Facing a September 30th deadline for passage of a bill which will repeal and replace the Affordable Care Act (Obamacare) with a simple majority instead a 60 vote requirement in the Senate, Republican lawmakers have cobbled together a Hail Mary known as the Graham/Cassidy health care bill. The good news for Republicans is that the bill might pass both the House and the Senate. The bad news for Republicans and tens of millions of Americans, and the country at large is that the bill might pass and be signed into law by Donald Trump, who is of course hungry for a win, any legislative win.
Evidently Congressional Republicans, like Trump, appear to be more concerned with fulfilling campaign promises than their political futures. There is no doubt that this bill will disrupt the health care industry and leave millions of our most vulnerable citizens without health care insurance coverage. Guarantees of insurance for people with preexisting conditions (an estimated one fifth of our population) will be jeopardized.
The health policy consulting firm, Avalere Health estimates that federal funds provided for Medicaid and private insurance subsidies will shrink $215 billion by 2026 and by $4 trillion by 2036. There will be winners and losers among the states in the completion for the remaining Medicaid funding. Money will flow from states which adopted expanded Medicaid coverage under Obamacare to states with relatively low medical costs and skimpy Medicaid benefits which refused to participate in the Medicaid expansion.
Now this sounds like Republicans are trying take care of their constituents in Red States, but here is where it gets confusing. It is true that Blue States with large populations such as New York and California will lose a good deal of their federal Medicaid funding, but blue states in general are richer and among those that can probably best afford to make up the difference. However, a total of 34 states will among the losers under Graham-Cassidy. Among the big losers are poorer Rust Belt and smaller, more rural states that decided to expand Medicaid – Alaska, Arkansas, Arizona, Indiana, Iowa, Kentucky, Louisiana, Maine, Montana, New Mexico, North Dakota, Ohio and West Virginia. What do these states have in common? Except for Maine, they are mostly Red States with a few Purple States thrown in. That makes Graham-Cassidy a dicey proposition for Republican politicians in those states.
If the bill passes, a few years from now everyone will have forgotten the “Graham-Cassidy” nomenclature and the new health care norm will be rightfully known as “Trumpcare” or “Republicare”. Republicans in general will feel the brunt of its failure. Confusion will reign for months, or even years as each state is involved in the very complex task of deciding how to best use their new block grants. Unfortunately, some families which now have health insurance coverage will be wiped out financially by health care emergencies and regrettably some family members will die due to insufficient medical care. Our hospital emergency rooms will again be jammed with people who could be treated much more efficiently and less expensively in doctor’s offices while the rest of us with real emergency situations wait hours and our insurance bills increase accordingly.
None of this will go unnoticed. The news media will cover such disasters in great detail, justly pinpointing the cause as the Republican repeal and replace bill which was rushed to passage without even a score card from the Congressional Budget office to point out its limitations and pitfalls. Republicans will pay a heavy price in terrible publicity for years. Their best hope is that at least three of their Senate members are wise enough to vote “No”.
But how can I be sure that the Graham-Cassidy legislation would be such a dismal failure if it passes? That’s easy. I’m going with the wisest sources available and relying on those who best know the heath care industry. Nearly every organization involved in health care in this country has come out in opposition the bill. This is list of the organizations that oppose the Graham-Cassidy bill along with some excerpts of their message to Congress:
The Doctors and Nurses:
American Medical Association: “We believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care.”
American Nurses Association
American College of Physicians
American Academy of Pediatrics
American Congress of Obstetricians and Gynecologists
American Osteopathic Association
American Psychiatric Association
Health Service Providers:
American Hospital Association (An association of 5,000 health care services organizations and companies.)
Kaiser Permanente (largest managed care organization in the United States)
National Council for Behavioral Health (Association of 2,900 organizations that deliver mental health and addictions treatment and services)
Planned Parenthood (Operates over 650 reproductive health clinics)
American Health Care Association/National Center for Assisted Living (Represents more than 10,000 non-profit and for-profit assisted living and nursing facilities)
The Insurance Company Associations:
Blue Cross Blue Shield Association (A huge federation of 36 separate United States health insurance organizations and companies) The organization warned that Graham-Cassidy “could further destabilize the individual insurance market…and could reduce health coverage for many Americans and undermine Obamacare protections for people with pre-existing medical conditions.”
