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Bill Straub: Latest effort to repeal and replace ACA not about improving health care … it’s about winning

WASHINGTON – To quote Michael Corleone, “Just when I thought I was out, they pull me back in.’’

Efforts a few months back by the Republican Congress to repeal the Affordable Care Act, better known as Obamacare, that dastardly program promulgated to bolster the nation’s health needs through an extensive insurance program, suffered an ignoble defeat, leaving Senate Republican Leader Mitch “Root and Branch’’ McConnell, of Louisville, all but openly weeping on the chamber floor.

It was a close vote. In fact there were a bunch of close votes as the GOP hierarchy juked and shimmied like Gale Sayers in his prime looking for the magic bullet that would result in the party’s crowning achievement – depriving millions of Americans of health care coverage. They failed and the chamber ultimately moved on to its more traditional duty of naming post offices.

But the fact is Republicans seethed over the loss, having dedicated themselves to ridding society of any and all vestiges of everything associated with former President Barack Obama, a Democrat and, zounds, a black guy to boot. It should come as no surprise, therefore, that the GOP is in there pitching again with a new Obamacare repeal plan, Graham-Cassidy, named after the two prime sponsors, Sen. Lindsey Graham, R-SC, and Sen. Bill Cassidy, R-LA.

It’s a disgrace.

So it’ll probably pass.

Ol’ Root ‘n Branch hopes to call the measure up for a vote next week even though lawmakers won’t have access to a Congressional Budget Office analysis that would tell them, among other things, the estimated number of people who will lose health insurance if the proposal becomes law. One very preliminary assessment places it at 30 million, but it should be noted it’s mostly speculation at this point.

The rush is on because the rules adopted for consideration of Obamacare repeal earlier this year, known as reconciliation, requires only 50 votes to pass. Under normal circumstances, given complete Democratic opposition, it would be subject to a filibuster, which would require 60 votes.

In other words, the GOP majority is pushing to pass a godawful bill, without committee consideration or vote, which could carry negative consequences for millions of Americans in order to slip it by with the most meager of majorities.

Old Jimmy Madison would be proud.

How bad is Graham-Cassidy? As the venerable A.B. “Happy’’ Chandler used to say, “I feel like a mosquito in a nudist colony – I barely know where to begin.’’

Obamacare, you’ll recall, requires everyone to purchase a federally-approved health insurance plan or maintain such protection provided by an employer. Those who can’t afford the premiums qualify for governmental subsidies. The program further established an insurance marketplace with the intent being to permit individuals to pick and choose their plans. It also expanded Medicaid eligibility, adding millions to the rolls.

In its simplest form, Graham-Cassidy scuttles Obamacare and turns the job of seeing to the nation’s health care needs to the states through a federal block grant program. That could almost be justified were it not for the fact that the federal government notoriously underfunds block grant programs and the states regularly abuse what little lucre Washington affords them. Pretty soon the indictments came raining down and nobody’s happy.

It’s a terrible idea but at least it’s in keeping with the entire Republican/conservative philosophy that goes by the misnomer of federalism, where authority devolves to the states. But, as usual, the devil is in the details, and in this case the whole Graham-Cassidy concept goes from terrible to entering Rodin’s Gates of Hell.

Graham-Cassidy eliminates the requirement that most Americans acquire health insurance and that large companies provide coverage to their employees, thus carrying the subsidies program and the Medicaid expansion down with them. Once an individual hits a pre-determined cap under his/her policy, their insurance carrier can quit making payments.

That means people with long-standing conditions that require expensive treatment – hemophiliacs, for instance, frequently run up bills exceeding $1 million a year – wind up having to foot the bill.

Maybe Graham and Cassidy have unused millions of dollars laying around but most folks don’t.

Furthermore, unlike Obamacare, the bill lets insurers hike premiums on those with certain medical conditions, increasing out-of-pocket expenses by tens of thousands of dollars. It also permits the states and, therefore, the insurance companies, to dump Obamacare’s so-called essential benefits package, gutting protections for people who require treatment for conditions like cancer, diabetes, MS, epilepsy, autism, pregnancy as well as those with mental health issues, just to name a few.

As has become de rigueur with Republican health care proposals, it eliminates for one year federal funding to Planned Parenthood for no sane reason, presenting millions of women with potential health concerns And, as previously noted and you’ve probably guessed on your own, Graham-Cassidy fails to provide adequate funding so the states can offer satisfactory health services to its residents.

According to an analysis by Avalere Health, which studies the nation’s healthcare system, Graham-Cassidy would lead to a reduction in federal funding to states by $215 billion through 2026 and more than $4 trillion over a 20-year period.

In other words, there’s nary a legitimate reason to vote for this horrendous trash that might ultimately wind up costing people their lives. It’s opposed by a bipartisan coalition of governors. You can’t find a health or medical organization who thinks it’s a good idea. The American Medical Association voiced strong opposition, asserting that the bill “violates the precept of ‘first do no harm.’”

“Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care,’’ said AMA CEO and Executive Vice President James L. Madara, M.D.

Nothing focuses the mind of a politician like an electoral defeat, or serving in the minority after enjoying the perks of the majority. In this case, looking to fulfill the campaign promise of all campaign promises, the GOP is engaging in its Battle of the Bulge, the last ditch effort to gain victory over defeat, and it doesn’t really matter how that’s accomplished

So what’s the point? Why are Senate Republicans going out on the limb to push poorly received legislation that is provably inferior to the law they seek to repeal? They have to realize they’re playing with people’s lives here, yet, to paraphrase Ol’ Root ‘n Branch, they persist.

The only logical rational is quite ugly. For the GOP, the current debate has little to do with improving the health care of thousands of their constituents.

It’s about winning.

Since Obamacare became law, Republican lawmakers have promised to repeal it “root and branch’’ as our boy Mitch famously said, vowing to come up with something substantially better.

But now that the GOP controls the House, the Senate and the White House, these same lawmakers have discovered that developing something apropos that even comes close to approaching Obamacare is no small task. Everything they have proposed thus far, including Graham-Cassidy, results in fewer people having health insurance, thus limiting their access to medical care unless they want to spend hours waiting in a hospital emergency room, one of the issues the Affordable Care Act hoped to address.

That failure has produced political consequences. Many big Republican donors are thought to be holding back, furious that their boys and girls in the U.S. Senate have failed to stand and deliver. Incumbents won’t be safe under this new order and the chamber could become even more reactionary – a special election in Alabama could very well produce a rightwing nut for a candidate – Roy Moore – over Sen. Luther Strange, the solid conservative appointed to fill the unexpired term of Attorney General Jeff Sessions.

Nothing focuses the mind of a politician like an electoral defeat, or serving in the minority after enjoying the perks of the majority. In this case, looking to fulfill the campaign promise of all campaign promises, the GOP is engaging in its Battle of the Bulge, the last ditch effort to gain victory over defeat, and it doesn’t really matter how that’s accomplished.

In this case it’s turning the health care problem over to the states, a terrible abrogation of responsibility. But if it enhances their electoral chances and reopens the money pipeline, who cares if it costs a few lives?


Washington correspondent Bill Straub served 11 years as the Frankfort Bureau chief for The Kentucky Post. He also is the former White House/political correspondent for Scripps Howard News Service. A member of the Kentucky Journalism Hall of Fame, he currently resides in Silver Spring, Maryland, and writes frequently about the federal government and politics. Email him at williamgstraub@gmail.com.

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