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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.)
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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.
Chart of the Day
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The typical American was expected to die a little earlier in 2015 than in 2014 — and a dramatic rise in drug overdose deaths is largely to blame, according to a new study in JAMA. The study examined changes in life expectancy between 2000 and 2015. It found that overall, life expectancy at birth increased by about two years in that time span. But drug overdose deaths decreased that number by more than three months. Read more from my colleague German Lopez.
Kliff’s Notes
With research help from Caitlin Davis
Today's top news
- “Mitch McConnell to bring up Graham-Cassidy healthcare bill on Senate floor next week”: "'It is the Leader's intention to consider Graham/Cassidy on the floor next week,' said David Popp, a spokesman for McConnell. The Senate has until Sept. 30 to use the reconciliation tool that only requires 51 votes to repeal parts of Obamacare.” —Al Weaver, Washington Examiner
- “Backlash throws last-ditch Obamacare repeal effort into doubt”: “Republicans hoping to jam a last-minute Obamacare repeal plan through the Senate are confronting a rising tide of opposition as health care groups, patient advocates and even some red-state governors join forces against a bill they worry would upend the nation’s health care system.” —Adam Cancryn, Politico
- “Insurer trade group blasts latest ObamaCare repeal bill”: “The nation's leading insurer group came out against the GOP's latest ObamaCare repeal effort Wednesday, warning that it could destabilize the individual market and hurt people with pre-existing conditions. In a letter to Senate leadership, America's Health Insurance Plans said a repeal bill sponsored by GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.) would have 'real consequences on consumers and patients.'” —Jessie Hellmann, the Hill
Analysis and longer reads
- “Blue States Face Biggest Cuts Under New Republican Health Care Plan”: “The biggest losers of federal funding are states that voted for Hillary Clinton in the 2016 presidential election. The Times calculated the funding impact per person by totaling the number of people receiving Medicaid benefits, those who purchased insurance in the Affordable Care Act marketplaces and those who are uninsured.” —Haeyoun Park, New York Times
- “Bemoaning Budget Cuts, Health Care Navigators Say Feds Don't Get It”: “The Trump administration says many of the organizations that help people enroll in health plans on the federal insurance marketplaces don't provide enough bang for the buck, sometimes costing thousands of dollars to sign up each customer. So it is cutting their funding, some by as much as 90 percent, the government told the groups last week. But the navigators, as they're called, say the government doesn't understand the time involved in the effort or the complexity of the enrollment challenge.” —Michelle Andrews, Kaiser Health News
- “Premiums For Employer-Sponsored Family Health Coverage Rise Slowly For Sixth Straight Year”: “In 2017, some 151 million Americans rely on employer-sponsored coverage. According to the nineteenth annual Kaiser Family Foundation (KFF)/Health Research & Educational Trust (HRET) 2017 Employer Health Benefits Survey, annual family premiums for employer-sponsored health insurance rose an average of 3 percent to $18,764 this year, continuing a six-year run of relatively modest increases.” —Health Affairs
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