It appears the Graham-Cassidy health bill is dead -- for now -- after Sen. Susan Collins of Maine on Monday became the third Republican to say she wouldn't vote for it. In practical terms, this means (barring a reversal by either Sen. Rand Paul or Sen. John McCain, the previous "no" votes among a caucus of 52) health reform is delayed by at least a year, since doing it via the reconciliation process meant it had to be passed by Sept. 30 in order to fit into the fiscal 2018 budget. But fiscal 2019 is still a possibility, and senators ought to press forward with this bill as their starting point and go through the legislative process, if only to see if Collins and McCain are actually worried about procedure or just don't want to change Obamacare.
In the meantime, Americans need to gain some understanding of just what a bill like this one does with respect to funding "cuts" for a program like Medicaid.
On the one hand, you have a widely circulated estimate by consultants at Avalere Health (with funding from the left-leaning Center for American Progress) saying Medicaid funding from 2020 to 2026 would be cut by a cumulative $215 billion*. On the other, you have this spreadsheet from the office of bill sponsor Sen. Lindsey Graham clearly showing Medicaid funding rises by a cumulative $230 billion during that time span. (Note that both estimates were for the bill as of last week; the bill was tweaked over the weekend.) What's going on here?
What's going on is the fundamentally dishonest way Washington talks about spending and spending "cuts."
The spreadsheet from Graham's office clearly shows that Medicaid spending would rise every year during the time frame, starting at $134.4 billion in 2020 and hitting $200 billion in 2026. The cumulative total, compared to that starting point of $134.4 billion, is $230 billion. Funding does not go down in a single year. In fact, the annual increases are 8.1 percent in 2021, 7.5 percent in 2022, 7.0 percent in 2023, 6.5 percent in 2024, 6.1 percent in 2025, and 5.8 percent in 2026. That's right: The slowest rate of growth under these "cuts" is triple the rate of overall inflation in the U.S. right now.
So how does Avalere come up with a $215 billion funding decrease? By comparing Graham-Cassidy's funding to the faster rate of increase under"current law." Presumably, that's why the analysis never shows actual funding amounts, just the "changes" -- meaning, changes vs. today's skyrocketing rates of increase. Otherwise, the implication that spending falls during this time period would be revealed for the falsehood it is.
Thus is an increase in funding -- to the tune of a cumulative $230 billion, so that program would still receive a whopping 49 percent more in 2026 than in 2020 -- branded as a "cut."
Folks, if we can't "cut" spending in this way, we may as well just throw in the towel as a nation.
Yet, this decrease-in-the-increase is how those in Washington, particularly Washington Democrats, routinely define a "cut." Now consider the ramifications of adopting their definition: It means demagogues can portray anything less than the previously scheduled increase as some kind of cruel attack on America's vulnerable, when in fact even at the end of this "cost-cutting" exercise from 2020 to 20206 funding would still rise on an annual basis by almost 6 percent.
I'm so old, I remember when "bending the cost curve (for health care) and starting to reduce costs for families, businesses, and government" (emphasis added) was something certain prominent Democrats supported .
I also remember -- because it's gone on all year -- Democrats claiming credit for health-insurance premiums on HealthCare.gov rising by "only" 105 percent between 2013 and 2017 as a slowdown in costs, on the premise they might've grown more rapidly absent Obamacare.
So on the one hand, you have the GOP saying a "slowdown" to 105 percent growth over four years for health-insurance premiums is not good enough, and that funding increases of 8 percent or more for Medicaid are not sustainable.
At the same time, Democrats are saying the 105 percent increase on the exchange represents progress, and that increasing Medicaid funding by 6 percent instead of 8 percent represents devastation.
Which approach is the credible one?
It took political malpractice for Republicans, having seized the high ground when it comes to Obamacare, to let the left shape the narrative about health reform, first with the House's bill, then with the Senate leadership's bill, and now with Graham-Cassidy. Now that their own members are forcing them to slow down, perhaps they'll figure out a better way to tell people what would actually happen under their proposals.
*The estimate goes on to say funding will drop by a further $3.9 trillion over the 10 years after that, because the bill doesn't set out a funding rate beyond 2026. This requires people to believe Congress would basically eliminate Medicaid after 2026, which is fever-swamp stuff.