The GOP senators insisted that the tens of billions in cuts to federal health spending proposed in the bill would not result in coverage losses because, they said, the states would have more flexibility.
.. The GOP senators insisted that the tens of billions in cuts to federal health spending proposed in the bill would not result in coverage losses because, they said, the states would have more flexibility.
Sen. Pat Roberts (R-KS):
“If we do nothing, it has a tremendous impact on the 2018 elections”
.. as a general rule the states do things better than the federal government does [things]. And that is essentially what the bill is
.. I think the efficiencies that come with transferring the funding to the states can very well make up the difference between what the federal thing would be.
Sen. Ted Cruz (R-TX):
“It lets states innovate and adopt creative solutions”
the heart of the legislation takes the policymaking role of Washington and sends it to the states. It lets states innovate and adopt creative solutions to local problems, which vary state by state.
But it’s not just devolving power from the federal government to the state. It also involves a 16 percent cut in federal spending [upfront] and a 34 percent cut over the next 10 years.
.. Ted Cruz
CBO’s analysis throughout this process has been ridiculously slow, unreliable, and based on policy assumptions that are demonstrably false.
You really believe that cutting federal spending by 34 percent will not result in any other people losing their insurance?
What federal spending is cut?
Well, the Medicaid expansion would be sunset, for one, is my understanding.
The decrease in future rates of growth is not a cut. And it is only in the bizarre world of Washington that billions more money is characterized in the press as a cut rather than an increase, which is in fact what it is.
Sen. John Kennedy (R-LA)
.. I have sent four amendments to Lindsey [Graham] and Bill [Cassidy] that I think will strengthen the bill. The one I feel most strongly about is that I want the Medicaid work requirement — I don’t want it to be optional; I want it to be a requirement. Just like we did with welfare reform.
.. number two, I want to get us to give guardrails to the states to say, “You cannot use these moneys to set up a state-run single-payer system.” I don’t believe in it. I think it’s a mistake.
[Guardian reporter] Lauren Gambino
Do you think that kind of goes against the idea of states’ rights and being able to use this money [as the states want to]?
No, no. We have plenty of federal rules that apply to every state, but we still agree with states’ rights.
I think it spends scarce resources in a more rational manner. It will control costs. I like the idea that it encourages states to innovate.
How does it do that? Any of those things?
Well, you need to read the bill.
Well, you’re voting for it, right? So what is the explanation for how it does those things?
I am. Because it gives states added flexibility. Read the bill and you’ll understand.
The bill would cut federal funding to states by 34 percent over the next —
But it wouldn’t cut Alabama, though.
Well, do you think the other states should deal with —
Well, you see some of our states, four of our states, are getting a disproportionate amount of money from health care now. You know which ones.
.. Sen. Johnny Isakson (R-GA)
What is the policy explanation for the Graham-Cassidy health care bill?
Policy explanation? I’m not into policy, so I don’t really know. I’m into facts.
[In a follow-up interview hours later on Tuesday] You were joking earlier, but what is the health policy in the Graham-Cassidy proposal that you like?
More state innovation. More input from the states.
.. Johnny Isakson
The governors — I’m from a state that didn’t expand Medicaid, and the way we were going in health care looked like those states would actually be hurt worse than other states.
By going to block grants, back to the states, the control of money stays with the states, and you have less [un]predictability and external deviation in terms of funding.
.. Jeff Stein
So just a follow-up on that. It’s one thing to say the bill gives the states power — that’s one thing.
But it doesn’t just do that. It also cuts the money they have — some estimates say around 16 percent of federal funding.
I’m not going to confirm that statement one way or another. I don’t know what the numbers are going to end up looking like.
Right, but if it does cut federal spending overall, would you support it?
You know, those are dangerous questions. I’m waiting until I see the totality of the legislation to say whether I support the whole thing or not, anyway.
I’m not a no, but I’m not a yes either — and I’m waiting for my governor to respond to me with their input as well. It’s really key what they’re doing.
.. Sen. John Barrasso (R-WY):
“The governors who decided to expand [Medicaid] knew that they were going to lose federal funding”
I want to ask, in a big-picture way: What is the policy explanation for how this bill makes people’s lives better?
It gets the money out of Washington, lets people at home make the decision, and gets state legislatures involved, and governors involved. It moves money out of Washington. It’s away from socialism.
CBPP says it will also reduce federal health spending on Medicaid and the exchanges by about  percent.
I’d love to reduce federal spending on health insurance.
Right, but so it’s not just about moving power to the states — it’s also about cutting funding.
It’s about moving power to the states, where money can be spent much more effectively.
How does it do that?
Well, you have to read the formula and read the bill, and it will tell you how it moves money to the states and how much they get and how much they don’t get. …
There’s a concern from Republican governors who have come out and said, “This is too dramatic a cut in spending; we won’t have enough money to insure everyone.”
You have to interview them on that.
Do you think they’re wrong?
Well, it depends on if they’re states that expanded Medicaid or not. …
In the Medicaid expansion states, they still have a lot of people who rely on Medicaid expansion for health insurance.
I opposed Medicaid expansion. I think the Supreme Court got it wrong [when it ruled in 2012 that Congress did have the constitutional authority to implement most of Obamacare].
