Lindseypoo: Elusive Care Eunuch

From Michael Hiltzik at The Los Angeles Times:

The Republican effort to repeal the Affordable Care Act is back, a zombie again on the march weeks after it was declared dead. The newest incarnation is Cassidy-Graham, named after chief sponsors Bill Cassidy of Louisiana and Lindsey Graham of South Carolina.

Compared with its predecessors, the bill would increase the ranks of America’s medically uninsured more — by millions of people — cost state governments billions more and pave the way for the elimination of all protection for those with preexisting medical conditions.

Original DVD cover

Over the last week or so, reviews of the measure have been pouring in from healthcare experts, and they’re almost unanimously negative. Major health provider and consumer organizations have turned thumbs down, as have analysts looking at its economic effects.

Fitch Ratings, which keeps an eagle eye on the fiscal condition of states issuing bonds, judges Cassidy-Graham “more disruptive for most states than prior Republican efforts.” Fitch finds that “states that expanded Medicaid access to the newly eligible population under the Affordable Care Act (ACA) are particularly at risk under this latest bill.”

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[…] Cassidy, Graham and their co-sponsors are trying to push the measure through by Sept. 30, the last day it could be passed with only 50 votes (plus a tie-breaker cast by Vice President Mike Pence) under Senate reconciliation rules. After that, it would need a filibuster-proof count of 60 votes, meaning it could — and presumably would — be blocked by Democrats. The deadline places more pressure on the Congressional Budget Office, which must analyze the bill before it can come to a vote, to move fast.

The CBO, however, announced Monday that it will be unable to complete a full analysis before Sept. 30.

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It also raises the question of how people like Arizona’s Republican Gov. Doug Ducey can say, as he did Monday, that the bill is “the best path forward to repeal and replace Obamacare.” How could he know? That’s important, because Ducey’s support is thought to be crucial in securing the votes of Arizona Sens. Jeff Flake and John McCain. Flake already said he would support the bill, but McCain has been cagey.

In recent days, the sponsors have claimed that their vote count is edging toward 50. But Sen. Rand Paul (R-Ky.) has stated that he’s a “no,” since the bill isn’t conservative enough for his taste. Sen. Susan Collins (R-Maine), whose “no” vote helped to scuttle the last repeal effort in July, isn’t expected to change her mind on this one. Sen. Lisa Murkowski (R-Alaska), who also voted it down, hasn’t been quoted on her position, but there don’t seem to be compelling reasons for her to shift to the “yes” column now. McCain also voted against the last bill, but he’s a close friend and frequent ally of Graham’s and aligned with Ducey. In any event, the backers still seem to be a vote or two short.

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The block grant to states, which Cassidy and Graham portray as one of their bill’s chief virtues, is in fact a poisoned chalice any governor would be a fool to accept.

 

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Block grants would be fixed, changing only according to a complex formula. And that formula would be “insufficient to maintain coverage levels equivalent to the ACA,” the Center on Budget and Policy Priorities calculated last week. Between 2020 and 2026, the center reckoned, the grant would provide $239 billion less than projected federal spending for the existing Medicaid expansion and subsidies. In 2026 alone, the shortfall in Medicaid and subsidy funds together would total $80 billion.

What’s worse is that the grant would be unable to respond to real-world conditions. Consider how healthcare costs are likely to rise in Texas and Florida in response to this summer’s floods, which drove thousands of residents out of their homes and increased the threat of water-borne disease. They’d get no help from the block-grant formula.

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As set forth in the bill, the formula would “over time move money away from states, predominantly Democratic [including California, New York and Massachusetts], that have expanded Medicaid and aggressively pursued enrolling their lower income populations in Medicaid and exchange coverage,” observes healthcare expert Timothy S. Jost. “Money would move toward states, predominantly Republican, that have not expanded Medicaid.”

 

States that shunned the Affordable Care Act would make out like bandits: Texas, which showed absolutely no regard for its ACA-eligible population, would get $8.2 billion more in 2026, and Mississippi, another black hole for healthcare reform, would get $1.4 billion more.

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The bill would allow states to request waivers from the federal government allowing them to nullify the act’s requirement that all policies include 10 essential health benefits, including maternity care, hospitalization, mental health and substance abuse treatment, and prescription coverage. This is an invitation to states to allow insurers to market junk insurance to their residents.

The states could also request waivers of the act’s all-important protections for people with preexisting medical conditions.

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Cassidy-Graham throws out that protection. It would allow states to request a waiver allowing insurers to charge more “as a condition of enrollment or continued enrollment… on the basis of any health status-related factor.” Translation: Under such a waiver, insurers could check applicants’ health or medical histories before setting premiums — even for renewals.

Finally, there’s that crucial Republican litmus test — abortion. The bill bars any insurance policy receiving federal funds — that is, a policy whose enrollees get subsidies or that is subject to payments under the Affordable Care Act’s reinsurance rule — from offering coverage for abortions except when the mother’s life is in jeopardy or in cases of rape or incest.

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As with other repeal efforts, this one is being brought out without a minute of hearings.

Cassidy asserts that this measure is a blow for equality. The measure “treats all Americans the same no matter where they live.” He’s right, in a way: It treats all Americans as potential victims of insurance company profiteering.