Senator John McCain’s puppet boy, Little Lindsey Graham, got his panties in a bunch yesterday when a reporter asked Senator Bill Cassidy about Jimmy Kimmel saying that he”lied to his face” about what he wanted in his health care bill, and that the Graham-Cassidy zombie “Trumpcare” bill fails the “Cassidy Test” (aka “Kimmel Test”).
“I do declare! How dare he impugn the honor of Senator Cassidy. He has offended my genteel Southern sensibilities. Hand me my dueling glove so I can challenge this scalawag to a duel!”
Even our Twitter-troll-in-chief took to Twitter to say Senator Cassidy “does not lie.” When the world’s biggest liar is your character witness as to your veracity, you have a serious credibility problem.
Caitlin Owens of Axiox.com reports, Repeal first, ask questions later: “If there was an oral exam on the contents of the proposal, graded on a generous curve, only two Republicans could pass it. And one of them isn’t Lindsey Graham,” a senior GOP aide told Caitlin.
So Little Lindsey Graham either doesn’t know what his bill will actually do, or he and Senator Cassidy are the lying sacks of shit that Jimmy Kimmel says they are. The fact checkers are going with the later. You want to duel you cracker, let’s duel!
ABC News reports Fact check: Sen. Bill Cassidy on his health care bill assertions:
Below are four statements by Cassidy about the legislation and our analyses of them, based on conversations with health care experts.
Statement: “There will be more folks covered under this bill than the status quo, and it protects people with pre-existing conditions.” — ABC News interview
Fact check: The Graham-Cassidy bill would scrap the individual mandate requiring people to buy health insurance — the crux of Obamacare, anathema to its opponents — meaning people would no longer be penalized for not having insurance.
James Capretta, a fellow with the right-leaning American Enterprise Institute, told ABC News that the absence of the individual mandate means it would be “highly, highly unlikely” more people would be covered under Graham-Cassidy than under current law.
“Absent other changes, it’s likely this kind of approach would encourage and provide an incentive for healthy people to stay out of the market as long as possible and get back only when they need it,” he said.
But even if more people will be covered under Graham-Cassidy, other experts said that increasing the number of people who are covered wouldn’t mean much if their policies don’t cover much.
“States could provide a lot more people with insurance cards in their pocket, but that’s not the same as saying there’s as much coverage as there is today,” Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told ABC News.
Besides the individual mandate, another big difference between the Graham-Cassidy plan and existing law is that the Republicans’ proposal would allow states to waive certain requirements — like covering certain essential health benefits and prohibiting higher premiums for people with pre-existing conditions, as long as they inform the secretary of health and human services, who would make the waiver determination, “how the state intends to maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions.”
That’s much weaker language than in the Affordable Care Act, which allows states to request waivers from requirements under a narrow program but requires them to ensure health care that is “as comprehensive and affordable as would be provided absent the waiver,” which Pollitz said is a much more stringent criterion.
Matt Fiedler, a health care policy fellow at the Brookings Institution, agreed, saying the bill would explicitly allow states to get waivers so that insurance companies could charge people differently, depending on “previous health status.” He referred to the “adequate and affordable” line in the bill as “toothless.”
“The federal government does not appear to have any authority to reject waivers, so states can do essentially whatever they want as long as there is a section on their application materials that pays lip service to this point,” he wrote to ABC News in response to questions about the bill. “Even if there were some ability for the federal government to meaningfully enforce this requirement (and an administration interested in doing so), the term ‘adequate and affordable’ is quite vague and elastic. That would make denying an application on these grounds hard.”
Capretta said it’s possible that fewer states than expected would request waivers that in effect scrap protections for pre-existing conditions, because those protections are among the popular aspects of the Affordable Care Act.
“States are allowed to come forward with waiver requests, and waivers can be granted, but the politics are not easy on a state level,” he said.
The Affordable Care Act’s waiver program, known as Section 1332, was geared toward states that wanted to employ “innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA,” according to the Centers for Medicare and Medicaid.
In response to questions about the waiver program in the bill, a Cassidy aide told ABC, “It is fair to point out that states can already approach coverage of people with pre-existing conditions differently through the 1332 waiver process. Graham-Cassidy merely adds another route through which states can apply for waivers to address the insurance needs of their populations, which they are far better situated to do than the federal government.”
Statement: “If a state applies for a waiver, it must ensure those with pre-existing conditions have adequate and affordable coverage.” — ABC News interview
Fact check: There are two issues with this assertion: There does not seem to be any language requiring waiver-seeking states to meet that criterion, and the criterion is open to interpretation.
“Every insurer must offer every individual a plan and ensure each patient with pre-existing conditions has access to ‘adequate and affordable health insurance coverage,'” the Cassidy aide said. But the language in the bill, requiring a proposal for “how the state intends to maintain access to adequate and affordable,” is weaker than portrayed by the aide.
