It remains to be seen whether it will matter, but Jimmy Kimmel is getting a lot of media coverage this morning for laying into Bill Cassidy for “lying to my face,” about the “Jimmy Kimmel Rule.” Cassidy has been making the rounds this morning defending himself, and the bill, mostly by lying to everyone else’s face and citing an artificial deadline for why this must pass, rather than speaking to the substance of the bill.
In interviews, Cassidy keeps saying that certain states — like Maine, Virginia, and Florida — would get more money, and he’s not wrong. It’s because they’re not getting any money now for Obamacare’s Medicaid funding because their Republican governors declined it, because they were more interested in sticking it to Obama than covering their citizens. So, yes: If you live in Mississippi, you’ll go from nothing to something. The catch is this: The overall funding is not going to increase — in fact, federal spending on healthcare will be reduced by around 20 percent —- so money that was initially spread among 31 states (minus 20 percent) will now be spread among 50 states, which means a lot of people who have healthcare now are going to lose it. In short: Graham-Cassidy essentially redistributes the money from blue states (and some red states) that opted in under Obamacare to red states that did not.
Most GOP Senators do not dispute this. Red state Senators who did not opt in under Medicare see this as a boon — rightfully so — while other red state Senators believe that states can make up for the huge losses in funding by eliminating inefficiencies at the state level. It’s a canard we have been hearing for a goddamn century — that our governments can save billions and billions of dollars by eliminating inefficiencies. Republicans say it to justify cutting funding, and Democrats cite it to suggest that programs won’t cost as much as Republicans say they will cost. It’s bullshit. There’s always going to be inefficiencies at both the state and federal levels, and I seriously doubt that California, for instance, is going to be able to recoup billions of dollars by eliminating a middle man (but GOP Senators running for re-election do not give a shit about California’s problems).
There is an interesting wrinkle and a real, potential opportunity for those who do live in certain very liberal states, however. The money would be given to states under block grants, which would give the states control over the money. California would lose billions of dollars but it could also use what money it does receive — and combine it, presumably, with additional state taxes — to fund single payer health care. That could work in wealthy liberal states like California, Massachusetts, New York, etc., and ideally, they’d provide models for other blue states like Maine and Minnesota to adopt single payer health care. But it’s going to leave the rest of the country out in the cold — with less money to provide coverage. Millions will lose health care.
Rand Paul is right about the bill, though: It keeps about 90 percent of Obamacare intact (with 80 percent of the funding), but it just moves the money around, and without the individual mandate, it will increase premiums on everyone.
But most of this is speculative, because nobody really understands what would happen under Graham-Cassidy because, again, the GOP refuses to wait for a CBO score (probably because they know it will look bad in the grand scheme of things, even if it will benefit a small number of red states). This is not about passing a good bill; it’s about passing any bill that will repeal Obamacare. The Republicans could rename Obamacare the Republican Senate Just Shat In Your Face Medical Bill and keep it exactly as is, and they could still get 48 votes.
Again, this all seems like it’s going to come down to Lisa Murkowski. Hundreds of hours of media time, millions of dollars spent in ad time, and reams of Internet posts (like this one) will be devoted to a subject where one person will have the ultimate say. She is going to be a tough sell because Alaska is one of those states that opted in under Obamacare, which means money would be redistributed away from Alaska under Graham-Cassidy. The Alaska governor — who Murkowski is taking cues from — is not keen on the bill because he knows that, while he will have added flexibility to spend the money he gets, he won’t have as much money to spend. (The bill would also defund Planned Parenthood for a year, which Murkowski is against).
But then again, McConnell could throw a lot of sweetheart deals at Alaska in exchange for her vote. There are fewer than 750,000 people in Alaska, so it wouldn’t be that hard to buy the state off, at which point Murkowski might have to decide, “Do I vote for a bill that’s better for my state (because of the sweetheart deals) or do I vote against a bill that is bad for the country, as a whole?”
We’ll find out next week.