What’s a trillion dollars among friends

Cassidy-Graham 2.0 came out last night.  There are some major policy changes in it:

  • No need for states to submit waivers
    • States must submit a plan
    • Plan does not define “Affordable” or “Adequate” or “pre-exisiting condition”
    • No specification of consequences or recourse if the state plan that was submitted failed to meet its objectives
  • States define their own Essential Health Benefits, out of pocket maximums and community rating
  • Risk pools can be split

There are a bunch of political provisions. Several are aimed at shoveling money to Alaska, but those are not the important provisions. The policy matters more.

The bill sponsors also released their estimates of state effects. They use magical math.

Who cares about a trillion dollars among friends?

Transitioning Medicaid from a shared responsibility program to a program where the state bears the entire risk of crisis is the most basic element of the entire series of Republican bills. This is what will dive state governors crazy as their budgets can’t handle a counter-cyclical shock or a hurricane or an infectious disease outbreak without a federal backstop.

You know what to do; call the senate, call your governor and call your Rep.






45 replies
  1. 1
    Spanky says:

    * States must submit a plan
    * Plan does not define “Affordable” or “Adequate” or “pre-exisiting condition”
    *

    Third bullet looks to be the best part of the plan.

  2. 2
    Downpuppy says:

    Thanks to state balanced budget rules, the next recession will be deadly.

  3. 3
    Dr. Ronnie James, D.O. says:

    Charles Gaba posted something late last night on the money shoveling to specific states – the URL provides a good precis:

    http://acasignups.net/17/09/25.....y-above-it

  4. 4
    Amir Khalid says:

    I don’t get it. If Graham and Cassidy need more Congressional Republicans to get on board with their Obamacare repeal bill, why revise it to fuck over their constituents even more?

  5. 5
    rikyrah says:

    Thanks for keeping us updated, Mayhew.

  6. 6
    FlipYrWhig says:

    Can I just ask, once more, why any of this would be any better than having the states that didn’t take the Medicaid expansion just TAKE THE MEDICAID EXPANSION and tinker with it to their heart’s content?

  7. 7
    ArchTeryx says:

    @Amir Khalid: Because as I said last night they are going for broke, and deregulating the entire health insurance market. It’s a game of chicken with hundreds of thousands of lives at stake.

  8. 8
    rikyrah says:

    @Amir Khalid:

    why revise it to fuck over their constituents even more?

    Feature, not bug

  9. 9
    ArchTeryx says:

    @Amir Khalid: Because as I said last night they are going for broke, and deregulating the entire health insurance market. It’s a game of chicken with hundreds of thousands of lives at stake.

  10. 10
    Laura says:

    @Amir Khalid: because Republican Governors are uniquely suited for doing just that. Scott Walker, Sam Brownback, Rick Scott, John Kasich, Paul LePage………

  11. 11
    rikyrah says:

    THE RACHEL MADDOW SHOW 9/22/17
    Protesters against Republican Obamacare repeal make it personal
    Rachel Maddow reports on protests and activism around the United States against the latest Republican effort to kill Obamacare.

  12. 12
    rikyrah says:

    The GOP bill’s latest math doesn’t add up, @CenterOnBudget, @TopherSpiro and others warn. https://t.co/ZfubAxjBgY pic.twitter.com/LtDkOC9yqM
    — Dan Diamond (@ddiamond) September 25, 2017

  13. 13
    rikyrah says:

    Don’t be fooled. Even with augmented funding Alaska, Maine and all other states will still experience overall cuts to Medicaid funding https://t.co/2GSm4IjKQ6
    — Mario Molina, MD (@drjmariomolina) September 25, 2017

    New Cassidy-Graham makes clear states could allow insurers to offer bare-bones plans: no required benefits & unlimited deductibles & copays.
    — Edwin Park (@EdwinCBPP) September 25, 2017

    New Cassidy-Graham bill confirms clear intent to make block grant temporary, eliminating it entirely in 2027 as #Medicaid cap cuts deepen.
    — Edwin Park (@EdwinCBPP) September 25, 2017

  14. 14
    rikyrah says:

    And, NEVER EVER FORGET.
    TRUMPCARE is not..
    HAS NEVER BEEN…
    about HEALTHCARE.
    Too many people make that mistake.
    Trumpcare is ABOUT TAX CUTS FOR THE RICH..
    Once you understand THAT…then all the versions of Trumpcare make absolute sense.

