Here We Go Again

Several weeks ago I wrote  twice about the American Healthcare mess. I tried to offer a thorough summary of the healthcare system and solutions that should be explored. Remember that I also did not express support for Obamacare. I’ve always thought it was good for some and bad for others, that it did not actually address the healthcare crisis, and that if that crisis is not addressed healthcare will increasingly weigh down the economy. Obamacare requires major reform or should be totally replaced. I also argued that “Trumpcare” and other Republican attempts to repeal Obamacare did not effectively address the crisis.

Now Senators Lindsay Graham of South Carolina and Bill Cassidy have introduced yet another attempt to repeal Obamacare. The Senate is scheduled to vote on the bill next week even though only about 17% of Americans favored the Trumpcare proposal introduced several months ago. Unless I’m wrong (always a distinct possibility) Americans will not be so crazy about the Graham/Cassidy bill as well, but Republicans are trying to push it through.

President Trump has voiced overwhelming support for the Graham-Cassidy bill. I’m confident he has not read it nor does he have a clear idea about the bill’s provisions.

I also watched Senator Jeff Flake argue in favor of the bill yesterday morning, but when questioned he admitted he had not read it. And when he was asked how many pages are in the bill, he could not answer. So once again members of Congress are arguing in favor of something they know nothing about.

Keep in mind that on May 4 when the Senate was debating Trumpcare Senator Graham tweeted: “A bill — finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate — should be viewed with caution.”  So he was complaining that:

  1. The bill under consideration that would repeal Obamacare had not been “scored”. Bills are scored by the non-partisan Congressional Budget Office, and that score tries to forecast the impact of legislation on the budget and on those affected by the legislation. Graham thought the Senate should wait for the CBO score.
  2. No amendments to the bill were being permitted. This is the standard legislative process under “regular order”, and Graham thought it should be followed. This also means that committees are involved so amendments, as well as the bill itself, may be deliberated.
  3. Only three hours of debate were scheduled even though the repeal of Obamacare would impact 1/5 of our nation’s economy.

Guess what? The Graham/Cassidy bill is being introduced and debated in precisely the same manner.

  • No time for a full CBO score.
  • Because of the way it was introduced debate may be limited to 90 seconds (yes…seconds).
  • Compromise through traditional means will be impossible because the deadline is September 30 (I won’t explain the arcane rules,).

Oh…and back in June Senator Graham said “well I worry about Conrhusker Kickbacks and Louisiana Purchases and if they start doing that crap they are going to lose me. I’ll vote to proceed but if you start taking some of the money and savings and buying off votes that’s exactly what got us Obamacare and I would rebel against that.” Graham was referring to incidents in the past when concessions were made to certain members of Congress to get them to vote a certain way on a bill. In other words, a bill would give benefits to some states not available to others to garner votes of those states’ legislators.

Guess what? The Graham/Cassidy bill makes a special exception for Alaska so that Medicaid beneficiaries in that state would receive more than those from other states. Did you know that Alaska Senator Lisa Murkowski was one of the three Republicans opposing the Republican healthcare proposal this summer? Did you know that if she doesn’t vote for Graham/Cassidy it will likely not pass?

Although I’ve disagreed with Senator Graham on many or most policy issues over time I always thought he was consistent.  Now I realize that he is as hypocritical as those whom he has previously denounced for doing precisely what he is now doing.

I could go in to the details of the Graham/Cassidy bill, but if you are interested NPR offers a pretty good summary. What it does essentially is take federal money from states that expanded Medicaid under Obamacare (mostly Democratic states) and shifts that money to the states that did not expand Medicaid. The largest states, California and New York, would lose while Texas gained. If the bill becomes law individuals will no longer be required to have health insurance, more money would be allocated to states based on “block grants” that leave much of the decision-making regarding healthcare to those states,  large employers would not be required to provide insurance to employees, and Medicaid expansion funding would be cut. It also appears that the requirement that insurance companies cover people with preexisting conditions would be severely weakened.

Since we have no CBO score it is difficult to know the consequences of passage, but analysis by The Commonwealth Fund concludes that 32 million people would eventually lose their healthcare coverage. The Center on Budget and Policy Priorities believes more than 32 million would lose coverage after about ten years.

Thus far  The American Medical Association, American Psychiatric Association, The American Public Health Association, The National Institute for Public Health, and Federation of American Hospitals have voiced opposition to the bill. Interestingly, Blue Cross Blue Shield also opposes it as do The American Cancer Society, American Diabetes Association, and the American Heart Association. So if you are paying attention you see that doctors, hospitals, insurance companies, and patient advocacy groups are voicing opposition.

So that begs the question, why are they pushing it? I’ll give you three guesses. Any takers?