for healthy people to stay out of the market as long as possible and get back only when they need it," he said.
But even if more people will be covered under Graham-Cassidy, other experts said that increasing the number of people who are covered wouldn't mean much if their policies don't cover much.
"States could provide a lot more people with insurance cards in their pocket, but that's not the same as saying there's as much coverage as there is today," Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told ABC News.
Besides the individual mandate, another big difference between the Graham-Cassidy plan and existing law is that the Republicans' proposal would allow states to waive certain requirements — like covering certain essential health benefits and prohibiting higher premiums for people with pre-existing conditions, as long as they inform the secretary of health and human services, who would make the waiver determination, "how the state intends to maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions."
That's much weaker language than in the Affordable Care Act, which allows states to request waivers from requirements under a narrow program but requires them to ensure health care that is "as comprehensive and affordable as would be provided absent the waiver," which Pollitz said is a much more stringent criterion.
Matt Fiedler, a health care policy fellow at the Brookings Institution, agreed, saying the bill would explicitly allow states to get waivers so that insurance companies could charge people differently, depending on "previous health status." He referred to the "adequate and affordable" line in the bill as "toothless."
"The federal government does not appear to have any authority to reject waivers, so states can do essentially whatever they want as long as there is a section on their application materials that pays lip service to this point," he wrote to ABC News in response to questions about the bill. "Even if there were some ability for the federal government to meaningfully enforce this requirement (and an administration interested in doing so), the term 'adequate and affordable' is quite vague and elastic. That would make denying an application on these grounds hard."
Capretta said it's possible that fewer states than expected would request waivers that in effect scrap protections for pre-existing conditions, because those protections are among the popular aspects of the Affordable Care Act.
"States are allowed to come forward with waiver requests, and waivers can be granted, but the politics are not easy on a state level," he said.
The Affordable Care Act's waiver program, known as Section 1332, was geared toward states that wanted to employ "innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA," according to the Centers for Medicare and Medicaid.
In response to questions about the waiver program in the bill, a Cassidy aide told ABC, "It is fair to point out that states can already approach coverage of people with pre-existing conditions differently through the 1332 waiver process. Graham-Cassidy merely adds another route through which states can apply for waivers to address the insurance needs of their populations, which they are far better situated to do than the federal government."
Statement: "If a state applies for a waiver, it must ensure those with pre-existing conditions have adequate and affordable coverage." — ABC News interview
Fact check: There are two issues with this assertion: There does not seem to be any language requiring waiver-seeking states to meet that criterion, and the criterion is open to interpretation.
"Every insurer must offer every individual a plan and ensure each patient with pre-existing conditions has access to 'adequate and affordable health insurance coverage,'" the Cassidy aide said. But the language in the bill, requiring a proposal for "how the state intends to maintain access to adequate and affordable," is weaker than portrayed by the aide.
The bill also contains no metrics for determining whether the state is following through on the explanations sent to the HHS secretary, nor is there a set definition for "adequate and affordable," so that can be left to the discretion of the HHS secretary.
"All in all, it looks to me like Republicans are absolutely determined to do something they can call repeal and replace, even if what they're doing is somewhat incoherent," Capretta said.
Statement: "We also take it through the CHIP program, the CHIP program which is wildly popular, both Democrats and Republicans, used by states to get more people enrolled." — ABC News interview
Fact check: In response to the concern about people with pre-existing conditions, Cassidy also posited the fact that the block grants issued to states will be funneled through the existing Children's Health Insurance Program (CHIP) which currently helps states provide health insurance for low-income children.
The comment left several experts scratching their heads.
"CHIP does not regulate insurance markets, so it has nothing to do with regulating where a state ends up on pre-existing condition," Joan Alker, a research professor at the Georgetown University McCourt School of Public Policy told ABC News.
And while it is true that states are already in the habit of using the CHIP program, Alker pointed out that unlike current Medicaid funds, which are entitled to states and individuals on a long-term basis, CHIP money has to be reauthorized by Congress each year.
"Frankly the fact that CHIP money is about to expire on Sept. 30 and Congress has not extended it is exhibit A as to why CHIP is not a good model. The Medicaid model is entitlement money. It is guaranteed funding for states," she continued.
"Sen. Cassidy is just not telling the truth."
