Graham-Cassidy,
the health bill the Senate may vote on next week, is stunningly cruel.
It’s also incompetently drafted: The bill’s sponsors clearly had no idea
what they were doing when they put it together. Furthermore, their
efforts to sell the bill involve obvious, blatant lies.
Nonetheless, the bill could pass. And that says a lot about today’s Republican Party, none of it good.
The
Affordable Care Act, which has reduced the percentage of Americans
without health insurance to a record low, created a three-legged stool:
regulations that prevent insurers from discriminating against people
with pre-existing conditions, a requirement that individuals have
adequate insurance (and thus pay into the system while healthy) and
subsidies to make that insurance affordable. For the lowest-income
families, insurance is provided directly by Medicaid.
Graham-Cassidy
saws off all three legs of that stool. Like other Republican plans, it
eliminates the individual mandate. It replaces direct aid to individuals
with block grants to states, under a formula that sharply reduces
funding relative to current law, and especially penalizes states that
have done a good job of reducing the number of uninsured. And it
effectively eliminates protection for Americans with pre-existing conditions.
Did
Graham-Cassidy’s sponsors know what they were doing when putting this
bill together? Almost surely not, or they wouldn’t have produced
something that everyone, and I mean everyone, who knows anything about
health care warns would cause chaos.
It’s not just progressives: The American Medical Association, the insurance industry and Blue Cross/Blue Shield have all warned that markets would be destabilized and millions would lose coverage.
How
many people would lose insurance? Republicans are trying to ram the
bill through before the Congressional Budget Office has time to analyze
it — an attempt that is in itself a violation of all previous norms, and
amounts to an admission that the bill can’t bear scrutiny. But C.B.O.
has analyzed other bills containing some of Graham-Cassidy’s provisions,
and these previous analyses suggest that it would add more than 30 million people to the ranks of the uninsured.
Lindsey Graham, Bill Cassidy, and the bill’s other sponsors have responded to these critiques the old-fashioned way — with lies.
Both
Cassidy and Graham insist that their bill would continue to protect
Americans with pre-existing conditions — a claim that will come as news
to the A.M.A., Blue Cross and everyone else who has read the bill’s
text.
Cassidy has also circulated a spreadsheet
that purports to show most states actually getting increased funding
under his bill. But the spreadsheet doesn’t compare funding with current
law, which is the relevant question. Instead, it shows changes over
time in dollar amounts.
That’s
actually a well-known dodge, one that Republicans have been using since
Newt Gingrich tried to gut Medicare in the 1990s. As everyone in
Congress — even Cassidy — surely knows, such comparisons drastically
understate the real size of cuts, since under current law spending is
expected to rise with inflation and population growth.
Independent analyses find that most states would, in fact, experience serious cuts in federal aid — and everyone would face huge cuts after 2027.
So
we’re looking at an incompetently drafted bill that would hurt millions
of people, whose sponsors are trying to sell it with transparently
false claims. How is it that this bill might nonetheless pass the
Senate?
One
answer is that Republicans are desperate to destroy President Barack
Obama’s legacy in any way possible, no matter how many American lives
they ruin in the process.
Another
answer is that most Republican legislators neither know nor care about
policy substance. This is especially true on health care, where they
never tried to understand why Obamacare looks the way it does, or how to
devise a nonvicious alternative. Vox asked
a number of G.O.P. senators to explain what Graham-Cassidy does; the
answers ranged from incoherence to belligerence to belligerent
incoherence.
I’d
add that the evasions and lies we’re seeing on this bill have been
standard G.O.P. operating procedure for years. The trick of converting
federal programs into block grants, then pretending that this wouldn’t
mean savage cuts, was central to every one of Paul Ryan’s much-hyped
budgets. The trick of comparing dollar numbers over time to conceal huge
benefit cuts has, as I already noted, been around since the 1990s.
In
other words, Graham-Cassidy isn’t an aberration; it’s more like the
distilled essence of everything wrong with modern Republicans.
Will
this awful bill become law? I have no idea. But even if the handful of
Republican senators who retain some conscience block it — we’re looking
at you, John McCain — the underlying sickness of the G.O.P. will remain.
It’s sort of a pre-existing condition, and it’s poisoning America.
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