A bill nobody took seriously suddenly sounds serious.
Repeal of the Affordable Care Act is back on the agenda, with Republicans suddenly talking about a bill that, until recently, few people in either party had taken all that seriously.
The prospects for the new legislation are murky. The proposal has generated a ton of conversation in political and health policy circles in just the past week, with multiple outlets reporting that leadership is now thinking about floor action before Sept. 30. That’s the magic date when, because of parliamentary rules, Republicans lose their ability to pass repeal with just 50 votes. But much of the chatter is hype from supporters and it’s hard to know how much enthusiasm for the proposal actually exists.
Starting in 2020, the Cassidy-Graham bill would eliminate both the Affordable Care Act’s subsidies and the enhanced federal funding that underwrites the expansion of Medicaid in 31 states (plus the District of Columbia). The bill would then establish a “block grant,” handing money directly to the states for helping people to pay for health care. This would produce the best of all worlds, as Cassidy and Graham would say, because it would mean states could stop worrying about the complications of the Affordable Care Act and simply use that money in ways that will work best for them and their citizens.
The substantive impact of the bill and the rushed process Republicans are using to push it make the Cassidy-Graham bill look a lot like the bills that failed to get majority votes back in July, when the Senate took them up.
Another factor in the bill’s eventual success or demise could be the way it shifts money among the states. Because of its complex funding formula, states like Alabama and Texas would initially see more funding, while states like California and Connecticut would see dramatic cuts, according to the same Center on Budget and Public Priorities analysis. The partisan tinge to the transformation is presumably intentional, since it’s mostly a transfer of money from Democratic states to Republican ones ― and, perversely, from those states that have tried hardest to expand coverage, by expanding their Medicaid programs and promoting enrollment, to those that have done as little as possible to help their citizens and in some cases worked actively to undermine the Affordable Care Act.
Bad Obamacare News Is Real. That Doesn't Mean Obamacare Is Dying.
But the formula doesn’t work out perfectly for Republican states, according to the same analysis. By year 10, for example, Alaska, Ohio and West Virginia would all be losing money, and that’s politically critical since Alaska’s Lisa Murkowski was one of three Republican senators who voted no on the final repeal bill while the votes of Ohio’s Rob Portman and West Virginia’s Shelley Moore Capito were in play until the end, although they both voted yes.