The governors who decided to expand [Medicaid] knew that they were going to lose federal funding over time, and they’re objecting to that — but they knew it. You could say, “Some of them didn’t understand it, and so-and-so wasn’t there, and he wasn’t governor yet,” but they understood that this would be part of the process. So if they used the money poorly —
And my concern with Medicaid is that the people who Medicaid was designed for originally have been cut out of the process, because they’re still on the waiting list to get on Medicaid. I don’t know how much you understand about Medicaid, but this whole expansion of Medicaid went for healthy, working-age individuals — it did not go for the people who [Medicaid] was designed for, which was low-income women, children, and the disabled.
.. Sen. Chuck Grassley (R-IA):
“This is the last attempt to do what we promised in the election”
.. Chuck Grassley
Let me give you a political answer, and then I’ll give you a substance answer.
The political answer is that Republicans have promised for seven years that we were going to correct all the things that were wrong with Obamacare, and we failed the first eight months. This is the last attempt to do what we promised in the election.
The substance answer is that Obamacare starts with the principle that all knowledge about health care, and all decisions on health care, ought to rest in Washington, DC. The complete opposite of that is Graham-Cassidy, that Washington doesn’t know best and we’ll let each of the 50 states [decide what’s best].
A vocal conservative opponent of the measure, Sen. Rand Paul, predicted the delay would strengthen critics’ position by giving them more time to mobilize against the bill.
“The longer the bill is out there, the more conservative Republicans are going to discover it is not repeal,” Paul (R-Ky.) said Sunday in an interview with CBS’s “Face the Nation.”
Paul said he spoke with Trump on Friday and suggested the president support repealing the Affordable Care Act and deciding the details of a replacement plan later if the latest version of the bill does not pass.
.. Trump administration officials failed to gain support from influential Republicans such as Nevada Gov. Brian Sandoval (R). Opposition from Sandoval and others will make it easier for undecided Republican senators from those states to vote “no” on the bill, potentially further endangering its prospects.
.. (63 percent) believes it is more important for the government to provide health coverage to low-income people compared with cutting taxes (27 percent). Among Republicans, 48 percent favored cutting taxes, compared with 39 percent who favored providing health coverage for low-income people.
.. “President Trump and I believe the Senate health-care bill strengthens and secures Medicaid for the neediest in our society,” Pence said
.. Collins strongly disagreed in an interview Sunday with CNN.
“You can’t take more than $700 billion out of the Medicaid program and not think that it’s going to have some kind of effect,” she said during an appearance on “State of the Union.”
.. “This bill imposes fundamental, sweeping changes in the Medicaid program, and those include very deep cuts that would affect some of the most vulnerable people in our society, including disabled children and poor seniors. It would affect our rural hospitals and our nursing homes, and they would have a very hard time even staying in existence.”
.. Pence’s speech was criticized by Democrats, health-care advocates and even some Republicans for mischaracterizing the possible ramifications of the GOP bill.
.. During the same speech, the vice president went after Ohio Gov. John Kasich (R), a critic of the legislation, by suggesting his state’s expansion of Medicaid left nearly 60,000 residents with disabilities “stuck on waiting lists, leaving them without the care they need for months or even years.”
The claim alienated many at the meeting, partly because waiting lists for Medicaid’s home- and community-based services were not affected by the program’s expansion under the ACA, and partly because many interpreted Pence’s remark as an overly aggressive shot at Kasich. The Ohio governor’s stance against the bill could shape the position of Sen. Rob Portman (R-Ohio), a pivotal vote for Republicans who is undecided on the current version. Some fear Pence missed an opportunity to woo Portman with his remark against Kasich.
.. Collins estimated Sunday that there are eight to 10 Republican senators with “serious concerns”
.. Health and Human Services Secretary Tom Price and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, worked to undermine that report and a forthcoming analysis by the Congressional Budget Office showing the legislation’s cost and insurance impact.
.. The Avalere study projected marked reductions in federal Medicaid funding to all 50 states, ranging from 27 percent to 39 percent by 2036.
When it comes to health care, there are lies, damned lies, and CBO-bashing.
.. But the really big push over the next couple of days will be the attempt to trash CBO estimates that are almost sure to show massive losses, even if the CBO is somehow prevented from considering the Cruz amendment.
.. everyone, and I mean everyone, who knows something about insurance markets is declaring the same thing: that this proposed bill would be a disaster. We’ve got the insurance industry declaring it “simply unworkable”; the American Academy of Actuaries saying effectively the same thing; AARP up in arms; the Urban Institute forecasting disaster; and more.
.. Yes, it overestimated the number of people who would sign up for the exchanges. But this was largely because it overestimated the number of employers who would drop coverage and send their workers to the exchanges. Overall, its estimates of coverage gains and premiums weren’t that far off,
.. Trumpcare – or maybe we should call it Cruzcare – is a leap into the known. Before the ACA, most states allowed insurers to discriminate based on medical history. Many also restricted access to Medicaid as much as they could. So we have a very good idea what health care in America would look like if the BCRA passes: it would look like health care in unregulated, low-aid states pre-ACA.
Or to not put too fine a point on it, it would look like health care in Texas circa 2010, with 26 percent of the nonelderly population uninsured.
.. It would establish a system very much like that which existed in those parts of America in which vast numbers of people lacked coverage in the past; why would this time be different?