Hail Mary? GOP Senators Offer More Money To Maine and Alaska To Save Floundering Health Care Alternative

Posted: Sep 25, 2017 8:00 AM

Sen. Susan Collins is leaning “no” on the GOP’s alternative Graham-Cassidy health care bill. Sen. Ted Cruz (R-TX) is against it “for now,” with Sens. John McCain (R-AZ), and Rand Paul (R-KY) being solid nay votes. As of now, the bill is virtually dead. This was a last ditch effort to get an alternative through the Senate before the reconciliation rules expire at the end of the month. It had the backing of the Trump White House and Speaker of the House Paul Ryan said that if it passes the Senate, he’d get it through the House. National Public Radio had a rundown of the bill:

Pre-existing conditions. One of the biggest issues in the repeal/replace debate has been coverage for pre-existing conditions, genetic risks and chronic illness. Before the Affordable Care Act, insurers could deny coverage to people with diseases like diabetes or charge them much higher premiums. The ACA requires insurers to cover pre-existing conditions without charging more. The GOP bills passed or proposed would give states the power to waive that requirement. People with disabilities or chronic diseases, people who have had cancer, and parents of children born with health problems like late-night host Jimmy Kimmel say that could make insurance unaffordable.

Medicaid. The federal/state insurance program provides health care for 20 percent of all Americans, including 40 percent of children, half of all births, 60 percent of nursing home expenses and 25 percent of mental health care. The Graham-Cassidy bill would transform the structure of Medicaid, giving states control over how they spend federal funds. The bill cuts Medicaid funding over time. States that expanded their Medicaid programs, including California and New York, would face the biggest cuts, while Texas and some states in the Deep South and West would fare better.

Essential Health Benefits. The Affordable Care Act requires that insurers cover 10 "essential health benefits," including maternity care, mental health, hospitalization, prescription drugs, emergency care, and children's health. The GOP proposals would let states opt out of those requirements, affecting insurance sold on the exchanges and employer-based coverage. But economists say that won't lower health costs as much as the bills' backers may hope, since the three biggest drivers of health costs are hospital care, doctor visits and prescription drugs — three things states may be most reluctant to cut.

Uncertainty And Market Instability. As far back as April, insurers were worried that they wouldn't have enough time to set rates for 2018. That fear has only increased. Earlier this month, entrepreneurs said the lack of clarity is interfering with hiring. Enrollment on the federal exchanges opens Nov. 1, though the Trump administration has cut advertising for open enrollment by 90 percent. Some private insurers are stepping up to fill the gap.

Guy cut through the liberal hysteria over it:

Its supposedly draconian cuts are neither draconian (see here) nor genuine cuts (spending levels would still rise year-over-year, but at a less steep rate). (2) Medicaid was badly broken before Obamacare's huge expansion of it, which perversely and disproportionately prioritizes less poor, able-bodied, childless adults over the most vulnerable people in the program.  That's grossly unfair.  Reforming Medicaid and at least putting both Medicaid populations on equal footing are necessary and fair goals.  (3) Block-granting funds to states in order to incentivize efficiencies, fiscal discipline, and pro-patient outcomes isn't just a talking point. (4) in the mid-1990's President Clinton proposed a Medicaid reform that would impose a per capita cap structure.  At the time, all 46 Senate Democrats endorsed the idea, our entitlement-fueled debt crisis has deepened significantly since then.  A cynic might be forgiven for concluding that today's outraged opposition to the concept is about anti-math, reckless, petty politics, instead of "helping" people.

Regardless, the bill is not going anywhere now that three, possibly four, Republican senators are against it, which brings us to last night’s Hail Mary; GOP senators are throwing more money at Alaska and Maine to shore up support from within their own ranks (via WaPo):

The Republican senators at the forefront of the latest effort to undo the Affordable Care Act plan to release a revised version of their bill Monday sending more health-care dollars to the states of key holdouts, as hardening resistance from several GOP senators left their proposal on the verge of collapse.

According to a summary obtained by The Washington Post, Sens. Bill Cassidy (R-La.) and Lindsey O. Graham (R-S.C.) will propose giving Alaska and Maine more funding than initially offered. Those states are represented by Republican Sens. Lisa Murkowski (Alaska) and Susan Collins (Maine), who have expressed concerns about the bill but have yet to say how they would vote.

The Cassidy-Graham legislation would overhaul the ACA by lumping together the current law’s spending on insurance subsidies and expanded Medicaid and redistributing it to states in the form of block grants. Alaska would get 3 percent more funding between 2020 and 2026 than under current law, and Maine would get 43 percent more funding during that time period, according to a summary obtained by The Post.

The vote for this bill is slated for this week, while Sens. Bernie Sanders (I-VT) and Amy Klobouchar (D-MN) are set to debate Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC) over health care tonight. Sen. Sanders is pushing for a $32 trillion single-payer overhaul.

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