With its prospects looking dimmer by the day, Republican Sens. Bill Cassidy and Lindsey Graham released a revamped version of their Obamacare repeal bill on Sunday night. The new draft attempts to win over skeptical conservatives by further weakening consumer protections for Americans in bad health. It also shovels money at Alaska in order to buy support from Sen. Lisa Murkowski, whose opposition could bury the bill.
The first tweak is a bit frightening. But we may not have to worry about it, because the bill’s attempt at legislative bribery seems so inept it’s hard to imagine this last ditch effort will succeed.
As a large chunk of the TV-watching public now knows thanks to Jimmy Kimmel, the last edition of Graham-Cassidy essentially shredded Obamacare’s safeguards for the sick. Under the bill, states could apply for waivers letting them drop rules that prevent insurers from charging higher premiums to customers with pre-existing health conditions, for instance, or that require plans to cover basic medical services. As the Kaiser Family Foundation’s Larry Levitt pointed out on Twitter Sunday night, the updated Graham-Cassidy makes it even simpler for states to deregulate.
With the new language, no longer would Mississippi or Texas have to go through the onerous process of applying for a waiver before sticking it to their patients with cancer or congestive heart failure; instead, they can just just submit a description of what they plan to do to the federal government. As Levitt told HuffPost’s Jonathan Cohn, the bill also gives states more room to let insurers sell cheap plans with even more massive deductibles than today:
“States don’t have to submit waivers, they just have to describe the rules they set, if any,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, told HuffPost. “It goes well beyond the previous bill by making clear that the federal out-of-pocket maximum and actuarial value requirements can be changed. That opens the door to very bare-bones insurance.”
Presumably, these revisions were meant to secure the support of conservatives like Ted Cruz, who felt the last bill didn’t go far enough on the regulatory front. But cutting protections for diabetics and children born with heart failure is also politically toxic. So Graham and Cassidy try to obscure their bill’s effects with a small semantic change. The last version required states to submit a description of how one “intends to maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions.” In the new version, “intends” becomes “shall”—as in, whatever they write down, it’s effectively already approved. To call it a fig leaf would be too generous, since fig leaves can actually hide things.
That brings us to the attempt to win over Murkowski, who helped sink the last Senate health care bill, and remains officially undecided on Graham-Cassidy. Since Sens. John McCain and Rand Paul appear to be more or less resolute no’s, Murkowski, who has said she is mostly interested in how the bill will effect Alaska, is a must-get. The bill now includes a number of handouts to her state, including a 25 percent boost to its Medicaid matching funds.*
But here’s the funny thing. Even with the polar payoff, as wonk Twitter has dubbed the wheelbarrow of cash Graham and Cassidy are apparently rolling to Murkowski’s office, Alaska still appears to come out a loser in this deal. Along with the updated bill, the pair circulated a table from the Department of Health and Human Services showing how each state would supposedly fare under the bill’s block grant system. It shows that Alaska would receive a 3 percent increase in federal spending compared to current law. But that’s transparently inaccurate, since it counts money the state would save from no longer having to help fund its Medicaid expansion as if it were new federal funding. If you ignore that little bit of legerdemain, Alaska actually ends up with 3 percent less federal money under Graham-Cassidy. (Of course, the table doesn’t even include cuts from the Medicaid block grant, but that’s a whole other issue.)
This is rather remarkable. Graham and Cassidy rewrote their bill largely to buy off a single Senator from their own party, who might wield the decisive vote on Republicans’ last realistic opportunity to repeal Obamacare in the near term. And yet, according to their own numbers, they couldn’t even put together a proper bribe package. Hopefully that means Americans with pre-existing conditions can rest easily this week.
*Correction, Sept. 25, 2017: Based on an outdated report, this post incorrectly stated that the bill allowed Alaska residents to continue receiving Obamacare premium subsidies.