GOP senators are rushing to pass Graham-Cassidy. We asked 9 to explain what it does.

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

Jim Inhofe

..  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.

Jeff Stein

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.

Jeff Stein

You really believe that cutting federal spending by 34 percent will not result in any other people losing their insurance?

Ted Cruz

What federal spending is cut?

Jeff Stein

Well, the Medicaid expansion would be sunset, for one, is my understanding.

Ted Cruz

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]?

John Kennedy

No, no. We have plenty of federal rules that apply to every state, but we still agree with states’ rights.

John Kennedy

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.

Jeff Stein

How does it do that? Any of those things?

John Kennedy

Well, you need to read the bill.

Jeff Stein

Well, you’re voting for it, right? So what is the explanation for how it does those things?

John Kennedy

I am. Because it gives states added flexibility. Read the bill and you’ll understand.

 ..

Jeff Stein

The bill would cut federal funding to states by 34 percent over the next —

Richard Shelby

But it wouldn’t cut Alabama, though.

Jeff Stein

Well, do you think the other states should deal with —

Richard Shelby

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)

Jeff Stein

What is the policy explanation for the Graham-Cassidy health care bill?

Johnny Isakson

Policy explanation? I’m not into policy, so I don’t really know. I’m into facts.

Jeff Stein

[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?

Johnny Isakson

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.

Johnny Isakson

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.

Jeff Stein

Right, but if it does cut federal spending overall, would you support it?

Johnny Isakson

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”

..

Jeff Stein

I want to ask, in a big-picture way: What is the policy explanation for how this bill makes people’s lives better?

John Barrasso

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.

Jeff Stein

CBPP says it will also reduce federal health spending on Medicaid and the exchanges by about [20] percent.

John Barrasso

I’d love to reduce federal spending on health insurance.

Jeff Stein

Right, but so it’s not just about moving power to the states — it’s also about cutting funding.

John Barrasso

It’s about moving power to the states, where money can be spent much more effectively.

Jeff Stein

How does it do that?

John Barrasso

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. …

Jeff Stein

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.”

John Barrasso

You have to interview them on that.

Jeff Stein

Do you think they’re wrong?

John Barrasso

Well, it depends on if they’re states that expanded Medicaid or not. …

Jeff Stein

In the Medicaid expansion states, they still have a lot of people who rely on Medicaid expansion for health insurance.

John Barrasso

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].

‘Medicare for All’ Isn’t Sounding So Crazy Anymore

To be able to deliver on its promises, single payer would not only require trillions in new revenue through higher taxes, but also huge cost savings from slashing payments to drug companies, doctors and hospitals. “There are a million and one complexities” to single payer that no one has really dealt with, said Dean Bake

.. Senator Sanders went out of his way to list all the tax hikes he’d use to pay for his 2016 proposal, including an across-the-board 2.2 percent income tax. But two prominent policy analysts said the plan would cost about twice as much as the senator claimed.

.. But many advanced, industrialized democracies with universal coverage don’t have a pure single-payer system. France, for instance, has health care for all that is largely state-financed, but most people also buy private supplemental coverage.

.. Mr. Baker believes the top priority is a credible transition plan. “If you just take everyone with employer-provided insurance and put all of them on a public plan, you’re going to freak people out,” he said. He’s interested in reviving the public option — a government-run plan that would compete with private insurance on the exchanges — as well as opening up Medicare or Medicaid to those who want to buy in.

.. Democrats risk making the same mistake on health care as Republicans: big promises without a plan to follow through.

Why Wasn’t Trumpcare More Popular?

Conservative health-care analysts on why the GOP couldn’t come up with a stronger replacement for Obamacare

.. outside groups—he implicated Heritage Action and Club for Growth—were urging Republicans to repeal Obamacare as quickly as possible. Because of that, House Republicans “didn’t give themselves enough time

.. “Repeal and replace” seemingly meant different things to different Republicans. Moderates wanted to protect the law’s more popular provisions while tweaking its subsidy structure.

.. the AHCA was authored in a way such that it would cut federal spending—the goal of conservative Republicans—not necessarily boost health-care coverage.

.. a 1989 plan from the Heritage Foundation—the one that started it all—also included tax credits and an individual mandate.

.. “The original outline was their idea!”

.. That’s because there are two basic models for health systems, Laszewski says: single-payer or Obama/Ryan/Trump/Heritage/PriceCare. One is a government-run system offers a rudimentary plan to everyone. The other one is a delicate Jenga tower of mandates, credits, and incentives, all balanced on the rickety table of the private-insurance industry.

.. Republicans had to go with the AHCA, that is, because there just aren’t that many other, non-socialist ways to do health insurance coverage.
.. Ultimately they settled on Obamacare, helping the poor at the expense of the better-off, while the AHCA would have done the opposite.
.. “We used to say Republicans didn’t have the health-care gene,”

Universal Healthare Access is Coming to the US. Stop Fighting It. Make it Work.

There are no countries where all health-related services, including optical and dental services, drugs, and long-term care, are entirely free to patients without co-pays or deductibles.

.. deductions and exclusions of health insurance premiums and related tax breaks cost the federal government some $250 billion in revenue in 2015 — a substantial burden on the federal budget.

.. If we categorize healthcare expenditures according to the ultimate source of funds rather than the primary payer, we find that government budgets account for over half of all spending, as this chart shows:

.. The individual insurance market is failing because too large a share of health care risks is inherently uninsurable. Two conditions must hold for a real insurance market to work. First, the risks in question must be fortuitous; that is, predictable statistically but not predictable for any particular individual.

.. the top 10 percent of households account for two-thirds of all personal healthcare spending, and the top 5 percent for half of all spending. The majority of these high spenders have one or more chronic conditions that keep their spending high year after year.

.. Ultimately, though, guaranteed issue is an unsustainable policy that threatens the whole individual insurance market with a “death spiral.”

.. economists believe that over time, employees end up bearing the cost of healthcare benefits through lower pay. Rising employer healthcare costs are thus a major contributor to the stagnation of wages.

.. from 1999 to 2014, the share of the nonelderly population covered by employer-sponsored insurance fell from 67 percent to 56 percent.

.. Even with the greatest administrative energy behind it, it would be hard to make the ACA’s private insurance market work well, and it is more likely that current administrators will work to undermine than to support its operation.