Trumpcare is not dead. A new bill to repeal and replace Obamacare may be the Republicans' worst take yet. The legislation is careening toward a vote in the Senate – without so much as a scorecard from the Congressional Budget Office detailing how many millions, or tens of millions, would lose health insurance.
Here's what you need to know:
Sponsored by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, the new bill is Trumpcare with a twist. Not unlike past Trumpcare bills, the legislation would dismantle Obamacare by ending the individual mandate to buy insurance, eliminating federal subsidies for health insurance policies bought by individuals and ending the expansion of Medicaid as universal health care for the poor and working poor.
As a replacement, Graham-Cassidy proposes giving the states a "block grant" – a lump sum of federal money – to structure and fund their own insurance markets and to provide Medicaid coverage. But this is no even trade. Federal funding under the new Zombie Trumpcare plan would be slashed compared to Obamacare, with the deepest cuts reserved for Medicaid. In the year 2026 alone, the federal support for health insurance (individual buyers and Medicaid recipients) would be $80 billion less than under current law, according to an analysis by the Center on Budget and Policy Priorities.
And here's the biggest twist: All federal funding under this law vanishes after 10 years. That would amount to repealing Obamacare without replacement in 2027 – which a previous CBO analysis found would deprive more than 30 million Americans of health insurance.
Graham-Cassidy touts a "federalist" approach that would give individual states the ability to deregulate health insurance by obtaining government waivers. This would permit GOP-led states to hike insurance rates for older Americans, reinstate penalties for pre-existing conditions, impose annual and lifetime caps on insurance payments and/or downsize the "essential benefits" package that insurers are required to cover. (The only major Obamacare protection the bill leaves untouched is the ability for Americans 26 and under to remain on a parent's policy.)
The most twisted feature of Graham-Cassidy is how it distributes its "block grant" funding. Not all states expanded Medicaid under Obamacare. Those that did expand received tens billions from the federal government to cover costs created by new enrollees. Those that refused expansion, in turn, left that federal money on the table.
Graham-Cassidy effectively redistributes spending – taking from (largely blue) expansion states and giving to (largely red) non-expansion states. According to the CBPP analysis, in the year 2026 the West Coast expansion states California, Oregon and Washington would lose nearly $35 billion, while Texas and Georgia would come out about $10 billion ahead. New York would forfeit $19 billion; Alabama and Mississippi would gain a combined $3 billion.
This gambit – a health care bill that punishes blue states and rewards red – is hampered by the inconvenient fact that some Republican-led states did expand Medicaid, meaning that states like Ohio, Kentucky and West Virginia all end up in deficit. This creates political hurdles in the Senate, but also may complicate the picture in the House substantially.
Is Graham-Cassidy a real threat to pass? It has the support of previous Trumpcare rejectionists like Nevada Sen. Dean Heller. And it has momentum. The bill has moved from the sidelines to midfield in less than a week. And Republicans would like to ram it through – without waiting even for the CBO to develop a full analysis.
The congressional scorekeeper released a statement Monday saying it could offer only a cursory report in coming days. "CBO will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks," it wrote.
This new Trumpcare bill is not an improvement over past, failed iterations. In many ways, it is crueler and cagier than anything that preceded it. The GOP Senate majority seems to be banking that Americans are either exhausted by past health care fights – or distracted by hurricanes Harvey, Irma and Maria and (as ever) Hurricane Trump. But if the health of tens of millions of Americans, not to mention one-sixth of our economy, matters to you, now is the time to snap to attention – and make your voice heard again in Washington, D.C.