Protesters in pristine pulmonary health didn’t stop chanting until chairman Orrin Hatch asked “Where’s the damn police?” and the damn police showed up. Sen. Lindsey Graham traveled miles off script and actually had saliva on his lips as he vowed to thrust “a stake in the heart of single-payer health care.” Most of the senators inside the committee room raised their voices at one point or another—including Sen. Tom Carper, a mild-mannered senior Democrat who typically speaks unperturbed.
If there’s only going to be one hearing about Graham-Cassidy, you might as well get all your emotions out at once.
Graham and Sen. Bill Cassidy, the two men primarily behind the congressional GOP’s last-gasp effort at Obamacare repeal, testified in defense of their legislation Monday before an unusually feisty Senate Finance Committee. The proceedings were delayed 15 minutes by demonstrators in the audience who were pulled from the room by authorities before Hatch, the 83-year-old dean of the upper chamber, gaveled the session back to order. Graham kept the atmosphere hot, however, with a fiery opening statement that deviated substantially from his prepared remarks. He called his bill “not the last chance, but the best chance” at undoing and sort-of replacing the Affordable Care Act.
“And to my friends to the left, I will do everything I can to stop and put a stake in the heart of single-payer health care,” he said, bobbing his head to the beat of the words. “You don’t like Obamacare. You don’t think it’s big-government enough. I am here to stop you. You care as much as I do about health care, but going beyond Obamacare is a nightmare for this country. It will ruin health care and bankrupt the American people.”
The measure is seen by some conservatives as the way to prevent further government involvement in the private health insurance market, since it would authorize Washington to disburse hundreds of billions of dollars to the states for them to establish their own systems. But Cassidy, who has devoted more time to selling the bill’s substance than its political ramifications, tried talking about the legislation’s details in often contentious exchanges with Democrats.
Ron Wyden, the finance committee’s ranking Democrat, was his most aggressive opponent. Wyden challenged Cassidy early in the hearing to say whether he agreed with experts who say Graham-Cassidy would undermine protections for certain individuals with pre-existing medical conditions.
“That is begging the answer. I think if you’re in a [non-Medicaid expansion] state, so therefore the patients and hospitals in your state do not get benefits—if you’re in Maine or Missouri or Florida or Virginia, you are pleased about this bill,” Cassidy said. The measure lumps the federal money spent on Obamacare’s tax credits, Medicaid expansion, cost-sharing payments to insurers, and Basic Health Program, and redistributes it in block grants to the states. The states Cassidy mentioned are among those that have not expanded Medicaid, and thus stand to benefit from receiving dollars at the expense of states that have.
Favoring or disapproving of such an approach is a matter of policy preference. Many Republican governors who would make out well under this scenario like it; those who come from high-cost states that receive a lot of health dollars from D.C., like Gov. Charlie Baker of Massachusetts, don’t. But this matter sidesteps the point to which the health reform debate has returned time and again this year: How does the legislation affect vulnerable consumers?
This was the pivotal consideration of Sen. Susan Collins, the moderate Maine Republican who was a no on previous Senate GOP proposals and finally announced her opposition to this one Monday evening as the hearing neared its fifth hour. Graham and Cassidy released updated text of their bill on Sunday, which altered the formula for the block grant funding and included some extra money for low-population-density states like Alaska, whose senior Republican, Sen. Lisa Murkowski, has been an undecided vote.
Collins was against each version.
“First, both proposals make sweeping changes and cuts in the Medicaid program. Expert projections show that more than $1 trillion would be taken out of the Medicaid program between the years 2020 and 2036. This would have a devastating impact to a program that has been on the books for 50 years and provides health care to our most vulnerable citizens, including disabled children and low-income seniors,” she said in a statement.
“Second, both bills open the door for states to weaken protections for people with pre-existing conditions, such as asthma, cancer, heart disease, arthritis, and diabetes. Some states could allow higher premiums for individuals with pre-existing conditions, potentially making their insurance unaffordable.”
Cassidy has disagreed with these assessments, contending that his bill safeguards low-income and sick Americans, and that governors would not harm consumers with the authority the bill grants states to waive certain Obamacare regulations.
“The supposition that governors are not going to take care of the people in their state, which kind of underlies all these questions by some who oppose the bill, I disagree,” he said during the hearing. “I think governors want to take care of the folks in their state. But if they apply for a waiver, the statute specifically says that the governor must establish that those with pre-existing conditions have access to ‘adequate and affordable coverage.’ If they fail that, there’s a provision in which the secretary of [Health and Human Services] can pull dollars back, both deny and pull dollars back, if they misuse the funds by not providing access to adequate and affordable coverage.”
Collins is now the third no vote on Graham-Cassidy, with Sens. John McCain and Rand Paul, sinking the legislation until further notice. It was expected that the bill would be brought to the floor this week, before a Sept. 30 deadline for the Senate to approve a health reform package under privileged status.
Cassidy was asked earlier Monday on CNN if the latest repeal and replacement effort is over if Collins announced her opposition.
“Yes, it is,” he said.
