If you thought it absurd and incredibly irresponsible for Republicans to propose last week a slipshod, radical health-care bill that would not even allow for a Congressional Budget Office score, then the Sunday night amendments cooked up by Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., will infuriate you.
The timing alone should be enough to stop the bill. Reworking one-sixth of the economy before the only hearing on the subject - and without time for senators to digest a fraction of the numbers - bespeaks desperation on the sponsors’ part. They don’t have “momentum” and aren’t just about to snag 50 votes; if they were, they wouldn’t resort to last-minute shenanigans. Sen. Rand Paul, R-Ky., another “no” vote, reportedly wasn’t swayed by the new numbers.
The changes are akin to pouring old wine into slightly different bottles, or rather, filling a few states to the brim while snoozing senators get far less than their outspoken colleagues. The Post reports:
“If you read the updated bill, which was leaked Sunday night to The Washington Post and other news outlets, it’s pretty clear which senators Cassidy and Graham are playing to. A state-by-state summary claims Alaska would get 3 percent more funding, Arizona would get 15 percent more funding and Maine would get 43 percent more funding from 2020 and 2026 compared to current law.
“Senators from all three of those states - Lisa Murkowski, John McCain and Susan Collins - had backed away from the bill in recent days. McCain indicated on Friday he’d oppose the bill because it wasn’t going through regular order, while Collins and Murkowski said they want to better understand how it would affect their own states. . . . The state funding estimates don’t take into consideration the bill’s additional cuts to regular Medicaid spending. If those cuts were considered, it would be clear that states like Alaska and West Virginia would still be losing out on federal funds overall.”
In short, if the sponsors are trying to bribe Alaska’s and Maine’s senators, they haven’t done a very good job of it. Outside analysts note that the Cassidy-Graham numbers themselves show an overall loss to the states. For example, Alaska would receive $99 million less under the block grant; Ohio would receive $1.6 billion less under the block grant; West Virginia would receive $477 million less under the block grant. And if that were not enough, Axios picked up on some mathematical chicanery in the Cassidy-Graham numbers: “They also add state savings to the block grants under the bill, but don’t include them in the current law baseline, meaning the comparison isn’t apples to apples.”
Aside from the math, the newest iteration of Cassidy-Graham makes crystal clear that the federal safeguards against charging more for people with preexisting conditions are gone. Timothy Jost in Health Affairs blog explains:
“As in the earlier version, a state must describe in its funding application ‘how the State shall maintain access to adequate and affordable health insurance coverage for individuals with preexisting conditions.’ As with the earlier draft, however, the consumer protections that the bill does allow states to permit insurers to waive makes protection for people with preexisting conditions very tenuous.
“A state must also certify that it will ensure compliance with the ACA requirement that insurers and health plans cover adult children up to age 26 and several pre-ACA insurance reform requirements - minimum hospital maternity stays, coverage of reconstructive surgery following mastectomies; mental health parity, and protection of genetic information.”
States can waive Obamacare restrictions that currently prevent states from “allowing insurers to vary [premiums] for coverage” (except on the basis of sex or genetic information); offering coverage that doesn’t meet the Obamacare minimum standards; and using multiple risk pools (which quickly price sicker people out of the health-care market). Jost finds that states therefore will be able to ignore the ACA’s “essential health benefit requirements, actuarial value and metal level requirements; out-of-pocket limit requirements; requirement that insurers offer child-only plans, requirement that insurers cover preventive services without cost sharing, single risk pool requirement, and age and area rating requirements.”
If Collins, Murkowski and other moderates had qualms about the first version, they’ll likely be doubly concerned by what they spot in the latest offering. And other senators (Hello, Ohio! Wake up, West Virginia!) may wonder why they didn’t get anything. Cassidy managed to slip in extra funding for his state. The question now is becoming not whether a senator or two will be persuaded, but how any senator in good conscience votes for this mess.