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Obamacare repeal dies — for now

U.S. Sen. Bill Cassidy, R-Louisiana, at a Senate Finance Committee hearing on his legislation to repeal the ACA. (Photo: Ron Sachs/CNP, via Associated Press)

Even as it entered its death spiral, the latest Republican attempt to do away with Obamacare came in for fiery denunciations from California health care leaders.

“Incredibly damaging.”

“Worst of all repeal bills.”

“Politics over policy.”

“Appalling.”

Those were only a few of the accusations.

On the receiving end of all the vilification is a bill before the U. S. Senate that would eliminate key provisions of the Affordable Care Act and replace them with block grants to states.  The bill is being carried by Republican Sens. Lindsay Graham of South Carolina and Bill Cassidy of Louisiana. Its chances look grim, and that may be understating it.

California would lose an estimated $78 billion through 2026, and people with pre-existing medical conditions would pay face higher health insurance costs, according to several analyses of the legislation.

“It would be incredibly damaging to us,” said Dustin Corcoran,  CEO of the California Medical Association, calling the Graham/Cassidy bill “appalling.”

Mario Molina, former chairman of the Molina Medical Group, said that in the unlikely event that Graham/Cassidy was approved, it would disembowel the state’s health care budgets to such an extent that there would be little money left for infrastructure spending.

“Our bridges are going to fall down,” he said.

“It’s the worst of all the (repeal) bills that have come up this year,” declared Mari Cantwell, chief deputy director of health care programs for the state Department of Health Care Services. In that position, Cantwell heads the Medi-Cal program.

“It’s politics over policy,” said Gary Cohen, vice president of public affairs for Blue Shield of California.

The unanimous, day-long and full-throated denunciations came during a conference (“Health Care in Crisis!”) sponsored last week by Capitol Weekly and the University of Southern California’s Sol Price School of Public Policy in Sacramento.

Senate Majority Leader Mitch McConnell theoretically has until Sept. 30 to push the bill. After that date, the bill would need an unobtainable 60 – rather than the current 51 – votes to pass.  The 51-vote figure includes 50 from the chamber and one from Vice President Mike Pence to give the majority. But at least three Republican senators – Susan Collins of Maine, Rand Paul of Kentucky and John McCain of Arizona have indicated they will vote against the bill, leaving the Republicans  short of the 50-senator vote needed.

McConnell decided not to bring the measure to a vote on Tuesday, effectively killing it.

“Everybody knows that’s going to fail,” Senate Finance Committee Chairman Orrin G. Hatch, R-Utah, said the day before at a hearing. “You don’t have one Democrat vote for it. So it’s going to fail.”

“Returning control to the states” means California would be especially hard hit if Graham/Cassidy were to somehow go into effect, panelist after panelist declared during Thursday’s conference.

President Donald Trump had put last-minute pressure on Republican senators to support the bill, after tweeting earlier in the week, “I hope Republican Senators will vote for Graham-Cassidy and fulfill their promise to Repeal & Replace ObamaCare. Money direct to States!”

McConnell and the House leadership remained unyielding in their support of the doomed bill.

“It would repeal the pillars of Obamacare and replace that failed law’s failed approach with a new one: allowing states and governors to actually implement better health-care ideas by taking more decision-making power out of Washington,” McConnell said in a Sept. 17 news release.

#Obamacare is failing. #GrahamCassidy returns control to states and empowers them to innovate and stabilize costs,” tweeted Kevin McCarthy, the Bakersfield Republican who, as House majority leader, is second in command to Speaker Paul Ryan.

But “returning control to the states” means California would be especially hard hit if Graham/Cassidy were to somehow go into effect, panelist after panelist declared during Thursday’s conference.

If it were to pass, Graham/Cassidy would blow a hole in the California state budget so large that dealing with it would be a primary issue in the 2018 gubernatorial race.

That’s because blue states such as California and New York that more fully embraced Obamacare and expanded their Medicaid programs (Medi-Cal in California) now stand to lose the most if the dismantling of the ACA if Graham/Cassidy goes forward.

Some Democrats, especially those in California, regard the bill as a deliberate attempt to inflict fiscal punishment on states such as Massachusetts, New York and California, that did not vote for Trump.

“The Graham-Cassidy proposal represents a significant shift of costs from the federal government to states resulting in nearly $4.4 billion in additional costs to California in 2020, growing to $22.5 billion in 2026 for the state to maintain current coverage levels,” Cantwell’s department said in an analysis released Friday.

If it were to somehow pass, Graham/Cassidy would blow a hole in the California state budget so large that dealing with it would be a primary issue in the 2018 gubernatorial race, and it would swamp all other policy priorities for Jerry Brown’s successor, said Hoffman.

Participants in Thursday’s four panels in effect sneered at the argument that Graham/Cassidy would give states more flexibility to deal with health care costs by providing block grants with fewer federal strictures.

“There’s nothing less flexible than no money,” said Anthony Wright, executive director of Health Access California.

The more liberal wing of the state’s Democratic Party is paying increasing attention to single-payer health care.

Diana Dooley, Gov. Brown’s director of the Health and Human Services Agency, condemned the “willful ignorance on display by Senate leadership” of health care needs.

“No one who is involved in medicine in any way is not opposed to this bill,” she said during her keynote address. She said Graham/Cassidy was an effort “to take medical care away from those who need it most.”

The “Crisis” declaration in the conference announcement is accurate.  Graham/Cassidy is not the only health care issue roiling California politics.

The more liberal wing of the state’s Democratic Party is paying increasing attention to single-payer health care. It was championed late last week in San Francisco by Vermont Sen. Bernie Sanders under the banner “Medicare for All.”

Lt. Gov. Gavin Newsom, the Democrat who polls show is leading the field for the Democratic gubernatorial nomination, has declared his “firm and absolute commitment” to pass universal health care in some form.

But his closest opponent, fellow Democrat Antonio Villaraigosa, tapped the brakes: The former Los Angeles mayor and Assembly speaker said he supports universal healthcare but supporters of a California single-payer system may be “creating false expectations” given the cost.

Even with the increasing likelihood that Graham/Cassidy will be defeated, it appears inevitable that health care, in one form or another, will loom large on California’s political radar in the 2018 election cycle.

Ed’s Note: UPDATES with decision to not put repeal legislation to a vote, updates headline and edits text throughout to conform. 

 

 


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