Like some Dickensian ghost of health battles past comes the spectral coda of Graham-Cassidy-Heller. If only facts and data had this many lives.
Just when Democrats thought it was safe to either stop paying attention or go full Don Quixote on Medicare For All, Obamacare repeal is back.
When an entire political party has campaigned and won for seven years on getting rid of a law that was about as popular as President Trump (as in not very), it’s hard to move on. We get that. And who would have thought the country would change its collective mind, just when Republicans won control of the whole government?
Actually, that was kind of predictable. Those dozens of Republican repeal drives, that “Defund Obamacare Town Hall Tour,” those threats to shut down the government, were consequence-free while President Obama was in office. Republicans didn’t have an alternative, but they didn’t need one. Obama was the fail-safe. And indeed, when a repeal bill finally passed both the House and the Senate last year, Obama vetoed it.
Now Trump is president and Republicans are trying to do things their way. And, as they say, the dogs don’t like the dog food. In fact, many of them belatedly seem attached to what’s in their bowls right now. And why not? It has expanded insurance coverage to millions, driven down the personal bankruptcy rate, saved lives.
OK, voters aren’t dogs. But the analogy is apt. There’s been so much overblown rhetoric in the last few years that it took actual GOP health proposals to expose the realities, both good and bad, of the Patient Protection and Affordable Care Act.
It’s true that premiums jumped way too high for some people, and that needs to be fixed. At the same time there’s enough good in the law that a bipartisan group of senators is coming out this week with a plan to stabilize insurance markets that Trump is trying to destroy by sharply cutting outreach and enrollment help and the enrollment window, and threatening cost sharing reduction payments that keep costs down for low-income customers.
Yet now, like some Dickensian ghost of health battles of the past 25 years, comes the spectral coda: the repeal bill known as Graham-Cassidy-Heller. Among other things, by 2026 it cuts one-third of the money now going to help low-income people get Medicaid or afford private insurance; increases what insurers can charge older people, eliminates requirements that people buy coverage and that large employers offer it; gives states control over a shrinking pot of health dollars, and redistributes the money so some states get a lot less.
If and when it’s graded by the non-partisan Congressional Budget Office, there no reason to think this latest version of repeal would fare better than the last one, which failed in the Senate by one vote. CBO has projected that previous versions of Republican repeal bills would result in up to 24 million or even 32 million fewer people with insurance by 2026. Those reports have made splashy headlines and mobilized opposition from the public and some lawmakers.
That’s no doubt why doctor-Sen. Bill Cassidy of Louisiana, the force behind the last-chance repeal bill, has dismissed in advance whatever the CBO might say this time. “I just don’t care about the coverage numbers, because their methodology has proven to be wrong,” he says. “And ours, frankly, empirically, is correct.”
He needn’t have bothered with the pre-emptive damage control. With only 52 senators, Republicans are desperate to meet a Sept. 30 procedural deadline for passing the bill with just 51 votes. CBO said Monday it will need “at least several weeks” to analyze the Cassidy bill’s impact on the deficit, health coverage and premium costs.
The good news for the GOP: No devastating headlines before the deadline. The bad news? Not much information for Congress, either, which could give one or two GOP senators a reason to vote no.
Cassidy’s comments were depressing but should not be surprising, given our current wallowing in disregard for evidence. The repeated rise of health care repeal out of the ashes is a sad demonstration that evidence can’t compete with ideology and special-interest money.