In a last-ditch effort to take affordable health care away from millions of Americans, Senate Republicans have proposed their worst plan yet to “repeal and replace” the Affordable Care Act.
The plan relies on a favorite GOP trick: converting federal spending into block grants to states. What that actually means: Big cuts in future federal spending and shifting burdens to unprepared states that must then make drastic cuts in services.
Cassidy-Graham would penalize states such as Kentucky, which expanded Medicaid under the ACA. Thanks to former Gov. Steve Beshear’s decision to expand Medicaid, the uninsured rate dropped more in Kentucky than any other state, from 20.4 percent to 7.8 percent.
About 500,000 more Kentuckians have health insurance coverage than did before the ACA. About 475,000 of them were covered under the Medicaid expansion. Another 63,700 got ACA financial help to buy insurance on the open market.
Another 945,500 Kentuckians — the state’s poorest and most vulnerable citizens — are covered by traditional Medicaid. The Senate bill would create a per-capita cap on the federal money Kentucky would receive for their coverage. It’s easy to see where that would lead: cuts in coverage, benefits and payments to providers.
The Senate bill would cut federal funding for low-income health care in Kentucky by $3.1 billion by 2026, according to an analysis by the Kentucky Center for Economic Policy. Beginning in 2027, federal money would be discontinued, leaving Kentucky without $6.9 billion in annual health care assistance funds.
Cassidy-Graham would eliminate the requirement that everyone have insurance. If young, healthy people opt out of the system, prices go up for everyone else. The bill also would open the door to allowing states to let insurance companies refuse to sell affordable policies to people with pre-existing conditions.
On top of all that, the Senate bill would leave Kentucky with a sicker population and work force, plus thousands fewer health care jobs. The National Rural Health Association warns that this bill would be especially hard on rural hospitals, many of which are in danger of closing.
Sen. Mitch McConnell wants to use a loophole in Congressional rules to push through this partisan bill without debate or scrutiny before Sept. 30. But it is unclear if he has enough votes to pass it. Sen. John McCain of Arizona said Friday he could not in “good conscience” vote for it. Sen. Rand Paul of Kentucky doesn’t like it either, but only because it doesn’t go far enough in destroying the ACA.
If this travesty passes the Senate, there is little doubt House Republicans, including five of Kentucky’s six congressmen, will go for it. Same with President Donald Trump. He loves this plan, even though it violates every health care promise he made to voters.
So who is against Cassidy-Graham besides Democrats? Just about every group that actually knows anything about health care.
Opponents include the American Medical Association, the American Nurses Association, the American Hospital Association, the American Cancer Society, the American Diabetes Association, the American Heart Association, the American Lung Association, the Arthritis Foundation, the National Health Council, the National Council for Behavioral Health and the National Association of Medicaid Directors, which represents the people who run Medicaid in all 50 states.
The insurance industry also warns that Cassidy-Graham would be a disaster.
“The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with preexisting medical conditions,” the Blue Cross Blue Shield Association said in a statement. “The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.”
So why are Republicans so determined to destroy the Affordable Care Act, which public opinion polls show more than half of Americans now support? Because they have demagogued “Obamacare” for so long to score points with their base that they have painted themselves into a political corner.
Ironically, many people in Kentucky and elsewhere who would be hurt by this plan vote Republican. But because conservative politics have become more about tribal loyalty than facts and logic, GOP leaders assume few of those voters will hold them accountable. They’ll just find a way to blame it on Obama.