There is no ambiguity about the terms of the Graham-Cassidy bill. It would roll back the Affordable Care Act’s expansion of Medicaid, which has enabled about fourteen million Americans to obtain health-care coverage. Then it would subject the rest of Medicaid to substantial cuts by converting it to a block-grant program. By targeting the low-paid, the sick, and the infirm, the legislation would create hundreds of billions of dollars in budget savings; these could then be applied to Republican tax cuts aimed primarily at rich households and corporations.
The bill isn’t just a smash-and-grab raid on the poor and nearly poor, though. It would also undermine the insurance exchanges set up under the A.C.A., by stripping away the subsidies for the purchase of policies, abolishing the employer and individual mandates, getting rid of the lifetime caps on health-care outlays, and allowing insurers to force people with preëxisting conditions to pay more.
How much more? According to a new analysis by the Center for American Progress, a liberal think tank, opioid addicts and people with rheumatoid arthritis would face surcharges of more than twenty thousand dollars a year. (That’s in addition to the regular premiums.) For people with serious heart conditions, the surcharge would be more than fifty thousand dollars a year. And for those with metastatic cancer, it would be more than a hundred and forty thousand dollars.
In addition to destroying Obamacare, the bill would hand over to the states some of the money that the A.C.A. raised and let them build their own health-care systems. (This, supposedly, is the “replace” bit of “repeal and replace.”) A few big states, such as California and New York, might try to maintain the current setup, but they would be forced to spend more of their own money to do so. In a blatantly political move, the Graham-Cassidy bill would redirect some of the A.C.A. money to the nineteen Republican-run states that didn’t expand Medicaid, such as Florida, North Carolina, and Texas.
The American Medical Association, which represents more than two hundred thousand doctors, and the American Association of Retired Persons, which has thirty-eight million members, also criticized the new bill. The A.M.A. said that the measure “would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care.” The A.A.R.P. added that the legislation would “jeopardize the ability of older Americans and people with pre-existing conditions to stay in their own homes as they age and threaten coverage for individuals in nursing homes.”
Jimmy Kimmel, the late-night host who, through a close call involving his infant son, became a flashpoint for healthcare legislation, has came out against it.
It turns out that Kimmel, by no means an expert on healthcare, understands the bill better than its authors.
So far only one Republican — Sen. Rand Paul — has definitively refused to support the Graham-Cassidy bill, and Republicans, who hold a 52-48 majority, can only afford to lose one more of their own in order to pass the bill with a tie-breaking vote from Vice President Mike Pence. If they lose two more Republicans, then there’s no path for the bill as written to proceed. McCain, Collins, and Murkowski – who have rejected prior ACA repeal attempts — have said they have “serious concerns”.
Someone noticed that there is a nice little perk in the bill for Alaska, hopefully to sway Murkowski. Another fifteen or so are “still studying the bill”. The fact there is no CBO scoring SHOULD dissuade the on-the-fencers, but you never know.