By Brendan Williams
With the broadcast media distracted by natural disasters and the president’s attack upon NFL players, a hurricane of misery was aimed at America’s most vulnerable citizens. The cruelty of the U.S. Senate’s Graham-Cassidy health care bill exceeded its failed predecessors.
The question isn’t so much why the bill died, it’s why such an abomination was even born. And could it happen again?
Graham-Cassidy would have done much more than simply repeal and replace the Affordable Care Act. It would have changed federal Medicaid participation from a system that matches state funding to one imposing arbitrary caps – decimating the “traditional Medicaid” predating the ACA by 45 years. Among those suffering would have been millions of seniors and those with disabilities on Medicaid being served in long-term care settings. That includes, as of last count, 54,705 Washingtonians in home-and-community-based care, and 9,659 in nursing homes.
Far from resulting from a public process, the bill’s framework was attributed to a barber chair discussion between Sen. Lindsey Graham, R-South Carolina, and former Pennsylvania senator Rick Santorum. President Trump, who long ago backtracked on campaign promises to protect Medicaid, provided his usual thoughtful Twitter analysis: “Graham-Cassidy Bill is GREAT! Ends Ocare!” The bill was so objectively awful that Sen. Charles Grassley, R-Iowa, told reporters, “I could maybe give you 10 reasons why this bill shouldn’t be considered,” yet he declared keeping campaign promises to repeal the ACA more important than “the substance of the bill.”
The bill was also jarringly inequitable. Even after a frantic, last-ditch effort to buy votes, an analysis by Avalere Health showed Washington, through 2026, would have lost $9 billion, while Graham’s South Carolina gained $2 billion. That’s true even though the bill would have replaced a matching formula where Washington is already disadvantaged; the federal government pays only 50 cents of each dollar spent on Medicaid in Washington compared to 71 cents in South Carolina.
Graham-Cassidy was full of such fund-shift inequities, making laughable the claim Graham posted that it “treats all Americans the same no matter where they live.” Sen. Rand Paul, R-Kentucky, even called it “a game of Republicans taking money from Democratic states.” The bill would have given some states more money without requiring “maintenance of effort” in their own spending. South Carolina might have just cut taxes further to attract Boeing work.
Eventually, however, every state would have lost. For all the talk of “returning power to states,” states must balance their budgets. Medicaid is frequently on the chopping block, even in relatively good times. State policymakers of both parties must reject any illusion that Medicaid “block grants” and other ideological games would make their jobs easier.
Nor do provider margins exist to further pare down spending. Nursing homes lose money on Medicaid, which subsidizes the majority of patients. Home care workers struggle for living wages. And in our aging United States there will be an estimated 3 million more 85-and-older residents in 2030 than there were in 2012, placing more demands upon traditional Medicaid. While the ACA’s Medicaid expansion has been a godsend to many in states that have embraced it, dismal rates create difficulties attracting providers. Even in Washington, for example, $22 is the Medicaid rate for an autism therapy session.
Graham-Cassidy would have shred an already-tenuous, half-century-old social safety net. It would have led to care rationing, and hastened deaths, for our most vulnerable. The threat may recur, and members of Congress must be told to resist such immorality.
Brendan Williams is an attorney and served in the state House of Representatives, 2005-10.