Statement: "States like Maine, Virginia, Florida, Missouri — there will be billions more dollars to provide health insurance coverage." — CNN interview
Fact check: This assertion needs to be fully unpacked in order to understand the full context.
Cassidy mentioned individual states because his bill would change the way states receive money to run their health care systems and help people pay for care, giving states more discretion with health care funds but less money.
A handful of states, including Texas and two of the states Cassidy mentioned — Virginia and Missouri — would end up with a net increase of funding over 10 years, according to a study by the policy analysis group Avalere. But overall, the study found that most states would end up with a net loss of federal funding versus current law.
Obamacare-era tax credits, subsidies and Medicaid expansion dollars would be eliminated. Instead, states would receive block grants of money to allocate as they determine. The states that accepted the Obamacare Medicaid expansion would see that money go back into the general pot of funding, the allocation of which depends on a complicated formula that factors in population size and resident wages, and states would not have to spend money to increase health insurance coverage. Graham-Cassidy block grants would expire in 2026.
But the point is that most states would receive less federal funding because there would simply be less funding to go around and because the funding formula changes so much. States that accepted the Medicaid expansion stand to lose the most, including blue New York and California, but also Ohio and Alaska, both of whose Republican governors oppose the bill, and Maine, which Cassidy still mentions as a relative winner despite the fact that it is a Medicaid expansion state and would stand to lose $1 billion, according to Avalere.
So while a few non-Medicaid expansion states might see more federal funding than they have under the Affordable Care Act, the net result would be a decrease in federal funding — $215 billion, according to Avalere's study.
"In general, the states who expanded Medicaid over the long run are the losers under this formula, because the formula tries to normalize funding per person across the states," Fiedler said. "That comparison is a little funny because the nonexpansion states had the option to expand and chose not to. The argument there is an inequity under current law I find a little bit puzzling."
Despite many evident shortcomings in a bill to repeal the Affordable Care Act health care law, Republicans have a responsibility to pass it, U.S. Sen. Chuck Grassley said Wednesday.
In a conference call with Iowa reporters, Grassley expressed support for the Graham-Cassidy health care reform proposal currently before the Senate, arguing that the GOP has pledged to repeal the law known as Obamacare and must seize any opportunity to do so.
“You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” Grassley said. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”
Grassley also expressed doubt, however, that the bill would pass in the Senate, in which the GOP holds a narrow majority. To move on to the House, Graham-Cassidy must win 50 of 52 Republican votes.
“No, I think we’re one or two votes short and I don’t see those other one or two votes coming,” he said when asked if the votes were there. “I hope I’m wrong.”
The Graham-Cassidy proposal would make over major parts of the American health care system, directing funding for the Medicaid health care program and other federal health care dollars into block grants handed over to the states on a per-capita basis.
States would have wide latitude in shaping health care benefits for residents, and could allow insurers to charge higher rates for sick patients and stop covering benefits currently required under federal law.
“This is a deregulation bill from Washington, D.C. … to basically provide the resources so each state can run their health care system to fit their state, to meet the needs of their people as they see it, not as Washington sees it,” Grassley said at one point during the call.
Allowing states to shape health care benefits and regulations to match their populations will better account for the geographic and economic diversity of the country.
“What might fit Massachusetts and New York and Maryland doesn’t fit Iowa very well,” Grassley said. “The upside of it is, we’re going to give states the opportunity to deliver health care more efficiently and effectively, and in a more affordable manner than Obamacare has in the past.”
But Grassley also acknowledged that Graham-Cassidy would not affect the most pressing Obamacare shortcoming facing Iowa: rising premiums and limited choices on the state’s individual health insurance market.
Instead, he said, that’ll have to be addressed first with a “stop-gap” plan now under consideration and ultimately with a separate legislation.
“What you want to do long-term is going to be done in the Alexander bill,” Grassley said, referring to a bipartisan bill to stabilize individual premiums nationwide that reportedly fell apart this week.
WASHINGTON — A last-ditch effort by Senate Republicans to fulfill a seven-year campaign promise to replace the Affordable Care Act appeared to be on life-support Friday after Sen. John McCain said he would vote against the bill.
With a full bloc of Senate Democrats opposing the health care overhaul, the bill’s sponsors can afford to lose only two Republicans to avoid defeat. Sen. Rand Paul, R-Ky., has also declared his opposition, and a third, Susan Collins, R-Maine, said Friday she was leaning that way.
