Sen. Bill Cassidy (R-La.) told late-night host Jimmy Kimmel, who had delivered an impassioned speech on health care after his own son was born with a heart defect, he would only support a bill that would make sure that a child like Kimmel’s would not lack health coverage. Cassidy later articulated his “Jimmy Kimmel test“: “Would the child born with a congenital heart disease be able to get everything she or he would need in that first year of life … even if they go over a certain amount?” Lo and behold, in the final days of the fiscal year (ending Sept. 30), Cassidy and Sen. Lindsey O. Graham (R-S.C.) are pushing a health-care bill that doesn’t remotely pass that test. The Post reports: Cassidy’s bill actually goes way further than either the House or Senate health-care bills in overhauling the ACA by essentially lumping its spending on ACA marketplace subsidies and Medicaid into block grants for states to cover people as they wish. … States would essentially have to create a new health program between now and 2020, when the marketplaces and Medicaid expansion would be disbanded. If they chose, states could abandon the ACA’s regulations on insurers to provide certain “essential benefits” and charge the same premiums to people regardless of their health status. This, too, has been a point of contention among some moderate Republicans. The Center for Budget Policies and Priorities, a center-left think tank that supports fixing Obamacare, explained: Starting in 2027, Cassidy-Graham would likely be even more damaging than a straight repeal-without-replace bill because it would add large cuts to the rest of Medicaid — on top of eliminating the Medicaid expansion — by imposing a per capita cap on the entire program. The Congressional Budget Office (CBO) has previously estimated that the repeal-without-replace approach would ultimately leave 32 million more people uninsured. Cassidy-Graham would presumably result in even deeper coverage losses than that in the second decade as the cuts due to the Medicaid per capita cap continue to deepen. In essence, Cassidy-Graham turns health care over to the states almost entirely, with few restrictions on how states reconstitute their own system. Some might even decide on a single-payer system (are conservatives paying attention?). Others could make radical changes if they accepted any federal money, including eliminating coverage for kids like Kimmel’s or pricing ordinary people out of the market: While insurers would still be required to offer coverage to people with pre-existing conditions, they could offer them plans with unaffordable premiums of thousands or tens of thousands of dollars per month. For consumers, an offer like that is no different than a coverage denial. Requirements that plans cover “essential health benefits.” Before the ACA introduced the requirement that all plans cover a defined set of basic services, 75 percent of individual market plans excluded maternity coverage, 45 percent excluded substance use treatment, and 38 percent excluded mental health care, according to analysis by the Kaiser Family Foundation. Under the Cassidy-Graham proposal, states could let insurers restore these exclusions, leaving many people — especially those with pre-existing conditions — without access to the health services they need. I asked Cassidy’s office if his plan passed Cassidy’s own Kimmel test. An aide refused to talk on the record or specifically say if the plan passed the Kimmel test but insisted that suggesting it would leave people uncovered was a “gross mischaracterization” of the plan since the states would have to certify that they were providing “adequate and affordable care.” (Obviously, that’s of little help when the feds are no longer requiring a minimum level of benefits and simultaneously are chopping away at Medicaid.) I have not yet received a response from Sen. Rob Portman (R-Ohio), whose state would suffer enormous Medicaid cuts. It is noteworthy that Sen. Susan Collins (R-Maine), who was previously looking at some constructive Obamacare fixes, is not a co-sponsor but hard-liner Sen. Ron Johnson (R-Wis.) is. In short, Cassidy-Graham is worse than the so-called repeal that failed with three GOP defections (Sens. John McCain of Arizona, Collins and Lisa Murkowski of Alaska). If they didn’t like draconian cuts to Medicaid, they’ll like this less. If they didn’t like a bill jammed through at the last moment on a straight party vote, they shouldn’t like this one. (Over the weekend, McCain’s spokeswoman told The Post, “As he has said before, Senator McCain believes health care reform should go through the regular order of hearings, open debate, and amendments from both sides of the aisle.”) Most important, the bill doesn’t do what Cassidy himself pledged. A middle- or working-class family in Kimmel’s spot, depending on where he or she lived, could find that their policy eliminated birth defects from coverage or charged an astronomical amount to cover a baby born with a life-threatening ailment. It would do that parent no good to point to his state’s boilerplate claim to the feds that it was providing adequate and affordable coverage. Perhaps Cassidy figures no one will figure out the bait-and-switch until it’s too late. I suspect someone with a gigantic nighttime audience won’t be fooled. He might even tell people Cassidy misled him and his audience.
Utne Altwire: healthcare