Republican lawmakers have wasted much of the year trying to repeal the Affordable Care Act, a move that would deprive millions of people of health insurance. They're back at it. Like a bad sequel to a terrible movie, a proposal whose main architects are Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., would in many ways be worse than bills that came before. It would punish states like California and New York that have done the most to increase access to health care and set in motion cuts to Medicaid, the federal-state program that provides insurance to nearly 70 million people, many of whom have disabilities or are elderly.
This is not an idle threat. President Donald Trump wants this bill passed by the end of next week, before the expiration of a budget rule that allows the chamber to pass a health care bill with only 50 votes (and a tiebreaker from the vice president). It's unclear whether the votes are there, but the bill's chances increased Monday when Gov. Doug Ducey of Arizona said he supported it. His endorsement is important because it could persuade Sen. John McCain, R-Ariz., who cast the decisive vote against repealing the ACA in July, to vote for this version.
It is hard to overstate the cruelty of the Graham-Cassidy bill. It would eliminate the mandate that even healthy people buy health insurance, end the subsidies that help people purchase coverage and stop the expansion of Medicaid. It would offer states block grants they could use to help people get insurance but would leave people at the mercy of individual state legislatures and, overall, would provide $239 billion less than what the federal government would spend under current law between 2020 and 2026, according to the Center on Budget and Policy Priorities.
Graham-Cassidy would further cripple Medicaid by putting a per-person cap on what the federal government spends on the program. Under current law, federal spending increases automatically to keep up with the rise in medical costs; a per capita cap would leave governors, who are ultimately in charge of administering Medicaid, in the unenviable position of denying care to poor and older Americans.
The rush job proposed by Cassidy and Graham and endorsed by the president is deeply unfair and leaves other lawmakers with little time to understand what's in the bill or its true costs. The Congressional Budget Office says it will not be able to determine the full impact of the legislation, including its effect on premiums and the number of people who have insurance, for several weeks.
The Senate should show a little patience; a better, more humane option awaits it. Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., are working on a bill that would strengthen the ACA by appropriating money for health subsidies that help low-income families; Trump has threatened to end those payments administratively. Alexander and Murray expect to produce their legislation this week.