The zombie is back. Just when you thought the crusade to repeal and replace the Affordable Care Act was dead -- beheaded and dismembered by Lisa Murkowski, John McCain and Susan Collins, along with the entire Democratic caucus -- we're back here again, so grab your phones and town hall "DISAGREE" signs and get ready to do battle.
The new attempt to roll back America's healthcare system to its pre-2010 nightmarish status comes to us from Lindsey Graham and Bill Cassidy. We first heard rumors about the Graham-Cassidy legislation back in July, but given Mitch McConnell's announcement that it was time to move on from the dual failures to overturn President Obama's signature legacy that provided affordable, comprehensive health insurance to 20 million Americans, we thought we were mostly safe. It turns out, the Republicans have 12 more days in which to pass a partial repeal of the ACA using the "reconciliation" rules of the Senate, allowing for certain budget-related bills to pass with a simple majority, avoiding the 60-vote filibuster threshold.
In case you're unfamiliar with the bill, the simplest way to describe it is to say it's nearly exactly the same as previous attempts to repeal key provisions of the ACA.
- Defunds both the subsidies and Medicaid expansion: Funding for both the marketplace subsidies for low-income Americans, along with funding for Medicaid will be cut by $300 billion over the next 10 years. By 2020, funding will be replaced with block grants, allowing states to re-allocate funds to other non-healthcare related projects. By 2027, all additional funding, including the block grants, would be eliminated, leaving us without subsidies or the Medicaid expansion. Essentially, we'd be back to pre-2010 insurance.
- Defunds Planned Parenthood: The GOP's white whale will finally be harpooned if Graham-Cassidy passes. However, this provision might be a poison pill, forcing moderate Republicans like Murkowski and Collins to vote against it.
- Eliminates individual and employer mandate: By doing so, customers with pre-existing conditions might be priced out of the market since sick or injured people would be allowed to game the system by only purchasing insurance when they need it, cancelling when they're better.
- Weakens pre-existing conditions coverage: Gives states permission to allow insurers to charge higher premiums for anyone with past or current illnesses or disabilities. In states where this would occur, the Center for American Progress estimated the following premium hikes for various conditions:
- Tens of millions would lose insurance coverage: While the CBO won't have a score ready for Graham-Cassidy before the end of September, previous repeal bills would've forced upwards of 32 million Americans to lose coverage.
It's worth mentioning here that there won't be a CBO score issued before the window for a reconciliation vote expires, which means the Senate will likely vote on this bill without the CBO's analysis. In other words, we won't know the full extent of the damage until after the bill is passed. Meanwhile, Mitch McConnell is rumored to be narrowing the floor debate on the bill to just several minutes (the ACA was debated for roughly 60 hours in 2009-10).
The upside is this: it's possible that both moderates and Freedom Caucus House members will object to this legislation for similar reasons as previous iterations, therefore it's possible that the House will demand a different version of the bill, forcing the Senate to vote again, along with the possible interjections of a conference committee. Of course, this doesn't mitigate the urgency of defeating Graham-Cassidy since it's also possible that Paul Ryan and Kevin McCarthy have the votes to pass the bill as-is, which case, it'll go directly to Donald Trump's desk for his signature and the world's most obnoxious beer party.
As with previous bills, the most confounding aspect of the repeal process is that it would harm red states more than blue states on a per-capita basis. In other words, the first states to decline to cover pre-existing conditions would be red states due to the nonsensical political drive to undermine all things Obama. Thus, red state voters who hate the ACA because of its linkage to Obama would be among the first lose their insurance coverage. Naturally, though, they'd blame Obama and the ACA rather than the GOP members of Congress who screwed their own voters.
In case you're wondering whether it's time to panic, the answer is abso-freaking-lutely. But we need to "use" the panic and manifest it with collective strength and determination to stop this bill dead in its tracks. Not only will doing so protect tens of millions of Americans, but it will thwack the Senate Republicans and the Trump administration with yet another major loss, despite the GOP's majorities -- and it'll be just as the 2018 midterm season begins to ramp up. Now's the time.