Before supporters of universal health coverage get all wrapped up debating a single-payer system, they need to focus on a dire threat to the Affordable Care Act likely to come up for a vote in the Senate before the end of the month.
The latest repeal bill is an offering from Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., that would tear apart the existing system and replace it with a block grant to the states. Block grants—flows of money for broad purposes with few strings attached—are a patented way to evade hard policy choices. All the tough decisions are kicked down to state capitals, usually with too little money to achieve the ends the block grant is supposed to realize.
Because Graham and Cassidy are civil interlocutors and have sounded more reasonable than many of their Republican colleagues in talking about health care, there is an unexamined assumption that their proposal must be more sensible than other approaches to repeal.
But it’s not. In fact, it would be disastrous. In certain respects, it’s even worse than the earlier repeal measures, which at least kept some of the structure of Obamacare’s subsidies in place. This bill would simply blow them up.
It would also shift money around in ways that would, on the whole, hurt states that have been trying to get health coverage to their less affluent residents. A report on the bill by the Center on Budget and Policy Priorities (CBPP), a think tank devoted to the interests of less-advantaged Americans, concluded:
“In general, over time, the plan would punish states that have adopted the Medicaid expansion or been more successful at enrolling low- and moderate-income people in marketplace coverage under the ACA [Affordable Care Act]. It would impose less damaging cuts, or even raise funding initially, for states that have rejected the Medicaid expansion or enrolled few low-income residents in marketplace coverage.”
This should make the bill impossible for two brave Republicans, Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, who stood up against July’s repeal effort. Both have said they would not be complicit in undermining health care coverage in their states. The CBPP report showed that Graham-Cassidy would reduce federal funding for health coverage in both Maine and Alaska and cut Medicaid overall.
Oh, yes, and the report also noted, with italicized emphasis, that as currently written, the block grant “would disappear altogether after 2026.” What happens then? The bottom line, said Jacob Leibenluft, a senior adviser at the center, is that Graham-Cassidy “punts all the problems to governors while giving them insufficient tools and resources to address them.”