Pressed by their donors who have vowed no new contributions without an ACA repeal, Republicans are making one last effort to roll back health care access. Their health care “reform” bill, Graham-Cassidy, is a clusterfuck on a scale that only Trump Era Republicans could possibly engineer.
I hope they pass it.
Republicans have already earned every ounce of the hatred and vitriol that a move like this will spark, but perhaps only this bill can bring that anger pouring into the streets. Graham-Cassidy breaks our healthcare system in a uniquely universal way. Almost no one will benefit from this bill. If you want to live in a country with universal healthcare without having to move to Canada, this proposal may open up the best opportunity in our lifetimes.
If someone set out to destroy America’s health care system they would probably design something like Graham-Cassidy. It starves Medicaid of funding to an extent likely to cripple the program in most states. It converts much of the funding delivered by the ACA to block grants, with very few restrictions on how that funding can be used (abused). It strips away the legal protections that people enjoyed most about the ACA (without realizing where those protections came from), including provisions allowing children to remain on their parents’ insurance until 26, protections against discrimination based on pre-existing conditions, and lifetime spending caps. Meanwhile it retains almost all of the ACA’s taxes on individuals. Graham-Cassidy also includes the Republican Holy Grail, terminating Medicaid entirely after a decade. It is basically the death panel of Republican wet dreams. Call it the “kill off the stinking poors bill,” because that’s what it is.
Fun facts: 93% of Medicaid enrollees in West Virginia are white. Two thirds of Medicaid enrollees in Indiana and three-quarters in Kentucky are white. I wonder who they voted for?
Graham-Cassidy is a complex bill that looks different depending on your perspective. Here’s an assessment from a supporter, Avik Roy. Here’s the explainer on the bill from Senator Cassidy’s office. And here are summaries from the LA Times and the Kaiser Family Foundation.
Graham-Cassidy has two glaring weaknesses that make it a unique poison pill for Republicans. First, they’ve spread the pain very broadly. Normally Republicans work hard to shelter white people, especially whites in the suburbs, from the impact of their stupid ideas. They have failed to do that here. Second, by stripping most of the federal government’s involvement in the health care industry, it opens the door to state-level innovations, including single-payer. That opening is the most exciting possibility and the reason why this bill could offer a silver lining to Democrats.
Although the bill would begin to cripple the exchanges from day one, the bulk of its most outlandish features would be deferred until after the 2018 election. At the state level, this will create an enormous tail-wind for legislative candidates promising to build state-level universal health insurance. Meanwhile, Congressional Republicans would find themselves strapped to the dead weight of this terrible bill going into the election cycle.
By passing this bill, Republicans would face the consequences at the ballot box before anyone gets killed by their stupidity. If you want to see universal health care someday, and you want to see Republicans gutted in the 2018 mid-terms, Graham-Cassidy is an ironic gift.
Since 2009, Republicans have campaigned on the evils of the ACA in the same way they campaign on abortion restrictions – protected from the consequences of their idiotic positions by the fact that they couldn’t possibly deliver on their promises. Perhaps the best thing that could happen to this country is to experience the results of Republican governance at a broad, personal level. Graham-Cassidy promises to punish Americans for electing Republicans in some particularly cruel, even lethal ways. I’m ready to step up and experience the consequences of this bill for the chance to see this country wake up and change directions. Let Trump’s voters have what they want, then let’s make sure every Republican in the country feels the impact of this mistake.