Senate Majority Leader Mitch McConnell is fond of talking and tweeting about the horrors visited upon Americans by the Affordable Care Act.
But, if the Graham-Cassidy bill he’s pushing to repeal and replace the ACA passes, we ain’t seen nothin’ yet in the health-care horror show.
McConnell’s home state of Kentucky will be among the hardest hit because it has made some of the greatest gains in extending access to health care under the ACA.
A good idea? Of course not.
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That’s why an exhausted public must once again besiege Congress to reject this latest, and probably worst, attempt to kill the ACA. Senate Republicans have only until the end of September to pass a healthcare bill with a simple majority as a budget reconciliation bill. After that repealing Obamacare will take 60 votes, far more than they could hope to muster.
The basic plan in Graham-Cassidy is to slash federal spending on health care, eliminating the subsidies that help middle-income earners buy their own insurance, and the Medicaid expansions that some states, including Kentucky, chose to extend health care to more vulnerable people.
Current estimates are that the majority of states would lose millions, if not billions, in federal health care dollars under the plan.
Those dollars would be partially replaced with block grants from the federal government to the states, each of which would have to design and implement its own health-care program. Those grants would diminish over time before expiring in 2027. Under this scenario:
▪ 475,000 Kentuckians who gained access to affordable health care through the Medicaid expansion would lose it.
▪ 81,000 middle-income Kentuckians who get subsidies to make coverage affordable would lose them.
Kentucky is a very poor and very sick state, although we have begun to see some gains under the ACA, including more people who have a personal physician and have had a routine checkup recently. Fewer report skipping medication due to cost; and there’s a 64 percent drop in people relying on emergency rooms for their care.
These are the building blocks for a healthier population with fewer of the medical emergencies that drive up the total cost of medical care.
But Republicans have campaigned for years on getting rid of the ACA. So, no matter how many thousands of Kentuckians and millions of Americans will suffer if they can rush Graham-Cassidy into law, they want to claim a victory, a promise fulfilled.
The opposition to Graham-Cassidy is wide, deep and earned.
It includes the American Hospital Association (it “would erode key protections for patients and consumers”); major insurance-industry trade groups, including Blue Cross Blue Shield (it “would increase uncertainty in the marketplace, making coverage more expensive”); the American Medical Association (it “would result in millions of Americans losing ... access to affordable coverage and care”); a host of patient advocacy groups such as the ALS and American Diabetes associations (it would “roll back important essential health benefit protections ... endangering access to critical care for millions of Americans”); and a bipartisan group of 10 governors, who urged senators instead to fix what’s wrong with the ACA.
On the other side are very strong voices, and checkbooks, clamoring for repeal. The oligarchs who have poured millions into Republican campaign coffers and other murkier groups have threatened to cut off the cash unless Obamacare is repealed and tax reform enacted.
Sean Lansing, who runs the Koch brothers’ Americans For Prosperity, left no doubt: “If they don't make good on these promises ... there are going to be consequences, and quite frankly there should be.”
Either way, there will be consequences. Politicians could lose their jobs or Americans will lose health care. Tough choice.