Cassidy is selling his health plan with misleading numbers

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We now have three separate analyses of how the Obamacare repeal bill offered by Sens. Bill Cassidy and Lindsey Graham would affect states.

Two of them — one from a left-leaning think tank, another from a health research firm — tell a very similar story of significant budget cuts for the states that have successfully implemented the Affordable Care Act.

The third, from Sen. Cassidy's office, tells a very different story — one in which every state gets a funding boost within a bill that, at the topline, includes a very significant spending cut.

Looking at these numbers in detail will give you a better sense of both what this bill does and how its sponsors are trying to sell it, by using misleading numbers that hugely underestimate the deep cuts many states face under Graham-Cassidy.

Let's start with the numbers that look similar. They come from the Center on Budget and Policy Priorities and Avalere Health.

Both show that the Graham-Cassidy plan ratchets down federal funding. Avalere estimates that it would cause a $215 billion cut between 2026, while the CBPP pegs it at $239 billion. Broadly, the two analyses agree: Graham-Cassidy means less money put toward health care programs.

Both show pretty clearly the trade-off Graham-Cassidy makes: it sends money from states that have high Obamacare enrollment (largely through Medicaid expansion) to those with less robust sign-ups. According to Avalere's analysis, California loses $78 billion while Alabama gains $5 billion between 2020 and 2026.

You can see a full map of the Avalere data, which shows which states gain and which lose under Graham-Cassidy. (Axios has made a great map of the CBPP data that looks very similar.)

Those are the CBPP and Avalere analyses. Then there is data that Cassidy has distributed, which paints a much rosier picture.

It finds that only eight states would see their funding decline between 2020 and 2026, and most of these cuts are in the 1 to 3 percent range. Cassidy's office includes an estimate that California's funding would actually rise by 15.8 percent over that time period, in strong contrast to Avalere and CBPP's prediction of deep cuts.

What's going on here is all about the baseline that Cassidy's office picks. They do not look at how funding would change compared to current law — presumably what states are interested to know. Instead, they look at how their block grant changes over time. The 2020 numbers in their analysis assume the cuts already exist.

Here's how the CBPP describes it:

These estimates do not compare states’ funding under the proposal to what states would receive under current law, the relevant comparison. Instead, they show how each state’s funding under the proposed block grant would change over time.

What's the point of the Cassidy numbers? They don't give a sense of how his bill would change American health care funding. They don't tell states whether they'd be better off or worse off under the Graham-Cassidy bill, as the Avalere and CBPP reports do quite well.

The Cassidy numbers mask what is really happening in the bill: a significant budget cut for 34 states that have generally embraced the Affordable Care Act. It's a spreadsheet that is able to show small changes, which can be used to make the argument that this bill isn't much of a change at all — that states will be safe.

Spreadsheets can only do so much, and if Graham-Cassidy becomes law, the fact that it contains big budget cuts for most states — the ones CBPP and Avalere point out — will become clear. That will have real human consequences and, at that point, will be quite difficult to roll back.

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Kliff’s Notes

With research help from Caitlin Davis

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