The doctor is in the house – well, actually the Senate. Dr. Bill Cassidy, also known as Senator Cassidy (R – LA), is still trying to come up with a cure for ObamaCare.
With the help of fellow Republican senators Lindsey Graham (SC), Dean Heller (NV) and Ron Johnson (WI) and former Senator Rick Santorum (PA), Cassidy has put together a new ObamaCare replacement bill called Graham-Cassidy-Heller-Johnson. This bill is intended to address the concerns of moderate Republicans who didn’t support the last Republican proposal called The Better Care Reconciliation Act.
Avik Roy, writing in Forbes, says the BCRA wasn’t supported by Senator Rand Paul (KY) because it did too much to replace ObamaCare. BCRA wasn’t supported by moderates like Susan Collins (ME), Dean Heller (NV) and Lisa Murkowski (AL) because they were reluctant to reduce federal spending on healthcare programs, especially Medicaid.
This new bill attempts to win the moderates with a proposal that gives states the option to take their ObamaCare funds and make their own decisions about how to spend them. The idea is to give block grants to the states, which could be used to design healthcare systems of their own choice. This would allow blue states to preserve ObamaCare, or even introduce single-payer healthcare, while red states could choose more market-driven plans which permit greater freedom to choose your own coverage and your own doctor.
Democrats should welcome such flexibility because it would allow them to pass single-payer legislation without Republican support in blue states like California, New York, and Vermont. These states are sure to take such steps if this legislation is passed but don’t expect Democrats to assist Republicans if it means replacing their beloved ObamaCare. They still believe they can get single-payer healthcare for the whole country, not just their bluest states.
The Best of Graham – Cassidy
Roy says the best features of this new bill are:
- Repeal of ObamaCare’s Individual Mandate
- Repeal of ObamaCare’s Employer Mandate
- Increase in annual contributions to Health Savings Accounts (HSAs)
- Phase down state-based Medicaid provider taxes
- Increased ability to purge Medicaid rolls of ineligible patients
- Per-capita allotment for the legacy Medicaid program
- Permits work requirements for Medicaid eligibility
- Ends the bias in Medicaid toward wealthier states
The Worst of Graham – Cassidy
Roy says the bill is weak in these ways:
- Permits single-payer initiatives funded by government subsidies
- Repeals few of the tax increases of ObamaCare
- Requires states to subsidize insurance plans that conform financially to plans states offer in their Children’s Health Insurance Programs (CHIP)
- Gives more money to states that focus on enrolling those with incomes between 50 and 138% of the Federal Poverty Level (FPL)
Unfortunately, there is a deadline looming, September 30th, for passage of any bill through the Senate under the 2017 rules of reconciliation. That gives Graham – Cassidy only two weeks to get 51 votes, anticipating no support from the Democrats. If they fail they will have to wait for 2018 fiscal year to bring the bill up again under reconciliation rules.
Once again, the Congressional Budget Office (CBO) will represent a significant obstacle since they seem to have “baked in” a number between 16 and 18 million Americans who will drop their insurance if the Individual Mandate is repealed. So when the CBO scores this new bill you can be sure Democrats, and possibly moderate Republicans, will harp on the CBO projections. Republicans must disregard the pressure of these projections and spare the country from another year of ObamaCare. They must trust the doctor knows what he is doing.