Senate foes of the Affordable Care Act, having failed to repeal and replace it, now are trying to blast the foundations from beneath the entire health insurance system. Everyone who cares about health care in America should shout out their opposition.
A haphazard bill in the U.S. Senate called Graham-Cassidy would steer us toward becoming a heartless nation in which people who have paid insurance premiums all of their lives could be priced out of medical care when they most need it.
Children, the disabled, the poor and the elderly in nursing homes would get less Medicaid coverage, as funding is reduced and Medicaid expansion is eliminated altogether after 2026. Under a system of state waivers, gaping gaps in coverage could again become a feature of individual insurance. Annual and lifetime payment caps could bankrupt Americans, or leave them without care altogether. Federal spending on health care would be slashed, and states would be given more discretion on how to spend the remaining money.
Eliminating the requirement that individuals buy health insurance and the subsidies that help many people do so could drive healthier people out of the system, creating a death spiral in which only sicker people buy ever-more-expensive insurance until it is out of reach for almost everyone. Unlike earlier proposed replacements for the Affordable Care Act, also known as Obamacare, nothing in this bill encourages healthy people to buy health insurance.
Many stunned supporters of the Affordable Care Act are saying Graham-Cassidy, whose lead proponents are Lindsey Graham, R-S.C., and Bill Cassidy, R-La., is the worst proposed Obamacare replacement yet. Senate Minority Leader Chuck Schumer, D-N.Y., said Graham-Cassidy is “an evil bill” that would take insurance away from 30 million people, gut Medicaid and do away with protections for people with pre-existing conditions. America’s individual health care system would suddenly be designed to function best for those who don’t need health care or who are financially well off.
Graham-Cassidy gained momentum this week as Republican senators realized that under the chamber’s rules they have only until Sept. 30 if they want to repeal Obamacare with just 50 votes, along with Vice President Mike Pence as a tie-breaker. After that, a Democratic filibuster could push that number up to 60, which is out of reach for GOP senators unless they can persuade eight Democrats to vote with them.
For the Senate to hurry to meet that deadline is like a doctor rushing through brain surgery without a careful diagnosis because the tee time is at 3 p.m. Full hearings won’t be held, which is alarming with a bill that contains so much uncertainty.
The Congressional Budget Office won’t have time to estimate how many people will lose insurance or how high premiums might soar. Many of the costs and hard decisions — but less money — will be shoved off onto state governments, which means years of legislative battles in Springfield and other state capitals. The Center on Budget and Policy Priorities estimates states would face cuts in federal health care spending of up to $80 billion a year by 2026. The Cook County Health and Hospitals System, which has worked for 40 years to get its fair share of Medicaid money, would likely have to start that fight over from scratch.
Even senators supporting Graham-Cassidy had a hard time explaining why. The best Sen. Pat Roberts, R-Kan., could do when asked by the news and opinion website Vox was to say, “[Y]ou need a car to get into, and this is the only car there is.”
But this car is headed to a world that many Americans hope never to visit.
Illinois would be among the big losers under Graham-Cassidy, which would shift money from states that worked hard to get their citizens covered under Obamacare to those that didn’t. A state-by-state analysis released Wednesday by Avalere concluded Illinois could lose $153 billion — yes, billion — from 2020 to 2036. The federal insurance exchange, through which Illinoisans get Obamacare insurance, would be eliminated.
Dismayingly, Gov. Bruce Rauner was not among a bipartisan group of 10 governors who sent a letter asking Congress to back away from the bill. On Monday, 16 major patient and medical-provider groups also came out against the bill, and the American Medical Association followed suit on Tuesday. Fifteen Republican governors have said they support it, as does President Donald Trump.
Even if Graham-Cassidy fails, it will have succeeded in in further undermining health care. Insurance companies must sign their contracts for 2018 rates by Sept. 27. And how can you plan ahead if you run a large hospital when you don’t know what your revenues and resources will be?
A vote for Graham-Cassidy next week would be an ill-thought-out vote for throwing nearly a fifth of America’s economy into disarray and jeopardizing the health, finances and even lives of millions of our fellow citizens. The Senate should kick this dangerous idea to the side of the road and move on.
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