Thursday, September 14, 2017

Graham-Cassidy health care bill: Beware a wolf in states rights clothing:

A version of this was published  in the Sky Hi News, 9/20/17

 Senators Lindsey  Graham and Bill Cassidy, are jamming through a bill that  is a wolf in states rights clothing.  It will eat alive your ability to buy affordable health insurance and eventually cripple  Medicaid.To beat the  September 30  deadline to pass bills through the budget reconciliation process, the two Senators are making a last ditch efforts to kill/replace Obamacare.  Budget reconciliation permits the Senate  to pass repeal-replace Obamacare legislation  with 51 instead of 60 Senate votes that would need some Democrats to join in.

 Graham/Cassidy  would give states block grants to administer Obamacare. These block grants are designed to take federal money from blue states who have expanded Medicaid and directs the funds to red states.  It is a strategy to overcome red states opposition that sank  the prior bill. It a) does not repeal or replace Obamacare:  it reduces funding by a third and changes the way money is distributed; b) would leave millions without health insurance . It has not yet been "scored" by the Congressional Budget Office that  to estimates costs and impact,. c)It  would lead to the collapse and affordability of whatever insurance is left since it removes mandates of healthy individuals and   businesses to participate and provide   health insurance, leaving mostly  the expensive to treat  sick in the pool. d) It would hasten the single payer system due to its failure and and causing suffering and harm, making even Medicare for All look even better; e) destroys federal  Medicaid and federal block grants by 2026, leaving states to shoulder the costs.f) It removes essential benefit requirements including coverage of preexisting conditions. 

Graham/Cassidy  has never gained much traction until now. It has been on the Senate table during the summer so that it has had  some scrutiny.    While its impact has never been scrutinized by the Congressional Budget Office, other green eye shade authoritative non-profit  groups did in July. Digging into it  the Center on Budget and Policy  Priorities found that the Graham-Cassidy plan would 
  • "Eliminate premium tax credits and cost-sharing reductions that help moderate-income marketplace consumers afford coverage and care, and eliminate the ACA’s enhanced match for Medicaid expansion starting in 2020.
  • Replace the marketplace subsidies (premium tax credits and cost-sharing reductions) and Medicaid expansion funding with a block grant set at levels well below what would be provided under current law.  States apparently could use these funds for a broad range of health care purposes, not just coverage, with essentially no guardrails or standards to ensure affordable, meaningful coverage.  After 2026 block grant funding would end altogether.
  • Maintain the Senate bill’s provision to convert virtually the entire Medicaid program to a per capita cap, with large and growing cuts to federal funding for seniors, people with disabilities, and families with children.  "  
 There are some temporary  fixes to Obamacare  being examined by Congressional committees now. The Kasich/Hickenlooper repair bill now in a Senate committee would retain mandates for Americans to buy health insurance but would give tax exemptions for insurers that offer plans in underserved counties  and give them access to existing federal plans and create a reinsurance program, propping up and stabilizing the insurance market to keep premiums from soaring..  

That Bernie Sanders and large number of Democratic Senators have signed on to his Medicare for All is significant.  While it has no chance of gaining 60 votes to pass, it is now a serious alternative  that is on the table and close  to becoming a Democratic party platform plank in the  near future.  The more GOP legislation takes insurance away from those who need it, the more likely the public will turn to single payer. However, in the process many people will be harmed and will suffer.  Democrats should beware that the GOP is trolling, hoping to split the party over the issue by putting Sander's plan as a bogey man, a "horrible" plan (per Pres. Trump's press person).  In the short term, Democrats will only feed success of  the truly  horrible  Graham-Cassidy bill  if they tie themselves in knots over the issue.

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