It’s back to school for members of Congress, and both Democrats and Republicans are trying once again to introduce legislation to address healthcare. To say there is daylight between the current Democrat and GOP healthcare proposals is an understatement. Just last week, Sen. Bernie Sanders, I-Vt., re-introduced a bill to implement a single-payer healthcare system. This legislation commonly referred to as “Medicare for All” is supported by roughly one-third of Democrats in the Senate but has no viable path forward.
On the flipside of the ideological coin, Sens. Lindsey Graham, R-S.C., Dean Heller, R-Nev., and Bill Cassidy, R-La., are pushing for their bill to block-grant funding to states to design their own health plans. It eliminates both the individual and employer mandates on health coverage, converts Medicaid into a per capita allocation to states, dissolves Medicaid expansion by 2020, and could increase costs for individuals with preexisting conditions, just to name a few implications.
All of the sudden, this GOP proposal, known as Graham-Cassidy, has gained steam in the Senate. It looks like “repeal and replace” efforts may have been revived with just a few short weeks before the Senate rules of reconciliation expire. Translation: Republicans only have until Sept. 30 to pass a health plan with 50 votes. Much like the last few attempts, the GOP have a razor thin margin and an uphill battle to get the votes necessary for passage, even with Vice President Mike Pence as a tie-breaker.
The bills’ sponsors and supporters tout the policy as one that empowers states by giving them the flexibility to design their own programs. As a former state senator who spent a decade working on health policy legislation, I speak from experience when I say this bill passes the buck to the states, literally and figuratively, to solve the healthcare conundrum.
In reality, this GOP proposal pulls the rug out from under state governments. Here’s how.
Graham-Cassidy would block grant dollars to states essentially to set up their own systems to offer health coverage and make it affordable. While current Obamacare rules, such as guaranteeing coverage for those for pre-existing conditions, would remain in place for states that elect to accept the block grant, it is worth noting that the funding allocation creates winners and losers among those states that take federal funds.
According to the center-left think tank Center for Budget and Policy Priorities, 20 states stand to lose between 35-60 percent of the funds they are receiving under current law. For example, my home state of Ohio is projected to lose roughly $2.5 billion under Graham-Cassidy. What’s more, these block grants would go away completely after 2026. This means states would have to find some way to make up for an abrupt loss of a significant amount of federal dollars. No money would also mean no coverage for millions of people, especially in states that initially get less from the block grant.
It is near-impossible for states to cut enough spending or raise enough revenue to match the federal dollars that will disappear.
And, frankly, a lot can change in the years between implementation of the federal law and when block grants would run out in about a decade. A major recession could put pressure on state budgets and increase demand for social services such as the current Medicaid program. States would no longer be able to adapt dynamically to meet the needs of their citizens, as the current funding partnership with the federal government would be gone. So, even the most lean and mean proactive states could fall short come 2026 or before.
It seems to me that the GOP is willing to ignore future consequences just to fulfill a key campaign promise before the 2018 midterms. Keeping their jobs seems to take precedence over people keeping their healthcare coverage or states balancing their budgets.
While I am a Democrat, I am not suggesting single-payer is the preferred alternative to what the Republicans are offering. I do, however, believe it would be more prudent to work in a bipartisan manner to develop both short- and long-term solutions. It is imperative to secure CHIP reauthorization by September 30 and address the immediate pressing issue of stabilizing the individual marketplace through appropriating for the Cost Sharing Reduction.
Democrats and Republicans are having constructive conversations on these important and time-sensitive health policy issues. They should be allowed to do their job. After these two policy areas are addressed, Congress should focus on continuing regular order and take their time to build a real plan to fix healthcare. Let’s not play politics with people’s health.
Capri Cafaro (@thehonorablecsc) is a contributor to the Washington Examiner’s Beltway Confidential blog. She is a former member of the Ohio State Senate, where she was the Senate minority leader. She is now an Executive in Residence at American University’s School of Public Affairs.
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