I think the GOP should realize Healthcare just ain’t that into you
by Luis Gómez
Co-editor in Chief
After years of promising to repeal and replace the Affordable Care Act, Republican lawmakers have struggled to make that promise into a reality. After narrowly passing a House bill in May, the Senate rewrote the bill and released a new piece of legislation, the euphemistically-titled Better Care Reconciliation Act, the act which failed to move to the floor vote after Senators Lisa Murkowski, Susan Collins, and John McCain all voted against the bill, joining a unified Democratic and Independent caucus. The most recent attempt, sponsored by Republican senators Lindsay Graham, Bill Cassidy, Dean Heller, Ron Johnson, and Roy Blunt, was another attempt at wholesale restructuring of the post-ACA insurance markets.
The bill was introduced on September 13th, and was set for a vote on the Senate floor by September 30th, giving only two weeks for discussion and analysis of the bill. The proposed legislation would have shifted funding power from the federal government to state legislators by switching to block-grant waivers that states could apply for. Further, Graham-Cassidy would have removed the federal subsidies for private insurance as well as end the Medicaid expansion.
The Congressional Budget Office, a nonpartisan number crunching organization, never had enough time to release a full estimate on the bill’s costs. The organization was able to release a preliminary score that insurance enrollment among those with “high-cost medical events would be reduced by millions compared with the baseline projections” over the next decade.
There’s no question that Graham-Cassidy would have been destructive to current insurance markets. By shifting to a block grant system, the bill would reduce the amount of money available to all states. Furthermore, the bill redirected funds from states that had expanded Medicaid in the wake of the ACA to those states that had not, meaning that states like California, New York, and Louisiana would see funds sent to Alabama or Kansas, essentially rewarding states that had refused to expand Medicaid with money taken from states that did.
Further, the nature of the block grant spending requirements shifted. Under the ACA, funds sent to states were designated with specific caveats, especially regarding protections for preexisting conditions, funding for essential health benefits such as prescription drugs and maternity care, and a focus on low-income benefits. Theoretically, states could use the funds received under Graham-Cassidy to continue some form of Medicaid expansion, or could provide lump-sum payments to hospitals and then whistle while walking in the opposite direction.
Graham-Cassidy’s coverage was at first dominated by the spat between Sen. Cassidy and Jimmy Kimmel, a newfound advocate of accessible healthcare following his infant son’s battle with heart disease. Cassidy had appeared on Kimmel’s show after the first repeal attempt fell through, and laid out what he called the ‘Jimmy Kimmel Test,’ which essentially put forth the idea that a child who has a heart condition at birth should be able to get anything they need to stay healthy without being rejected by their insurance company. This kicked off a round of criticism from Cassidy and other Republicans that essentially claimed that since Jimmy Kimmel was a comedian he shouldn’t have an opinion, to which Kimmel responded that he was a human person with the ability to read and understand things, so he could have his opinion.
Indeed, Kimmel’s choice to use his platform to publicize Graham-Cassidy’s flaws are responsible in part for the reinforced groundswell of activist pressure against Senate Republicans, and convinced Senators Rand Paul and Suzanne Collins to vote ‘no,’ while Lisa Murkowski was apparently resistant to the bill, and had a long list of changes.
Interestingly, few people actually attempted to defend the bill or its passage process, due to the nature of the vote. In order to avoid the need for a 60 vote passage, Republican lawmakers were attempting to pass Graham-Cassidy via the budget reconciliation process. However, given the rules surrounding that process, the bill needed to be passed by September 30th. This would have left the Senate with a mere 72 hours to actually debate and offer amendments for the bill, which would instantly reshape a sixth of the US economy. Even when compared to previous repeal attempts Republican lawmakers had introduced in the summer, the amount of time reserved for this iteration of health care repeal was astoundingly small.
Ultimately, John McCain was the deciding ‘no’ vote, pushing the Senate to remove the bill from the floor before the vote could take place. Given budget reconciliation rules, Senate Republicans likely can’t reintroduce health care repeal legislation before next year. Ultimately, the fate of the ACA lies in the continued lack of a health care plan that appeals to both hard line repeal advocates like Rand Paul and moderates like Susan Collins. Until then, the Affordable Care Act will continue on.