Maybe you've heard: The GOP is donning wax wings yet again with its latest attempt to repeal the Affordable Care Act. Though marginally more policy-focused than earlier iterations, the latest proposal, from Senators Lindsey Graham (who should know better) and Bill Cassidy, leaves health care oversight to the states, and cuts federal funding for it by 6.4 percent. And it's especially bad for states like ours.
According to "Impacts of New Graham-Cassidy Repeal and Replace Proposal," a policy report authored by Manatt Health for the Robert Wood Johnson Foundation, Graham-Cassidy would leave the fate of the 23 million people projected to receive health care through the Affordable Care Act in the hands of individual states, working from block grants that, in many cases, provide considerably less funding than current law. The Manatt report estimates that the block grant system "would provide states with $81.6 billion less in federal funding than would be available under current law, a reduction of 6.4 percent." By 2026, the report continues, the number grows to 8.9 percent.
States facing the biggest cuts include those that opted to expand Medicaid under the Affordable Care Act, or that have more expensive care—among these are Oregon, Washington, Alaska, Connecticut, Delaware, New Hampshire, New Mexico, New York, and Vermont.
Another troubling prospect: Graham-Cassidy gives states leeway to deviate from "the essential health benefit or any other benefit rule [and] allow insurers to vary premiums based on health, age, or any other factor than sex or membership in a protected class."
One of the more revolutionary pieces of the ACA was its categorization of birth control as an essential health benefit, which makes birth control available without a copay. If Graham-Cassidy passes, individual states might be able to stymie this unprecedented access. And don't ignore that second part, either. Allowing insurers to vary premiums is equally bad. It means people with pre-existing conditions could be faced with higher premiums or limitations on what their insurance policies will cover. The bill's removal of key guidelines for state insurance markets also makes it likely that insurance premiums will go up.
You can download the full report here. I recommend doing so with ready access to your whiskey and crying (or in my case, yelling and angry texting) closet.
Here's what I find truly disingenuous about this bill: It operates on the premise of leaving health care coverage choices up to the states. But the fact is that individual states already are involved in health care coverage through state-level implementations of the Affordable Care Act. The states have already made individual choices about health care. They've already spoken, and some did so by choosing to take part in the ACA's Medicaid expansion. This bill effectively takes that choice away from the states, and punishes them for health care decisions they've already made—while claiming to give them more freedom. Let's be clear: This is not about states' rights or better uses for federal funding. It's a befuddling excuse for policy that does nothing in the public interest, has the power to have a tremendously negative impact on ordinary people, and still could pass. I think you know what to do.