McCain announced his decision in a statement in which he said he “could not in good conscience” support the bill because the partisan process that created it would “leave the American people guessing from one election to the next whether and how they will acquire health insurance.”
Senate Republicans, who hold a slim 52-48 majority, are pushing for a vote by Friday, when special rules that would allow the bill, co-sponsored by Sens. Lindsey Graham, R-S.C. and Bill Cassidy, R-La., to pass with a bare 50 votes plus a tie-breaking vote by Vice President Mike Pence. After Friday, 60 votes would be required for passage.
One hearing is scheduled with the Senate Finance Committee for Monday afternoon, and the nonpartisan Congressional Budget Office, Congress’ official arbiter of major legislation, has said it cannot complete analysis of the impact of the proposal on health-insurance coverage and premiums by Friday’s deadline.
As in July, when McCain cast the dramatic vote that killed the last Republican effort to repeal the current health law, the Arizona Republican lamented a legislative process devoid of committee hearings and a Congressional Budget Office review.
“I believe we could do better working together, Republicans and Democrats, and have not yet really tried,” McCain said. “Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it.”
McCain acknowledged that his move probably torpedoes the bill co-sponsored by Graham, his closest friend in the Senate.
“The bill’s authors are my dearest friends, and I think the world of them,” McCain said. But he blasted the process his party used to move legislation that he said would affect “a fifth of our economy and every single American family.”
Graham said his friendship with McCain is not based on how he votes but on “how he’s lived his life and the person he is,” and said he would “press on” with his bill.
There was no immediate reaction from President Trump. But Pence said the fight wasn’t over.
“This is not going to be easy. Some have gone so far as to announce their opposition already,” he said. “President Trump and I are undeterred.”
A defeat of the Graham-Cassidy bill, if it happens, would be a huge break for California, which vigorously embraced the Affordable Care Act, using its federal funds to expand coverage to 5 million people, and would be among the hardest hit by its repeal. By some estimates, the state stands to lose $78 billion in federal funds from 2020 to 2026 alone under the legislation.
House Minority Leader Nancy Pelosi, D-San Francisco, praised McCain for “once again” showing courage on behalf of the public, and urged House Speaker Paul Ryan, R-Wis., to begin bipartisan talks in the House to fix some of the widely acknowledged problems in the Affordable Care Act that have kept premiums high, especially for small businesses and individuals buying policies on its state exchanges.
Such negotiations had been started in the Senate Health, Education, Labor and Pensions Committee between its chairman, Lamar Alexander, R-Tenn., and ranking Democrat Patty Murray of Washington, after the July repeal effort failed, but Senate Majority Leader Mitch McConnell, R-Ky., killed those talks when he announced that he would bring the Graham-Cassidy bill to a vote next week.
Murray also applauded McCain.
“I agree with Sen. McCain that the right way to get things done in the Senate — especially on an issue as important to families as their health care — is through regular order and working together to find common ground,” she said. She added that she is confident “that we can reach a bipartisan agreement as soon as this latest partisan approach by Republican leaders is finally set aside.”
Senate Minority Leader Chuck Schumer, D-N.Y., said he “assured Sen. McCain that as soon as repeal is off the table, we Democrats are intent on resuming the bipartisan process.”
Republicans have faced broad opposition to their repeal bills from nearly every corner of the health care industry, which grew louder and more unified with each legislative iteration. On Friday, California-based Kaiser Permanente and its unions came out strongly against Graham-Cassidy, joining the nation’s biggest names among insurers, doctor and hospital groups and patient advocacy organizations.
McCain’s announcement came on the same day that Collins, who joined McCain in voting against the Republican repeal effort in July, said she is “leaning against” the current bill, especially because it, in effect, would void the current law’s requirement that insurers issue policies to people with chronic medical conditions such as cancer or diabetes. An estimated 100 million people have what is known as a pre-existing condition.
Under the Graham-Cassidy plan, states would be required to set up their own health-insurance systems, with far less federal money than they get now, and would have the flexibility to radically alter the current law’s rules.
Collins said that while the bill ostensibly requires insurers to cover people with pre-existing conditions, it could allow insurers to charge them premiums that she said would “be so high they would be unaffordable.”
