Graham-Cassidy: One More Attempt to Gut Medicaid

UPDATE: There has been a lot of good reporting on the impact of Graham-Cassidy. "How the Latest Obamacare Repeal Plan Would Work" by Reed Abelson and Margot Sanger-Katz explains how Medicaid would be fundamentally altered:

Like several earlier Republican health bills, this one would also change the structure of the 52-year-old Medicaid program, which even before Obamacare’s expansion to poor adults in many states covered tens of millions of vulnerable Americans, including poor children, older Americans in nursing homes, adults with disabilities, and many pregnant women. The program currently pays for 49 percent of all births and 64 percent of all nursing home residents’ bills.

The Graham-Cassidy bill moves funding for the Medicaid expansion population into the state block grant. It would also convert the rest of the program from an open-ended commitment of paying a share of those people’s medical bills to a capped allotment for each person every year, set to grow by a fixed amount. Independent analysts have said that the change would cause substantial shifts in financial responsibility to states, ultimately leading to reductions in benefits or in the number of Americans covered by Medicaid over time.

That was published Wednesday. Yesterday there was "Latest Obamacare Repeal Effort Is Most Far-Reaching" by Kate Zernike, Abelson and Abby Goodnough:

For decades, Republicans have dreamed of taking some of the vast sums the federal government spends on health care entitlements and handing the money over to states to use as they saw best.

Now, in an 11th-hour effort to repeal the Affordable Care Act, the party has come up with a way to repackage the funding for the law it loathes into a trillion-dollar pot of state grants.

The plan is at the core of the bill that Senate Republican leaders have vowed to bring to a vote next week. It was initially seen as a long-shot effort by Senators Lindsey Graham and Bill Cassidy. But for all its ad hoc, last-minute feel, it has evolved into the most far-reaching repeal proposal of all.

It dismantles the Medicaid expansion and the system of subsidies to help people afford insurance. It gives the states the right to waive many of the consumer protections under President Obama’s landmark health law. And it removes the guaranteed safety net that has insured the country’s poorest citizens for more than half a century.

“This is by far the most radical of any of the Republican health care bills that have been debated this year,” said Larry Levitt, a senior vice president with the nonpartisan Kaiser Family Foundation. “And the reason for that is that this would be the biggest devolution of federal money and responsibility to the states for anything, ever.”

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The reanimation of Trumpcare in the form of the Graham-Cassidy bill is one last attempt to gut Medicaid before the rule allowing heath-care legislation to pass by simple majority expires at the end of next week. Graham-Cassidy would take the Obamacare money and block grant it back to the states; it would also block grant Medicaid, at the same time it ends the Obamacare expansion of the program. According to Robert Pear and Thomas Kaplan in "Republican Leaders Defy Bipartisan Opposition to Health Law Repeal":

Besides creating block grants, the Graham-Cassidy bill would make deep cuts in Medicaid. It would end the expansion of eligibility under the Affordable Care Act, which has provided Medicaid coverage to 13 million people. And it would put the entire program, which serves more than 70 million people, on a budget, ending the open-ended entitlement that exists. States would instead receive a per-beneficiary allotment of federal money.

[snip] 

Republicans were trying desperately to round up votes for the Graham-Cassidy bill before the end of next week, when the measure will lose the procedural protection that allows it to pass with a simple majority, rather than the 60 votes that would otherwise be required.

While Republicans like the idea of federalism and block grants, many wanted to know how their states would be affected. Under the legislation, states with high health care costs — especially if they expanded Medicaid under the Affordable Care Act — would generally lose money, while low-cost states that did not expand Medicaid would gain.

[snip]

The Republican governors who signed the letter opposing the latest Republican repeal plan were John R. Kasich of Ohio, Brian Sandoval of Nevada, Charlie Baker of Massachusetts and Phil Scott of Vermont.

Two other Republican governors, Mr. Sununu and Larry Hogan of Maryland, expressed similar concerns in separate statements.

“The Graham-Cassidy bill is not a solution that works for Maryland,” Mr. Hogan said. “It will cost our state over $2 billion annually while directly jeopardizing the health care of our citizens.”

Mr. Graham and Mr. Cassidy have cited Maryland as a state that, in their view, has been receiving more than its fair share of money under the Affordable Care Act.

Mr. Sununu said he could not support the Graham-Cassidy proposal because “New Hampshire could possibly lose over $1 billion in Medicaid funding between 2020 and 2026.” He said such a cost shift would be a particular problem for his state because “New Hampshire is proud of its tradition of not having an income tax or sales tax.”

Rand Paul and Susan Collins have already signaled "No" votes. This means that it is up to Lisa Murkowski to scuttle the bill, which shouldn't be a problem for a politician who won a general election to the U.S. Senate as a write-in.

Can there be a bigger whore than Lindsey Graham? In criticizing Trumpcare, he postured and preened as a defender of moderation and fairness, only to end up voting for it in a losing effort. Now he is actually sponsoring a new version of Trumpcare. That bitch Graham will do anything for a buck.