At a rally for Sen. Luther Strange, R-Ala., on Friday night, President Donald Trump claimed Arizona Sen. John McCain’s decision to vote no on the Cassidy-Graham health-care bill was “an unexpected thing.” If so, Trump is oblivious and his legislative liaisons are rotten at their jobs. McCain’s decision was unexpected only if one hadn’t been paying attention or hadn’t taken him seriously when he nixed the prior version of Trumpcare.
In a written statement on Friday, McCain, R., said:
“As I have repeatedly stressed, health care reform legislation ought to be the product of regular order in the Senate. Committees of jurisdiction should mark up legislation with input from all committee members, and send their bill to the floor for debate and amendment. That is the only way we might achieve bipartisan consensus on lasting reform, without which a policy that affects one-fifth of our economy and every single American family will be subject to reversal with every change of administration and congressional majority. ...
“I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it. Without a full CBO score, which won’t be available by the end of the month, we won’t have reliable answers to any of those questions.”
The question is not why McCain would vote against the bill under such circumstances but why any responsible Republican would vote for it.
In yet another swipe at the Senate majority leader who had short-circuited a bipartisan effort to fix the Affordable Care Act, McCain urged: “Senators (Lamar) Alexander (R-Tenn.) and (Patty) Murray (D-Wash.) have been negotiating in good faith to fix some of the problems with Obamacare. But I fear that the prospect of one last attempt at a strictly Republican bill has left the impression that their efforts cannot succeed. I hope they will resume their work should this last attempt at a partisan solution fail.”
With McCain’s no, a no from Sen. Rand Paul, R-Ky., and an almost certain no vote from Sen. Susan Collins, R-Maine, who said she was leaning strongly against the bill, plus a possible no vote from Sen. Lisa Murkowski, R-Alaska - more on her in a moment - Cassidy-Graham is on life support. As of this writing, it was uncertain whether Majority Leader Sen. Mitch McConnell, R-Ky., intended to subject highly vulnerable senators (e.g., Dean Heller of Nevada) to a vote next week, which he almost certainly would lose.
The bill has been hammered over the past few days by a bipartisan group of governors, a slew of medical groups, independent health-care analysts and even a conservative duo. Joseph Antos and James Capretta, considered by many to be the most trustworthy conservative health-care gurus around, warned:
“Graham-Cassidy, like the AHCA and the BCRA, would reduce federal spending below the levels provided by the ACA. The plan also reduces some ACA taxes, but not nearly as much as the previous proposals. The net effect of the plan would likely be a reduction in future federal deficits. Moreover, the shift of federal funding for insurance enrollment toward a block grant, along with the per-person limits on federal financing of Medicaid (indexed to rates of inflation below the expected growth of the program under current law) would produce substantial budgetary savings over the medium and long-term. If enacted, Graham-Cassidy would represent the most far-reaching entitlement reform since perhaps the Social Security amendments of 1983. ... so there is little doubt that CBO will estimate that the plan would also lead to a large number of people dropping out of insurance enrollment.”
They criticized the Senate for contemplating a process so obviously unserious and irresponsible. The “Senate needs a detailed estimate from the Congressional Budget Office (CBO) that allows consistent comparisons with previous reform proposal,” they said. “Although CBO has indicated that it will provide a preliminary estimate, a full cost estimate will not be available before a possible Senate vote during the last week of September.”
Things were already looking bleak when McCain finally stepped in. The Washington Post reported:
“An internal analysis by the Trump administration concludes that 31 states would lose federal money for health coverage under Senate Republicans’ latest effort to abolish much of the Affordable Care Act, with the politically critical state of Alaska facing a 38 percent cut in 2026.
“The report, produced by the federal Centers for Medicare and Medicaid Services, focuses on the final year of a block grant that states would receive under the Cassidy-Graham legislation. It shows that government funding for such health insurance would be 9 percent lower overall in 2026 under the plan than under current law.”
Indeed, a bribe-a-thon seemed to be underway late last week to win over Murkowski. This is a much worse bill than the one she voted against in July, according to multiple outside studies. Moreover, it contains the one-year ban on Planned Parenthood and leaves out the opioid abuse-treatment fund that convinced some members to back the last bill. So what did the sponsors offer? They apparently were willing to allow Alaska to keep Obamacare. Kaiser Family Foundation chief executive and President Drew Altman tells The Post,“If Alaska wasn’t worse off under the bill, why would they have to pay them off?” The bill’s authors have denied that there will be cuts, but that is false, as their own offering to Murkowski demonstrates.
It was not only Alaska that was going to be worse off but many others, including Ohio and West Virginia.
Avalere Health, for example, finds that Alaska would lose $1 billion by 2026 and $2 billion by 2027 and $14 billion between 2020 and 2036. West Virginia would be cut by $1 billion from 2020 to 2026 and by $3 billion from 2020 to 2027. The cliff after 2026 would result in a cut of $2 billion in 2027 alone. From 2020 to 2036, West Virginia would lose $27 billion. Ohio would lose $9 billion from 2020 to 2026 and $19 billion from 2020 to 2027. Between 2020 and 2036, Ohio would lose $161 billion.
Likewise in the Manatt Health analysis, Alaska loses $1.160 billion from 2020 to 2026, not including the per capita cap on Medicaid. Manatt shows West Virginia would lose $1.65 billion from 2020 to 2026. That also does not include the per capita cap on Medicaid. Likewise, even without the per capita caps, Ohio loses $297 million from 2020 to 2026.
If you prefer the Kaiser Family Foundation numbers, then Alaska loses $275 million from 2020 to 2026 and $632 million just in 2027. West Virginia would lose $964 million from 2020 to 2026 while Ohio would lose $610 million from 2020 to 2026.
How could the sponsors give Murkowski a break and not every other state? Their bill is certainly the most damaging of any GOP version - and its sponsors the least informed (or least honest) when it came to acknowledging what was actually in the bill.
McCain is a man of principle, a living legend who stands out in a body of small-minded, feeble lawmakers. For goodness sake, where were Sens. Rob Portman, R-Ohio, and Shelly Moore Capito, R-W.Va., to defend their states, which would be horribly damaged if the bill were to pass? Waiting for McCain to save them, I suppose. And why should an esteemed veteran such as Alexander crumble like a stale cookie when McConnell told him to halt bipartisan talks? Why would Sen. Ben Sasse, R-Neb., who fancies himself an independent-minded intellectual, go along with the rush to embrace awful legislation? Go down the list of Republicans and one must conclude as a group that they are undeserving of the public’s trust and, as future presidential aspirants, they lack the maturity, honesty, independence and intellectual rigor to take on the country’s problems.