Wednesday, September 20, 2017

The Graham-Cassidy Bill: It's Not Their Job to Do It Well

They’ve got to be kidding. Right?

Alas, no. The Republicans still have not found a cure for their obsessive compulsive disorder, and they’re going to take another shot at repealing Obamacare, which, apparently, I have to explain is the same thing as the Affordable Care Act.

The Congressional Budget Office (CBO) hasn’t had a chance to score the latest proposal. It “is working to provide a ‘preliminary assessment’ of the latest Republican health-care bill by early next week but will not estimate how the measure would affect health insurance premiums or the number of people with medical coverage until later.” [1] That might be a problem, because if “the Senate does not vote by the end of next week, it will become nearly impossible to repeal the law because the drive to kill the Affordable Care Act will lose the procedural protections that allow it to pass the Senate with a simple majority, rather than the 60 votes that would otherwise be needed.” [2] Republicans may thus feel pressed to push the matter to a vote (again) without a proper CBO analysis.

The leaders of this latest effort are Republican Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, and their “bill has two major elements, one that is new and one that was found in many other Republican repeal bills this year.”

“The new element is a block grant,” which “would give each state a fixed amount of federal money for health care and health insurance each year from 2020 to 2026,” in an amount that “is slightly less than what the federal government is expected to spend under the Affordable Care Act on the expansion of Medicaid, on premium tax credits and on subsidies to reimburse insurers for reducing the out-of-pocket costs of low-income consumers.”

What is not so new about “the Graham-Cassidy bill” is that it “would make deep cuts in Medicaid. It would end the expansion of eligibility under the Affordable Care Act, which has extended coverage to 13 million people. And it would put the entire program, which serves more than 70 million people, on a budget, ending the open-ended entitlement that now exists. States would receive a per-beneficiary allotment of federal money.” The CBO “has estimated that 15 million fewer people would have Medicaid as a result of similar proposals in other Republican bills.” So we will not be out of line in anticipating that the Graham-Cassidy bill will do the same.

One has to wonder what inspires such misanthropy, especially since it has been carried out in such a manic fashion. But we should consider the possibility that the greatest fear of the Republican contingent regarding Obamacare is that it will eventually work. And it will be called “Obamacare,” after a Democratic president.

Submitted, thus, for your observation, the worst part of having political parties: they don’t want the other party to accomplish anything good or worthwhile. They want to be the ones doing good, so as to better sell themselves come election time. And they are not above actively getting in the way of the other party doing something that will benefit the citizenry. So the Republicans have never wanted the Affordable Care Act to work, which is probably why many Republican governors opposed the Medicaid expansion that came along with it.

All of this is simple and intuitive enough. But there is a particular problem that arises in connection with Republicans and healthcare. There are defects in Obamacare, things that need to be fixed, not least of which is the fact that it doesn’t ensure that every citizen has health insurance. The application of common sense discloses that covering more people would be an improvement.

But the Republicans are largely foreclosed from taking that route, because much of its donor base does not believe that the federal government should involve itself with such concerns, and is also opposed to taxes that are adequate to fund such endeavors in any event. It is, therefore, not surprising that every substitution for the Affordable Care Act that the Republicans come up with covers fewer people than does the current legislation, not more.

It’s tough to be a Republican when it comes to healthcare. If you improve on the current law, or even do nothing, you will anger your donor base. If you make things worse you’ll have to try very hard to keep the voters from noticing. The healthcare controversy cries out for a reform of the manner in which we elect people to office.