Also, the bill contains no metrics for determining whether the state is following through on its plan, nor is there a definition for “adequate and affordable,” so that can be left to the discretion of the HHS secretary.
“All in all, it looks to me like Republicans are absolutely determined to do something they can call repeal and replace, even if what they’re doing is somewhat incoherent,” Capretta said.
Statement: “We also take it through the CHIP program, the CHIP program which is wildly popular, both Democrats and Republicans, used by states to get more people enrolled.” — ABC News interview
Fact check: In response to the concern about people with pre-existing conditions, Cassidy said the block grants to states would be funneled through the existing Children’s Health Insurance Program (CHIP), which helps states provide health insurance for low-income children.
The comment left several experts scratching their heads.
“CHIP does not regulate insurance markets, so it has nothing to do with regulating where a state ends up on pre-existing condition,” said Joan Alker, a research professor at the Georgetown University McCourt School of Public Policy.
While it is true that states are already in the habit of using the CHIP program, Alker pointed out that unlike current Medicaid funds, which are entitled to states and individuals on a long-term basis, CHIP money has to be reauthorized by Congress each year.
“Frankly, the fact that CHIP money is about to expire on Sept. 30 and Congress has not extended it is exhibit A as to why CHIP is not a good model. The Medicaid model is entitlement money. It is guaranteed funding for states,” she said.
“Sen. Cassidy is just not telling the truth.”
Statement: “States like Maine, Virginia, Florida, Missouri — there will be billions more dollars to provide health insurance coverage.” — CNN interview
Fact check: Cassidy mentioned individual states because his bill would change the way states receive money to run their health care systems and help people pay for care, giving states more discretion with the funds but less overall.
A handful of states — including Texas and two of the states Cassidy mentioned, Virginia and Missouri — would end up with a net increase of funding over 10 years, according to a study by the policy analysis group Avalere. But overall, the study found, most states would end up with a net loss of federal funding.
Obamacare-era tax credits, subsidies and Medicaid expansion dollars would be eliminated. Instead, states would receive block grants of money to allocate as they determine. The states that accepted the Obamacare Medicaid expansion would see that money go back into the general pot of funding, the allocation of which would depend on a complicated formula that factors in population size and resident wages, and states would not have to spend money to increase health insurance coverage. Graham-Cassidy block grants would expire in 2026.
But the point is that most states would receive less federal funding because there would simply be less funding to go around and the funding formula would change significantly. States that accepted the Medicaid expansion would lose the most, including not only blue states like New York and California but also Ohio and Alaska, whose Republican governors oppose the bill, and Maine, which Cassidy still mentions as a relative winner despite the fact that it is a Medicaid expansion state and would stand to lose $1 billion, according to Avalere.
So while a few non-Medicaid-expansion states might see more federal funding than they have under the Affordable Care Act, the net result would be a decrease in federal funding — $215 billion, according to Avalere’s study.
“In general, the states who expanded Medicaid over the long run are the losers under this formula because the formula tries to normalize funding per person across the states,” Fiedler said. “That comparison is a little funny because the nonexpansion states had the option to expand and chose not to. The argument there is an inequity under current law I find a little bit puzzling.”
Oh, it’s not puzzling at all. Tea-Publicans want to steal money from blue states that expanded Medicaid and redistribute that money to red states that deliberately refused to expand Medicaid because this is how to secure GOP votes from those states, with “red state Welfare” (even though 46 GOP senators would vote for a blank piece of paper, sight unseen, if told it repeals “Obamacare.”)
The Atlantic reports Little Lindsey Graham’s cynical speech in the Senate. The Real Losers of the Graham-Cassidy Health-Care Bill:
“Obamacare, for whatever reason, favors four blue states against the rest of us.” So South Carolina Senator Lindsey Graham, in a floor speech on Monday, defended the central rationale of his Obamacare replacement, the Graham-Cassidy bill. In that speech and other statements, Graham has cast his bill as a redistribution, taking federal Obamacare money poured into the liberal bastions of California, New York, Massachusetts, and Maryland, and giving some of it to cash-strapped red states that have been left out, and whose sicker populations have languished. In this telling, Graham is Robin Hood, and his co-sponsors Bill Cassidy of Louisiana, Dean Heller of Nevada, and Ron Johnson of Wisconsin are his merry men.
There are a few problems with this reasoning, though. To start, the states that receive the most money from the Affordable Care Act are the ones that have expanded Medicaid, while the ones left out of the revenue stream have deliberately chosen not to accept federal funds to do so. Additionally, Graham-Cassidy’s “redistribution” isn’t really a redistribution: It would allocate Medicaid expansion and exchange tax-credit funds on an equal per-capita basis to states for covering low-income people, but would do so after greatly restricting eligibility and shrinking the funding base. In essence, Graham-Cassidy would diminish support for the majority of states to provide a reduced version of benefits to states that have refused more generous benefits in the past.