  15. 15
    rikyrah says:

    2: Here’s the ledger for Alaska. Even their own estimates show Alaska still losing $100 million. This is pretty simple and clear. But… pic.twitter.com/STvXtNXcSy
    — Topher Spiro (@TopherSpiro) September 25, 2017

    4: First, and most obvious, ANY numbers released by Graham/Cassidy should be treated with great skepticism. They’ve been misleading before.
    — Topher Spiro (@TopherSpiro) September 25, 2017

    6: Their table includes a column on “state savings” that flips many states from being in the red. Phony, a big magic asterisk. Here’s why.
    — Topher Spiro (@TopherSpiro) September 25, 2017

    8: For total state funding under current law, they estimate only federal funding. Which is fine, but then…
    — Topher Spiro (@TopherSpiro) September 25, 2017

    10: State funding is state funding. Cutting it is not “savings”
    with no impact on health care programs.
    — Topher Spiro (@TopherSpiro) September 25, 2017

    12: This is not a “he said / she said” situation. This stuff is obvious. Every independent estimate does not assume “state savings.”
    — Topher Spiro (@TopherSpiro) September 25, 2017

    14: Some did not. This story should be corrected, or @GlennKesslerWP should fact check. @WaPoSean @pw_cunningham https://t.co/CIDHWayIIi
    — Topher Spiro (@TopherSpiro) September 25, 2017

  16. 16
    Julie says:

    David, have you heard anything about September CSR payments?

  17. 17
    Lurking Canadian says:

    @FlipYrWhig: You mean, like, just let the black guy win?

  18. 18
    FlipYrWhig says:

    @Lurking Canadian: Indeed. But it’s just so goddamn stupid. If you’re trying to remedy a disparity in who’s getting Medicaid funding, TAKE THE FUCKING MEDICAID FUNDING THAT WAS PART OF THE FUCKING BILL IN THE FIRST PLACE. It just goes to show, as if we needed it, that they’re not trying to fix that, they’re just running around the control console unplugging wires.

  19. 19
    PPCLI says:

    Remember when the Repubs were shocked, just shocked, by the “Cornhusker Kickback” that was the most crass corrupt political pay off ever in history? The one that Scalia ranted about from the bench during one of the Obama care cases, even though it didn’t go in the bill?

    As always IOKYR.

    why don’t the Republicans just propose IOKYR as the next amendment to the constitution? It would merely formalize existing practice.

  20. 20
    d58826 says:

    Between this issue and Der Fuhrer’s antics over the weekend, I would contribute to a GOFUNDME campaign to help the NK and kim buy more H-bombs and put this country out of it’s misery. Waiting for the asteroid seems like a long shot. (snark)

  21. 21
    ...now I try to be amused says:

    @Spanky:

    Third bullet looks to be the best part of the plan.

    PROFIT!

  22. 22

    @Amir Khalid: i think they are giving it a ‘new version’ so that senators can suddenly say their reservations have been addressed and they’re going to vote for it this time. As for why it’s this particular new version, that’s because they’re evil.

    I hate these fuckers so much.

  23. 23

    @Amir Khalid:

    why revise it to fuck over their constituents even more?

    If you keep the poor from voting, they’re no longer constituents are they?

  24. 24
    Scott says:

    Not only will constituents be screwed, every state government will be left holding this bag of dog crap when they can’t implement anything by Jan 2020. Oh by the way, no one is talking yet about the massive middle class medical job losses that are going to occur.

  25. 25
    OzarkHillbilly says:

    @🐾BillinGlendaleCA: The 3/5th rule comes back into play.

  26. 26
    daveNYC says:

    Several are aimed at shoveling money to Alaska, but those are not the important provisions.

    If they’re enough to get Murkowski on board they might end up being very important.

  27. 27
    Matt McIrvin says:

    @FlipYrWhig: That approach doesn’t slash overall coverage to fund a tax cut, which is the actual point here.

  28. 28
    rikyrah says:

    THE MUTHAPHUCKA WHO WANTS TO TAKE AWAY YOUR HEALTHCARE.

    Facing scandal over taxpayer-funded jet travel, Price scrambles
    09/25/17 09:30 AM
    By Steve Benen

    It’s a story that looked awful at the outset, and managed to get progressively worse very quickly. Just six days ago, Politico first reported that HHS Secretary Tom Price has been chartering private jets, paid for by American taxpayers, for official business. We learned soon after that the far-right cabinet secretary, who used to be outraged by stories like these, has taken at least 24 of these flights, at a cost exceeding $300,000.

    Pressed for an explanation, Price initially didn’t want to talk about it. Then the excuse related to the recent hurricanes, which didn’t make any sense. His press office later said the chartered jets were about “making sure he is connected with the real American people,” which was hilarious, since almost all real Americans tend to fly commercial.

    We were then told Price started taking private jets because he had a bad experience with a cancelled flight, which, as excuses go, wasn’t exactly persuasive.

    Late last week, the Department of Health and Human Services’ inspector general’s office announced an investigation into Price’s travel arrangements, and soon after, the cabinet secretary said he’ll stop taking chartered flights – at least for now.