Americans Health Insurance Plans (An association of 1,300 member companies that sell health insurance)
America’s Health Insurance Plans (The insurance industry’s leading lobbying group)
Charitable Organizations Supporting Health Care:
Sixteen of these organizations wrote Congressional leaders a letter which stated in part: “This bill would limit funding for the Medicaid program, roll back important essential health benefit protections, and potentially open the door to annual and lifetime caps on coverage, endangering access to critical care for millions of Americans. Our organizations urge senators to oppose this legislation … We urge Congress to continue the important bipartisan effort rather than advancing proposals that would weaken access to the care Americans need and deserve”. The organizations signing that letter were:
American Cancer Society Cancer Action Network
American Diabetes Association
American Heart Association
American Lung Association
Cystic Fibrosis Foundation
Family Voices (Supports children with special health care needs)
JDRF (Funds type 1 diabetes research)
Lutheran Services in America (Coordinates the work of over 300 independent Lutheran health and human service organizations)
March of Dimes
National Health Council
National Multiple Sclerosis Society
National Organization for Rare Diseases
Volunteers of America (Provides affordable housing and assistance with health services primarily to low-income people)
WomenHeart (The National Coalition for Women with Heart Disease)
Other Charitable Organizations Opposed:
The Arc (Serving people with intellectual and developmental disabilities)
The Alzheimer’s Association
Alzheimer’s Impact Movement
Consumers Union (Focuses on, among other consumer services, helping consumers to make informed decisions in the marketplace and encouraging market actors to place the needs of consumers first)
Other Interested Voices:
AARP (lobbing group for 38 million older Americans) “Overall, the Graham/Cassidy bill would increase health care costs for older Americans with an age tax, decrease coverage, and undermine preexisting condition protections … In addition, this bill would jeopardize the ability of older Americans and people with disabilities to stay in their own homes as they age and threaten coverage for individuals in nursing home. … The bill could increase premiums and out-of-pocket costs by as much as $16,174 a year for a 60-year-old earning $25,000 annually if they wanted to keep their current coverage.”
A bipartisan group of ten state Governors – Bill Walker (I) of Alaska, Brian Sandoval (R) of Nevada, John Kasich (R) of Ohio, Charlie Baker (R) of Massachusetts and Phil Scott (R) of Vermont, John Hickenlooper (D) of Colorado, Steve Bullock (D) of Montana, Tom Wolf (D) of Pennsylvania, Terry McAuliffe (D) of Virginia and John Bel Edwards (D) of Louisiana:“As you continue to consider changes to the American health care system, we ask you not to consider the Graham-Cassidy-Heller-Johnson amendment and renew support for bipartisan efforts to make health care more available and affordable for all Americans.”
Gov. Chris Christie (R) of New Jersey – also opposed
Again the best thing that could happen to Republicans in Washington is for three Senators in their ranks to be stand up and be counted in opposition to the Graham-Cassidy bill. Then most Republican lawmakers could return to their home states and districts saying, “Hey, I tried” without having to suffer though the outrage when their constituents learn what they have really done to them. If it wouldn’t hurt so many millions of our most vulnerable citizens, I would like to see the Republicans commit political suicide and pass the bill and for Trump to sign it, thus joining their harikari ceremony. But the health, lives, and financial well being of far too many is at stake.
As I finished writing this article I learned that John McCain has now publicly stated that he will not support the Republican’s last ditch effort to “repeal and replace”. Since he is Lindsey Graham’s best bud, most political analysts believed that McCain’s would support his friend’s legislation. With McCain now a “no” vote, chances are that Graham-Cassidy will fail. New conspiracy theory: One has to wonder whether Graham knew all along that McCain would not go along and the whole thing was staged in an effort to allow Congressional Republicans to save face.