The states with populations that would be hurt most by such a scheme aren’t California and New York, but cash-strapped, smaller, mostly-rural states or Rust Belt states that decided to expand Medicaid, often in order to meet extraordinary statewide health crises. These states are not liberal bastions Graham claims are favored by Obamacare; rather these states—Louisiana, Arkansas, Arizona, Kentucky, Ohio, Indiana, Maine, Iowa, Alaska, New Mexico, North Dakota, West Virginia, and Montana—are largely dominated by Republicans, and make up a large swathe of the party’s geographic base.
While the exact effects of Graham-Cassidy are so complex and dependent on state decisions that the Congressional Budget Office announced it won’t be able to properly score the bill for weeks at least, a rough picture of the best-case funding scenario in each state is emerging. A new analysis of that scenario from consulting firm Avalere finds that Graham-Cassidy would reduce overall federal health funding to all states by $215 billion by 2026, and by $4 trillion by 2036.
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[T]he Avalere analysis finds that between 2020 and 2027 those impacts would pull about $100 billion from the aforementioned states. Only 11 states—all places that have declined the Medicaid expansion—would gain funding over that term. The biggest beneficiary of this reprioritization would be Texas, which would gain $24 billion in funding. Texan politicians have repeatedly fought the Medicaid expansion, against arguments from hospitals, public-health officials, patients, and economists.
The collection of red states that would lose under Graham-Cassidy is notable. Their governments fought for Medicaid expansion against the party line because they were often in dire need of those funds. Kentucky, New Mexico, and Louisiana are the three poorest states in the country, and Louisiana, Arkansas, West Virginia, Indiana, Ohio, and Maine are all among the worst 10 states in infant mortality. Many of those states score close to last in other health indicators. Additionally, West Virginia, Ohio, Kentucky, Maine, and New Mexico are on the front lines of the opioid epidemic, and have needed extra Medicaid funds to buoy health infrastructure that has been incredibly strained.
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While governors and other officials from red states that have expanded Medicaid are split on their support of Graham-Cassidy, those that oppose the bill are perhaps even more important opponents than Democratic lawmakers. Ohio Governor John Kasich, a Republican, leads an influential bipartisan group of governors—including fellow Republican Brian Sandoval of Nevada—that is fighting against Graham-Cassidy and led the charge to make more moderate fixes to the ACA. Democrats John Bel Edwards of Louisiana and Steve Bullock of Montana are also in that group. Louisiana health secretary Rebekah Gee has also blasted the plan and Cassidy’s involvement for potential harmful effects on Louisianans.
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Under Graham-Cassidy, funding for the Medicaid expansion and exchange block grants would expire in 2026. If future funds aren’t appropriated, states would revert to the pre-Obamacare status quo, only with a less substantial, capped Medicaid program in place. Essentially, Graham-Cassidy creates the conditions for a near-complete repeal of Obamacare in the future, which would leave every state with less funding to cover sick and needy populations. So, after 2026, there wouldn’t be any perceived bias, whether to the blue states Graham resents or against the red states in the middle. There wouldn’t be winners and losers. Just losers.
More about the Avalere Health study:
The analysis by Avalere Health, a Washington-based health-policy consulting firm, forecasts that the amount of federal money devoted to Medicaid and private insurance subsidies would shrink by $215 billion between 2020, when the plan would begin, and 2026, the last year money is provided in the bill.
More than half of the overall cuts in the legislation — named for its primary sponsors, Republican Sens. Bill Cassidy (La.) and Lindsey O. Graham (S.C.) — would come from Medicaid, the analysis shows.
Greg Sargent adds, Trump’s repeal push just took a massive new hit:
[A]s the new study shows, because of the bill’s funding formula, a lot of states will end up with substantially less federal money to spend on health-care coverage than they would have under current law. In the period from 2020 to 2026, overall the bill will mean a $215 billion cut to federal spending. Here’s how that cut will impact individual states:
- Arizona would get $11 billion less. McCain, who was one of the three senators who sank “skinny repeal,” has said he may oppose the bill because he is unhappy with the lack of regular order, but on top of that, we now learn his state would take a hit, too.
And from the Veterans Administration: Study: ‘Obamacare’ repeal or replace would increase uninsured veterans, strain VA: Federal health care reform proposed by Republicans in Congress would increase the number of aging, sick and low-income veterans without insurance and put pressure on an overburdened Veterans Affairs system, according to a study released Thursday.
The health insurance industry, which has been cautious about previous bills to repeal the Affordable Care Act, came out sharply against the latest version. Insurers Come Out Swinging Against New Republican Health Care Bill.