    Health and Human Services Secretary Tom Price told Fox News on Saturday that he’ll stop his taxpayer-funded travel on private jets, pending a formal review by his department’s inspector general.

    “We’ve heard the criticism. We’ve heard the concerns. We take that very seriously and have taken it to heart,” Price said.

    That may sound like a good start, but as Politico’s latest report noted, Price continued just last week to take additional chartered flights, costing tens of thousands of dollars, even after the controversy broke. The new total cost to taxpayers for Price’s private flights is now over $400,000 – and that only includes the flights we know about since May.

    Asked about the controversy yesterday, Donald Trump said, “We’re looking into it.”

  29. 29

    @Julie: They were paid on time and in full

  30. 30
    Redshift says:

    Everyone: Graham-Cassidy is the worst repeal bill yet!

    Graham & Cassidy: Hold our beers!

  31. 31
    Chris says:

    @Major Major Major Major:

    i think they are giving it a ‘new version’ so that senators can suddenly say their reservations have been addressed and they’re going to vote for it this time. As for why it’s this particular new version, that’s because they’re evil.

    Honestly, yes. (It’s traditionally the indispensable step in getting Rand Paul’s vote; let’s see if McCain holds).

  32. 32
    ThresherK says:

    @rikyrah: “Scrambles”! Intentional jet joke?

  33. 33
    Boatboy_srq says:

    It strikes me that CG is following the same line of thought that led to financial crises in PIIGS, encouraged Brexit and is threatening European unity. Federal-level standards, applied to state-level financial structures with no accommodation for individual states’ domestic issues, is a recipe for multiple localised crises.

    This is Secessionism 2.0. In this instance, states will want to secede not because of slavery or racial/ethnic politics, but because remaining under the Fed and abiding by Congressional funding constraints will not be tenable for a number of Red States. The “chronic overspending” the Reichwingnuts complain about is happening in their own backyards, and once they are prevented from doing that remaining in the Union will be fiscally as well as ideologically untenable.

    How do we address that? Can we call out CG as magical Neoconfederate thinking?

  34. 34
    Ohio Mom says:

    Did my calls for the day: as usual, Portman’s Ohio offices have full voice mailboxes, and not an intern able to pick up a phone in sight in DC, though that answering machine is still taking messages. It’s disgusting that he is so inaccessible.

    For good measure, called Collins, Murkowski and McCain and left voice mails thanking them again for their No votes this summer, and saying I hope I can call them next week with more thanks.

    Next on the agenda is moping about today’s very-early-in-the-morning IEP meeting. It’s not the teachers, they are terrific. It’s the lack of options for my autistic 20 year old. Well, there are options but he is not cooperating, as per his disability.

  35. 35
    rikyrah says:

    @Ohio Mom:

    Next on the agenda is moping about today’s very-early-in-the-morning IEP meeting. It’s not the teachers, they are terrific. It’s the lack of options for my autistic 20 year old. Well, there are options but he is not cooperating, as per his disability.

    Sending you positive thoughts.

  36. 36
    rikyrah says:

    The revised Graham-Cassidy bill is a fraud.On Sunday night, Lindsey Graham and Bill Cassidy began circulating a revised version of their Obamacare repeal bill, as well as an accompanying analysis of its effects. The revision is aimed at wooing holdout senators, and the top-line numbers for their states look enticing: Alaska, Arizona, Maine, and Kentucky would get an increase of federal funding of 3 percent, 14 percent, 43 percent, and 4 percent, respectively. Alaska’s Lisa Murkowski hasn’t declared how she will vote yet, while Maine’s Susan Collins leans no and Kentucky’s Rand Paul and Arizona’s John McCain have already said they would vote against the bill. (Republicans can only lose two votes.) On Sunday, Donald Trump tweeted the following:

    …………..

    However, according to independent experts, the revised bill misleads in order to get to these numbers. First off, the state-by-state analysis released by the bill’s authors doesn’t include cuts that would result from instituting a per-capita cap in Medicaid. This means that some $120 billion in cuts over 10 years is not being counted. And then there is the fact that the analysis only counts federal funding when looking at the current law, while under the new law it includes “state savings” that would come from reducing the amount states have to pay into Medicaid. Topher Spiro, health analyst at the Center for American Progress, says this is like comparing “apples to oranges.”

    “It’s quite obvious what they’re doing,” Spiro told the New Republic. “They released the numbers late at night, they get a few tweets from reporters on top-line findings which are inaccurate. They even got a press story or two that just repeated verbatim their top-line findings. They’re counting on there not being enough time for news outlets to ask questions and for independent experts to analyze it and release independent estimates.” Even the authors’ own analysis shows that federal funding for Alaska drops almost $100 million, before they include the “state savings,” an amount that Spiro maintains might still be an underestimate.

