“Repeal and replace” is back and it’s worse than ever. In a last-ditch effort to get rid of the Affordable Care Act, Senators Lindsey Graham (R- SC) and Bill Cassidy (R- LA), along with their fellow Republican Senators Dean Heller (R-NV) and Ron Johnson (R-WI), have created a new bill that they hope can garner support from the 50 senators it needs to pass.
How can this bill possibly be worse than the previous attempts? Graham-Cassidy would cut more funding for health care and leave more people uninsured, while hurting the most vulnerable. Unlike other proposed Republican health plans, which lowered funding for the Obamacare plan subsidies and Medicaid expansion but kept these elements intact, Graham-Cassidy ends the marketplace and Medicaid expansion entirely by 2020. Instead, this money would be distributed to the states as a lump sum for them to restructure their insurance markets.
Rather than distribute this money by population, or rates of chronic illness, or some other sensible metric, the bill gives the most money to states that did not expand Medicaid or federal subsidies (which benefits mostly southern red states). In essence, this funding structure punishes the states that made use of Obamacare to better cover their residents. And it’s no small peanuts; the cut would be a combined loss of $250 billion between 2020 and 2026, according to some estimates. (The important exceptions are Alaska and Maine, which will be exempt from certain funding cuts, in a naked attempt to persuade senators Lisa Murkowski (R-AK) and Susan Collins (R-ME) to vote for the bill).
Republicans have praised the bill for increasing “flexibility” and “efficiency” by transferring money to the states. What this will likely mean in reality is decreased insurance coverage and unequal access. If Graham-Cassidy were passed, states could waive the requirement that insurers not discriminate against those with pre-existing conditions, which would lead to more expensive and worse coverage for these individuals (or they will be priced out entirely). There is also no requirement that states use the money to expand insurance coverage, nor is there an individual mandate that everyone be covered. The outcome, of course, is that many more people will be uninsured – 32 million is the latest estimate, a much higher number than projected for previous repeal and replace bills.
Maybe what’s most astonishing is the Senators who vote in favor of this bill will do so knowing that the majority of their constituents don’t support it. With this bill, Republican Senators are making it clear that they care more about achieving their political goal of repealing Obamacare than they do about the health of the American people.