Another blow to the GOP effort came Friday from Alaska’s Department of Health and Social Services, which said the state would lose 65 percent of its funding under the repeal bill, going further than previous GOP repeal efforts.
Sen. Lisa Murkowski, R-Alaska, also voted against the July repeal effort but has not stated her position on the latest version, and had said its effect on her state would play a big role in her decision.
Graham-Cassidy, the health bill the Senate may vote on next week, is stunningly cruel. It’s also incompetently drafted: The bill’s sponsors clearly had no idea what they were doing when they put it together. Furthermore, their efforts to sell the bill involve obvious, blatant lies.
Nonetheless, the bill could pass. And that says a lot about today’s Republican Party, none of it good.
The Affordable Care Act, which has reduced the percentage of Americans without health insurance to a record low, created a three-legged stool: regulations that prevent insurers from discriminating against people with pre-existing conditions, a requirement that individuals have adequate insurance (and thus pay into the system while healthy) and subsidies to make that insurance affordable. For the lowest-income families, insurance is provided directly by Medicaid.
Graham-Cassidy saws off all three legs of that stool. Like other Republican plans, it eliminates the individual mandate. It replaces direct aid to individuals with block grants to states, under a formula that sharply reduces funding relative to current law, and especially penalizes states that have done a good job of reducing the number of uninsured. And it effectively eliminates protection for Americans with pre-existing conditions.
Did Graham-Cassidy’s sponsors know what they were doing when putting this bill together? Almost surely not, or they wouldn’t have produced something that everyone, and I mean everyone, who knows anything about health care warns would cause chaos.
It’s not just progressives: The American Medical Association, the insurance industry and Blue Cross/Blue Shield have all warned that markets would be destabilized and millions would lose coverage.
How many people would lose insurance? Republicans are trying to ram the bill through before the Congressional Budget Office has time to analyze it — an attempt that is in itself a violation of all previous norms, and amounts to an admission that the bill can’t bear scrutiny. But C.B.O. has analyzed other bills containing some of Graham-Cassidy’s provisions, and these previous analyses suggest that it would add more than 30 million people to the ranks of the uninsured.
Lindsey Graham, Bill Cassidy, and the bill’s other sponsors have responded to these critiques the old-fashioned way — with lies.
Both Cassidy and Graham insist that their bill would continue to protect Americans with pre-existing conditions — a claim that will come as news to the A.M.A., Blue Cross and everyone else who has read the bill’s text.
Cassidy has also circulated a spreadsheet that purports to show most states actually getting increased funding under his bill. But the spreadsheet doesn’t compare funding with current law, which is the relevant question. Instead, it shows changes over time in dollar amounts.
That’s actually a well-known dodge, one that Republicans have been using since Newt Gingrich tried to gut Medicare in the 1990s. As everyone in Congress — even Cassidy — surely knows, such comparisons drastically understate the real size of cuts, since under current law spending is expected to rise with inflation and population growth.
Independent analyses find that most states would, in fact, experience serious cuts in federal aid — and everyone would face huge cuts after 2027.
So we’re looking at an incompetently drafted bill that would hurt millions of people, whose sponsors are trying to sell it with transparently false claims. How is it that this bill might nonetheless pass the Senate?
One answer is that Republicans are desperate to destroy President Barack Obama’s legacy in any way possible, no matter how many American lives they ruin in the process.
Another answer is that most Republican legislators neither know nor care about policy substance. This is especially true on health care, where they never tried to understand why Obamacare looks the way it does, or how to devise a nonvicious alternative. Vox asked a number of G.O.P. senators to explain what Graham-Cassidy does; the answers ranged from incoherence to belligerence to belligerent incoherence.
I’d add that the evasions and lies we’re seeing on this bill have been standard G.O.P. operating procedure for years. The trick of converting federal programs into block grants, then pretending that this wouldn’t mean savage cuts, was central to every one of Paul Ryan’s much-hyped budgets. The trick of comparing dollar numbers over time to conceal huge benefit cuts has, as I already noted, been around since the 1990s.
Will this awful bill become law? I have no idea. But even if the handful of Republican senators who retain some conscience block it — we’re looking at you, John McCain — the underlying sickness of the G.O.P. will remain.
It’s sort of a pre-existing condition, and it’s poisoning America.
Read my blog, The Conscience of a Liberal, and follow me on Twitter, @PaulKrugman.