  37. 37
    rikyrah says:

    Trump administration abandons subtlety in ACA sabotage campaign
    09/25/17 11:30 AM
    By Steve Benen
    To the great annoyance of its detractors, the Affordable Care Act is doing pretty well, but that doesn’t mean the system is immune to sabotage. The Wall Street Journal reported over the weekend:

    The Trump administration plans to shut down healthcare.gov, a website consumers use to sign up for the Affordable Care Act, for 12 hours on nearly every Sunday of the coming ACA enrollment season.

    The outages, which the administration says are for maintenance, will occur from midnight through noon on every Sunday other than Dec. 10.

    Just so we’re clear, the Republican administration has already shrunk the open-enrollment period, cutting it in half. On top of that, consumers will now have even less access to the federal exchange marketplace on Sundays, with Trump’s HHS shutting down the website for 12-hour increments.

    Frank Baitman, a former chief information officer for HHS, made the case on Friday that there’s no credible technological reason for this kind of decision. He added that the move reflects a “lack of will and respect” for the American people.

    Sen. Chris Murphy (D-Conn.) was even more direct on this point, arguing, “This is not normal maintenance. This is sabotage. Cold blooded. Clear. Out in the open.”

  38. 38
    rikyrah says:

    From Benen:

    The Center on Budget and Policy Priorities recentlypublished a list tracking each of the actions Trump World has taken to “sabotage the ACA by destabilizing private insurance markets or reversing the law’s historic gains in health coverage.” It’s not a short list.

  39. 39
    Ohio Mom says:

    @rikyrah: Thanks. I will regroup. He will get where he needs to be, eventually, but taking the more roundabout path is going to be all uphill.

    A very steep, rocky and craggy hill. Lots of twisted ankles ahead and I will probably have to become an expert at metaphorical ace-bandage wrapping.

    He can’t see that but then again, I know I am hardly the only parent with a twenty-year who doesn’t take advice and guidance. It’s a long line of parents of young adults shaking their heads and biting their tongues and I am in the back.

  40. 40
    marcopolo says:

    I realize this is probably a dead thread but just called my Senators for today. The thing that so depresses me is the absence of historicity (if that is a word) for the coverage of G/C in regards to the preceding efforts to repeal the ACA. I mean all the prior concern for funding for opioid abuse treatment is now apparently gone. Concerns that health insurance actually be a worthwhile product that covers essential health benefits in an affordable manner. Not allowing folks to be penalized for pre-existing conditions. It is nuts. And I don’t sense the same level of outrage that the prior attempts created. I don’t know, maybe it is just issue fatigue?

  41. 41
    rikyrah says:

    @marcopolo:

    And I don’t sense the same level of outrage that the prior attempts created. I don’t know, maybe it is just issue fatigue?

    On Maddow’s show on Friday, she had a segment on this, and the mother of a disabled child on Medicaid said.

    ” I don’t know why I have to keep on coming back to the Senator’s office to tell him WHY I think my child should live.”

    She was tired. But, there’s something else there.
    They really don’t understand. People understand that this is life or death for them and their loved ones. They are hardening people, who will never forget who did this to them.

  42. 42
    Dave says:

    I urged Senator Heller (no, I didn’t vote for him, but I live in Northern Nevada, so I’m stuck with him, at least until he’s primaried by some even more evil right wing douchebag) to vote for the bill and get as many of his dirtbag colleagues to do the same, to help ensure the total destruction of the GOP. I know, they’ll just blame the Democrats and their supporters will believe them, but I’m tired of seeing these fuckers vote for assholes and not paying a price for their stupidity and indifference. Yeah, millions will be hurt, many will die, but I sincerely hope the majority of those hurt are GOP supporters and voters.

  43. 43
    Ohio Mom says:

    @Dave: Be careful — those Republican interns don’t do sarcasm! After talking to dozens of them this summer, I can assure you they are gullible, humorless dolts. Really, they are not very smart.

  44. 44
    Duane says:

    Nineteen Republican controlled states refused Medicaid expansion.Improving your state’s economy or the life of its citizens be damned.
    Ideology is all that matters to these warped,sociopathic politicians.I’ve hit the efg zone.Fuckem.

  45. 45
    Dave says:

    @Ohio Mom: Agree, I’ve talked to them on many occasions. I don’t know who reads the messages for Senator Heller, but I’ve recently taken to writing him on his website rather than calling. For awhile I was posting my comments on his Facebook page, but I must have hit a nerve or two, because he blocked me from posting on his page several months ago. I haven’t deleted my FB account (yet) because I have so many family members and true friends on it, but I haven’t signed on to FB for several months now. I get too upset when I see how many people are still buying the load of shit that 45 and the GOP are selling.

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