Graham-Cassidy, the health bill the Senate may vote on next week, is stunningly cruel. It's also incompetently drafted: The bill's sponsors clearly had no idea what they were doing when they put it together. Furthermore, their efforts to sell the bill involve obvious, blatant lies.
The Affordable Care Act, which has reduced the percentage of Americans without health insurance to a record low, created a three-legged stool: regulations that prevent insurers from discriminating against people with pre-existing conditions, a requirement that individuals have adequate insurance (and thus pay into the system while healthy) and subsidies to make that insurance affordable. For the lowest-income families, insurance is provided directly by Medicaid.
Graham-Cassidy saws off all three legs of that stool. Like other Republican plans, it eliminates the individual mandate. It replaces direct aid to individuals with block grants to states, under a formula that sharply reduces funding relative to current law, and especially penalizes states that have done a good job of reducing the number of uninsured. And it effectively eliminates protection for Americans with pre-existing conditions.
Did Graham-Cassidy's sponsors know what they were doing when putting this bill together? Almost surely not, or they wouldn't have produced something that everyone who knows anything about health care warns would cause chaos.
It's not just progressives: The American Medical Association, the insurance industry and Blue Cross/Blue Shield have all warned that markets would be destabilized and millions would lose coverage.
Both Lindsey Graham and Bill Cassidy insist that their bill would continue to protect Americans with pre-existing conditions - a claim that will come as news to the AMA, Blue Cross and everyone else who has read the bill's text.
Cassidy has also circulated a spreadsheet that purports to show most states actually getting increased funding under his bill. But the spreadsheet doesn't compare funding with current law, which is the relevant question. Instead, it shows changes over time in dollar amounts.
That's actually a well-known dodge, one that Republicans have been using since Newt Gingrich tried to gut Medicare in the 1990s. As everyone in Congress - even Cassidy - surely knows, such comparisons drastically understate the real size of cuts, since under current law spending is expected to rise with inflation and population growth.
Independent analyses find that most states would, in fact, experience serious cuts in federal aid - and everyone would face huge cuts after 2027.
So we're looking at an incompetently drafted bill that would hurt millions of people, whose sponsors are trying to sell it with transparently false claims. How is it that this bill might nonetheless pass the Senate?
One answer is that Republicans are desperate to destroy President Barack Obama's legacy in any way possible.
Another answer is that most Republican legislators neither know nor care about policy substance.
I'd add that the evasions and lies we're seeing on this bill have been standard GOP operating procedure for years. The trick of converting federal programs into block grants, then pretending that this wouldn't mean savage cuts, was central to every one of Paul Ryan's much-hyped budgets.
In other words, Graham-Cassidy isn't an aberration; it's more like the distilled essence of everything wrong with modern Republicans.
Will this awful bill become law? I have no idea. But even if the handful of Republican senators who retain some conscience block it, the underlying sickness of the GOP will remain.
It's sort of a pre-existing condition, and it's poisoning America.
The New York Times