Bill Cassidy, a Republican senator holding a safe seat in Louisiana, could easily have spent the past six months imitating his state’s other senator by basically lying low and voting for whichever health care bills leadership puts in front of him. But Cassidy was a medical doctor before he was a politician, his state has gained enormously from Medicaid expansion, and in the early days of the Affordable Care Act repeal process he made a name for himself as a rare GOP coverage hawk.
The legislation he co-authored with Maine Republican Susan Collins would essentially have allowed state governments that like their Obamacare to keep it. And he vocally touted what he termed the “Jimmy Kimmel test” for health care policy.
“Coverage does not have to have bells and whistles,” he told Business Insider’s Bob Bryan on May 14, “but does the coverage cover a tragedy that could occur in someone's health or to a loved one?”
Around this time, his colleague Lindsey Graham of South Carolina was expressing concern about the rushed process and hasty drafting of Paul Ryan’s American Health Care Act. Four months later, Cassidy and Graham are the lead authors of what’s become the GOP’s final stab at repealing Obamacare. Their bill brazenly casts aside all of their previous doubts, featuring the most slipshod legislative process yet and no guarantees of adequate coverage whatsoever. And neither of them has bothered to explain to anyone why they changed their minds.
Lindsey Graham wanted a deliberative process
Back in early May, Graham was expressing profound concerns about the slapdash manner in which the House had thrown together a major piece of health reform.
I appreciate the apparent progress on health care reform in the House of Representatives. I will admit, I’m concerned with the process.— Lindsey Graham (@LindseyGrahamSC) May 4, 2017
A bill -- finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate -- should be viewed with caution.— Lindsey Graham (@LindseyGrahamSC) May 4, 2017
He now finds himself spearheading a process that is, if anything, more slipshod and ridiculous. The scoreless AHCA that Graham rightly objected to had, at least, been scored in an earlier form, even though the final amended text had not.
The Congressional Budget Office has done no analysis at all of Cassidy-Graham, and it’s entirely the fault of Graham and Cassidy personally, who didn’t bother to turn their half-baked policy idea into legislative text until it was way too late. Now the Senate will vote on legislation without “estimates of the effects on the deficit, health insurance coverage, or premiums.”
But it gets worse. House members told reporters back in May that they were voting to move the process forward but counting on the Senate to improve the bill. That was a fairly lame excuse. But at least they had an excuse. Because the Senate’s reconciliation instructions expire on September 30, whatever they pass will be set in stone when it’s sent over to the House for an up-or-down vote in which there will be enormous pressure on House Republicans to vote yes. There’s no chance to amend or fix any aspect of a bill that’s had no real committee hearings, markup, or formal analysis.
All we know is people will get less health care.
Cassidy’s coverage concerns have vanished
“Once you pre-fund health savings accounts,” Cassidy told Bryan in that May interview, “someone can pay for their colonoscopy, or for their Pap smear, or for their cholesterol check with the HSA. That's what it's there for. So we think we cover that, but we do it in a cost-effective way.”
Reasonable people can disagree as to whether pre-funded HSAs are really a better way to ensure that that kind of semi-routine diagnostic work can be paid for. The point, however, is that Cassidy was operating in a universe in which people are going to need health care services and thus the government needs to find a way to ensure that they can afford them. His new Cassidy-Graham bill casts all that to the wind. It launched with an initial, dramatic 16 percent cut in federal health spending that, according to analysis from the Center on Budget and Policy Priorities, grows to a 34 percent cut by 2026.
It also lets insurance companies bring back the time-honored practice of pricing insurance for people with preexisting conditions at a higher — prohibitively higher if need be — rate, violating the absolute core of the Jimmy Kimmel test. Under Cassidy-Graham, a kid born with medical problems will face much higher prices and receive less government help to offset the cost. If his dad happens to be a successful television host, he’ll probably end up okay regardless. If not, good luck.
A cynical, hypocritical, baffling stab in the dark
“Medicaid changes that significantly reduce federal funding to states will cause states to consider a broad mix of spending cuts or revenue increases to maintain long-term fiscal balance,” writes the bond ratings agency Fitch, when contemplating the impact of Cassidy-Graham on state and local fiscal health. “In a time of already muted revenue growth, spending cuts could affect K-12 and higher education the most, as those are the other largest areas of state spending outside of Medicaid.”
Fitch’s bottom line, in essence, is that passing this bill could impair the credit ratings of certain states but also of various sub-state entities that will end up seeing their funding cut as a secondary or tertiary consequence of Cassidy-Graham.
Neither Cassidy nor Graham nor a few dozen other Senate Republicans appear to have given this any thought or bothered to do any analysis of how it will play out. And for the few dozen, that’s not surprising even if it is shocking. Replacement-level Senate Republicans have never taken an interest in health policy or cared much about process. This bill repeals Obamacare and cuts spending, and that’s all they need to know.
But Cassidy and Graham both went out of their way to brand themselves as more concerned about such matters.
CASSIDY wants to see a CBO score that shows any replace plan doesn't insure fewer people than Obamacare as Trump promised. Or add to debt.— Steven Dennis (@StevenTDennis) March 7, 2017
They didn’t need to do that. They aren’t representing purple states or otherwise facing electoral vulnerability. Unlike Dean Heller or Jeff Flake or many of their House colleagues, they won’t personally pay an electoral price for destabilizing the American health care system. They just used to believe it would be a mistake to do so — that it would be wrong, morally speaking, to massively imperil Americans’ health insurance coverage via a slipshod legislative process. So they said so.
And then, for some reason, they changed their minds.