The Senate Republicans’ latest anti-Obamacare bill has bigger goals than destroying the Affordable Care Act and dismantling Medicaid. This bill aims to blow up the very foundation upon which a national health care system could be built — even if it roils private insurance markets via massive premium hikes for 2018.
This overarching goal — to destroy the health care system’s structural underpinnings that could be used to create a national health care system—was made clear in the opening boasts of the Senate bill's co-sponsor, Sen. Lindsey Graham, R-S.C., when he introduced the bill on the same day Sen. Bernie Sanders, I-Vt., introduced a Medicare for All bill.
“If you want a single-payer health care system, this is your worst nightmare,” Graham boasted on September 13, referring to his own bill. “Hell no to Berniecare!” If that wasn't clear enough, Graham doubled down on Tuesday, when in an appearance with Vice President Mick Pence, Graham said, “federalism versus socialism, you pick.” Then on Wednesday, a Pence aide told reporters the vice president was leaving a U.N. Security Council meeting on peacekeeper reforms “to speak with leader McConnell on continuing momentum behind Graham-Cassidy.”
The legislation introduced by Graham and his co-sponsors is the GOP’s last hope to take action before the new federal fiscal year begins October 1. It has run into opposition from within GOP ranks — at least six Republican governors don’t want to see millions of federal dollars diverted from state-run Medicaid programs, which expanded coverage of lower-income people under the ACA. On top of that, virtually every medical association opposes the bill because they know the chaos it would bring, starting with double-digit insurance premium hikes and leading to an estimated 32 million people losing coverage over the next decade. It also deregulates minimum coverage requirements, meaning the private insurance industry would lessen what’s covered.
The bill’s parade of horribles doesn’t end there. It would cut an estimated $4 trillion in federal funds to states for Medicaid over the next two decades, which typically is a fifth of state budgets, and turn the federal subsidy into block grants with no strings attached — meaning the grants could be used for anything else, like roads or corporate subsidies. And it would pull tens of billions of dollars out of blue states that expanded their Medicaid programs under Obamacare (California loses $78 billion, New York $45 billion) and redistribute it to red states that refused to expand their Medicaid programs (Texas gets $35 billion, Georgia $10 billion), according to an analysis by Avalere Health LLC.
As expected, the political response has been a mounting firestorm that is on track to equal the intensity of the opposition last summer to earlier Obamacare repeal bills. The stakes became apparent Tuesday, when Senate Majority Leader Mitch McConnell suspended that body’s consideration of a bipartisan effort to ward off private insurance premium increases in 2018. In short, McConnell single-handedly sabotaged the bipartisan effort by Senate Health Education Labor and Pensions Committee chairman and co-chair, senators Lamar Alexander, R-Tenn., and Patti Murray, D-Wash., in one fell swoop.
“I am disappointed the Republican leaders decided to freeze this bipartisan approach and are trying to jam through a partisan Trumpcare, but I am confident we can reach a deal if we keep working together,” Murray said in a statement after McConnell knee-capped her.
The Senate Republican bill has so many potentially harmful effects it is easy to lose sight of the bigger picture and the GOP’s game plan. McConnell, Graham, Pence and the others lining up behind this ruthless legislation don’t just want to kill Obamacare. Graham, to his credit, laid out the stakes very candidly when he said “hell no” to Berniecare and portrayed the choice as “federalism versus socialism.”
Bernie Sanders' bill is most accurately described as an “aspiration,” as the New Yorker put it, in that it creates a national single-payer system by expanding Medicare, the federal health program for those 65 and over. Sanders doesn’t say how it’s to be paid for, nor does the bill address how that transition would be phased in beyond lowering Medicare's eligibility age over a four-year period. But 62 percent of the public support national health care, according to a nationwide poll by the Associated Press. That means Sanders is winning the war of ideas, even if he isn’t offering the implementation details.
In contrast, Graham’s bill attacks the governing structures and foundation of a national health care system like a malignant cancer. The Republicans don’t care a whit about being aspirational. They are ruthless and remorseless, and focused on dismantling the building blocks for a nationwide system: the federal funding of Obamacare and Medicaid, and the government’s most prominent means of delivery, state-run Medicaid and subsized Obamacare. As NBC Capitol Hill Reporter Lee Anne Caldwell tweeted about Graham's fellow South Carolina sentor, "SenTimScott#: (the bill) stops us from having conversation in the future about Medicare for All" bc $ (because money) and decisions go to states."
This is not the first time powerful Republicans have used Medicaid as a deliberate fissure to undermine Obamacare’s potential.
You may remember 2012’s U.S. Supreme Court decision written by Chief Justice John Roberts that preserved Obamacare. He ruled the law’s tax penalties (for not having coverage) were legal, but did so by saying the feds could not force states to expand Medicaid — even if the feds initially were paying for that expansion. In short, Roberts validated the parts of Obamacare that was corporate welfare for private insurers (Obamacare subsidies), but fractured a nationwide public program, Medicaid expansion. Taken together, Roberts ensured that the private sector would flourish while impeding any government program that could build toward a national system.
What’s happened since then is the American public — as evidenced by the AP poll and a handful of Republican governors who have expanded Medicaid and see its benefits to their citizens — increasingly are realizing that government-managed health care is viable and preferable to the current mostly privatized system. (The GOP governors are from Ohio, Nevada, Massachusetts, Vermont, Maryland and New Hampshire.) In other words, the Supreme Court’s 2012 Obamacare ruling slowed, but didn’t reverse, the progression toward nationalized health care, as seen in polls and successful Medicaid expansions.
The target of the Senate bill is not just Obamacare. That’s the political opening for a larger and deeper attack on the structures that are the basis for national health system — perhaps like what’s in Sanders’ bill. By dismantling Medicaid, ending federal subsidies for Obamacare policy holders, ending minimum insurance coverage standards, cutting trillions in health care funding, and shifting billions from blue to red states, Republicans are knowingly destroying the near-term possibility for socialized health care — to use Graham’s words, “federalism versus socialism.”
The Supreme Court slowed the march toward a national system when it made Medicaid expansion optional. Now, the Republicans running the Senate and White House are aiming at the systemic underpinnings of implementing national health care solutions.
They might not succeed in the long run. But if they’re successful passing legislation next week, when the bill comes to the Senate floor, America’s health care system would be set back years — with multitudes of people needlessly suffering from a triumph of right-wing extremists.