With only two weeks remaining in the fiscal year, when the authority to repeal “Obamacare” with a simple majority of 51 in the Senate under special budget reconciliation rules expires Sept. 30, Republicans stopped negotiating with Democrats on possible fixes to the ACA and instead brought up another “repeal and replace” bill drafted in secret by Sens. Lindsay Graham (R-S.C.) and Bill Cassidy (R-La.) with no participation by Democrats.
The Graham-Cassidy bill would do away with many of the ACA’s consumer protections and it would eliminate the subsidies ACA provides for insurance coverage for lower middle-class families. The Republicans also would convert much of Medicaid into block grants that would go to each state so state officials could develop their own health care plans.
Neither the White House, nor many senators, knew details of the bill, and a comprehensive report from the Congressional Budget Office was not expected before the Senate voted on it. But, based on the previous repeal-and-replace bills, independent analysts estimated the latest bill would cause 32 million people to lose their insurance by 2026, obliterating the gains made since the ACA was implemented in 2013.
The new repeal-and-reform bill came under fire from a diverse array of critics, including medical associations, insurance lobbyists, hospitals, bipartisan governors across the country, Medicaid directors from all 50 states and late night TV host Jimmy Kimmel, who has become a prominent critic of Republican efforts to roll back requirements for insurance coverage since his son was born in April with a congenital heart defect.
A report from the US Centers for Medicare and Medicaid Services (CMS) obtained by Axios projects federal health care spending would be $18 billion lower in 2026 under the Republican health care bill than under current law, but that’s on the low end of estimated lost funds. An analysis by the nonpartisan health consulting firm Avalere found that the Medicaid funding caps in the Graham-Cassidy bill would reduce federal funds to states by $215 billion between 2020 and 2026. Within two decades, states would suffer from cuts in federal health care funding of more than $1 trillion.
The bill also would do away with the ACA’s prohibition against insurance companies charging more because of a pre-existing health condition. Despite the assurances by the bill’s authors that the bill protected people with chronic health problems, an analysis by the Center for American Progress found that a 40-year-old diagnosed with metastatic cancer could be forced to pay an additional $140,510 on their annual health premium, while patients with more common conditions, such as diabetes or asthma, could see their premiums double.
The Republican bill would allow insurance companies to resume denying coverage for a series of basic medical treatments, including pregnancy and maternity care; prescription drugs; mental health services; reproductive health services, including birth control; and substance abuse treatment.
Nor were seniors spared. A report from the American Association of Retired Persons found that a 60-year-old earning $25,000 a year could see their premiums and out-of-pocket costs rise by $16,174 if they wanted to keep their current coverage.
The Graham-Cassidy bill would also allow states to charge older adults more by waiving federal protections that limit age rating, a move that the AARP concluded would make insurance “simply unaffordable” for seniors who don’t yet qualify for Medicare.
The Republican bill also could finish off hundreds of rural hospitals that rely on Medicare and Medicaid payments to keep them from shutting their doors. That would leave millions of rural residents isolated from health care.
As we went to press, Republican leaders had reworked the bill to steer more federal funds to Alaska, Arizona and Kentucky in a desperate attempt to gain the votes of Sens. Lisa Murkowski, John McCain and Rand Paul, but Susan Collins of Maine, McCain and Paul announced they still would vote against the bill.
Even if McConnell fails to get the votes to pass the Graham-Cassidy bill under the budget reconciliation rules, Republicans will get another shot at the reconciliation process next year. But that will be an election year, and Republicans would like to put at least a year between the election and their vote to make insurance unaffordable for 32 million potential voters. And a CBS News poll released Sept. 25 found only 20% of Americans support the repeal bill. Most people want Obamacare to be improved, not repealed, as 9% said it should be kept in place and 65% said it has good things but needs changes.
The good news is that any major changes are unlikely to take place until 2020. By that time, voters awakened to Republican perfidy on health care matters can put Democrats in majorities in the House and Senate, where a progressive majority could use the same budget reconciliation rules that Republicans have abused to simply expand Medicare to cover all Americans — and dare Trump to veto it.
Democrats are not going to regain majorities in the House and Senate in 2018 by simply promising the same incremental improvements that have failed to excite voters in the past few elections. Democrats need a net gain of three seats in the Senate to regain the majority, but there are only two Senate Republicans who Democrats have a solid shot at unseating out of eight Republicans up for election next year. At the same time, Democrats must defend 23 Senate seats, in addition to two independents who caucus with them.
The main pickup opportunities for Dems appear to be in Arizona (Jeff Flake) and Nevada (Dean Heller), with a longshot attempt to unseat Ted Cruz in Texas. But Dems will be defending incumbents in states Trump won, including Bill Nelson in Florida, Joe Donnelly in Indiana, Debbie Stabenow in Michigan, Claire McCaskill in Missouri, Jon Tester in Montana, Heidi Heitkamp in North Dakota, Sherrod Brown in Ohio, Bob Casey in Pennsylvania, Joe Manchin in West Virginia and Tammy Baldwin in Wisconsin. If Republicans pick up a couple seats in 2018, they could finally repeal “Obamacare” in 2019.
Democrats need to gain 24 seats in the House and, while severe gerrymandering his made the House Republican majority seem nearly invincible, Hillary Clinton carried 23 House districts held by Republicans, and Donald Trump got less than 50% in 17 other districts held by Republicans.
Republicans have spent the last 45 years determined to block Democratic attempts to show that government can help working people and the oligarchs have tried to convince voters that Democrats are not interested in helping white people.
Insurance companies had their chance with the ACA to show they could play a part in providing universal health care, and they failed. It’s time to expand Medicare to cover everybody, as was planned when Medicare was adopted in 1965. Sen. Bernie Sanders (I-Vt.) and Rep. John Conyers Jr. (D-Mich.) have filed the bills, we’re already spending twice as much on health care per capita as Canada, with less to show for it, and recent polls show solid majorities of voters support it.
This could be the game-changer that demonstrates a key difference between Democrats, who would improve Social Security and Medicare, and Republicans, whose determination to defund the ACA bows to the demands of wealthy donors to divert funds from Medicaid and insurance subsidies for working families to pay for massive tax cuts for billionaires and corporations. — JMC
From The Progressive Populist, October 15, 2017
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