Day 249: GOP’s “Healthcare” Bill Tries to Buy Key Senators With Worse Deals Than They Currently Have

Republicans are desperate for a big win and are willing to strip healthcare from millions of Americans to save a handful of people some real money in the form of tax cuts. The convergence of those two things is their most recent iteration of a bill to “repeal and replace” the Affordable Care Act: Graham-Cassidy.

Graham-Cassidy is an ever-changing piece of legislation that guts the ACA, specifically the portions that expand Medicaid. It also allows states to choose whether their insurers may add lifetime caps to coverage or allow premiums to skyrocket for preexisting conditions, as Graham-Cassidy merely requires that coverage be offered to everyone. In other words, if you have a chronic illness, you must be offered a policy, but the premiums will now likely be totally unaffordable.

Donald Trump’s team, gasping for a win as well, is apparently pulling out all the stops behind the scenes to get the bill passed.

The GOP has already failed twice, but with their final chance to pass the bill with a simple majority in the Senate expiring on September 30th due to budget rules, they’re growing increasingly desperate — resorting to patently obvious political bribery — by altering key portions for the benefit of a select few.

The revised bill includes provisions that would steer more federal funding to Alaska, Arizona and Kentucky. All three are home states of senators representing pivotal GOP swing votes who either have opposed or expressed concerns with the bill — John McCain, Rand Paul and Lisa Murkowski. However, Democrats said Senate Republicans are using misleading numbers to obscure massive funding cuts still in the Graham-Cassidy plan.

Under the revised measure, the bill’s authors now project increases in federal funding for Arizona (14 percent), Kentucky (4 percent) and Alaska (3 percent), which would have seen declines in funding under the previous version, according to a leaked analysis from Trump’s health department. In particular, Murkowski’s home state would uniquely benefit from Sec. 129, which allows the state with the highest separate poverty guideline — Alaska — to receive a 25 percent hike in federal matching funds for Medicaid.

On top of that, all of the states that are being dangled extra money end up in a far worse position under Graham-Cassidy than under Obamacare.

Alaska, Arizona, Kentucky and West Virginia would still receive less funding under Graham-Cassidy compared with Obamacare, according to Topher Spiro, a health analyst with the left-leaning Center for American Progress. In Twitter postings, he said the bill’s authors were accounting for money states saved as a result of ending Obamacare’s Medicaid expansion to low-income adults, which is overwhelmingly funded by the federal government but requires states to pay a fraction of the cost.

In its simplest form, Graham-Cassidy is akin to asking someone to forgo $50 because you can pay them $25.

Sen. John McCain (R-AZ), focusing on both substance and procedure, announced he would not support the bill last week and seems highly unlikely to change his mind. By the revisions focusing on Alaska, Arizona, Kentucky and West Virginia, it also appears as though the GOP has punted on trying to flip Sen. Susan Collins (R-ME). If that’s true, they would have to sweep the remaining senators or the bill would fail.

Sen. Rand Paul (R-KY) has excoriated the bill as Obamacare Lite.

He sure sounds like a no, but he’s also a showman who enjoys cameras and his face on television. He’s liable to change his mind or claim to be persuaded by some minute detail of the bill. (During the last repeal and replace bill — dubbed “Skinny Repeal” — his no vote was flipped to a yes vote for the low price of Sen. Mitch McConnell (R-KY) putting a straight repeal of Obamacare — as opposed to repeal and replace — on the floor for a vote that Paul and the GOP knew they wouldn’t win.)

The third vote to stop the last bill was Sen. Lisa Murkowski (R-AK), who continues to get a full court press from the GOP. Alaska’s population leads to wild fluctuations in healthcare premiums and the state has taken advantage of the ACA’s Medicaid expansion provisions to stabilize prices. Sweetening the pot for Alaska isn’t particularly costly or challenging, but Murkowski has to weigh the long-term impacts of the bill, something that’s largely impossible considering the lack of study, debate or CBO score on the bill. With the language and key provisions changing frequently, it’s a risk for her state when Alaska is currently taking advantage of the ACA.

A random senator could step up and oppose the bill too, though obvious “moderate” choices like Sen. Dean Heller (R-NV) appear more concerned about losing a primary than doing what’s best for their state. In Nevada, Governor Brian Sandoval, a Republican, blasted Graham-Cassidy. He pointed out that it would pit seniors against sick children to compete for care and dollars. Heller, however, is beholden to big money donors like Sheldon Adelson and Steve Wynn, who have been pressuring Heller non-stop since he initially opposed a previous Trumpcare bill.

I am sure that some of his prime benefactors, such as Steve Wynn and Sheldon Adelson are very upset with his opposition to this bill, because there are tax breaks in the bill that are huge. One calculation put Adelson’s at $40 million.

(Yes, $40 million seems steep, but Adelson, 84, is worth north of $30 billion. The tax cut would represent about 0.13% of his net worth. It’s the equivalent of someone with $100,000 in the bank losing $130.)

While Heller was tied to the hip of his governor at one point, it appears he’s wedged between Adelson and Wynn’s hips now.

In all likelihood it comes down to this: a bill that nobody really understands, hasn’t been properly debated or vetted, affects a sixth of the United States economy and must pass the Senate within the next week will fall on the backs of a couple senators in relatively small states who are being openly bribed with funds that pale in comparison to what they’re currently receiving for their constituents, all so the GOP can claim a win after lying to the American people that they had a healthcare plan for the better part of decade.

249 days in, 1213 to go

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