California, New York, Massachusetts and Maryland

According to the Congressional Parliamentarian, the GOP-Senate has until September 30 to repeal Obamacare (the Affordable Care Act – ACA) with a 51 member simple majority vote (when their nuclear option expires); after that, they would need an impossible 60 votes to reach the same goal (to achieve cloture). They would be stuck having to work with Democrats to “fix” the ACA, just as House Speaker, Republican Paul Ryan said he had no intention of allowing any of those fix-it bills to reach a full House vote.

So Senate Majority Leader, Mitch McConnell (R-KY), has hastened a red-state-biased piece of legislation, fomented by Bill Cassidy (R-LA, left above) and Lindsey Graham (R-SC, right above), which would repeal the ACA and replace it with allocated block grants to the states from the federal government without any reference to local medical costs, instead simply based on a simple per capita allocation. McConnell and Graham stated, rather openly in a press conference, their expressed intention to end the 37% of all ACA dollars going to the above four specifically-named states – not coincidentally “blue” states with large urban populations – and spread the block grants at exactly the same per capita level to red states, where historically rural healthcare costs are significantly lower than what is charged in more urbanized areas. For more details, see my September 9^th Repeal and Destroy blog. In short, red state healthcare remains the same or gets better; blue state care crashes and burns.

The GOP thinks that they can muster the votes, as the “Congressional efforts to repeal the Affordable Care Act sprang back to life on Monday [9/18] as Senate Republicans pushed for a showdown vote on new legislation that would do away with many of the health law’s requirements and bundle its funding into giant block grants to the states.

“The Republican leaders of the latest repeal effort, Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, said their effort — considered all but impossible earlier this month — was gaining momentum. The seven-year drive to repeal President Barack Obama’s signature domestic achievement appeared to collapse in July when it fell one vote short in the Senate…

“Under the Graham-Cassidy bill, millions could lose coverage, Medicaid would face cuts comparable to those in earlier repeal bills, and insurers in some states could charge higher premiums to people with pre-existing conditions. But only days remain before the expiration of special parliamentary language that protects repeal legislation from a filibuster in the Senate, and pressure is mounting for another vote.” New York Times, September 18^th.

Indeed, Republican Gov. Doug Ducey of Arizona has strongly pressed the swing vote that tanked the earlier effort to repeal the ACA, John McCain (R-AZ), to reverse himself and support this repeal. The GOP mantra is that there is nothing in fixing the ACA that particularly benefits their red state constituency and that the only big losers would be the blue states with big cities. Not a completely accurate assessment, as noted above. McCain’s immediate response: “I’m not interested in only having an up-or-down vote on what’s one-fifth of the gross national product.” Will he hold the line? Time will tell.

It is McConnell’s expressed intention to limit committee hearings – literally only giving Lindsey Graham and Bill Cassidy a platform to present the bill. Otherwise, the total amount of discussion will be limited to two minutes, with no amendments, no other votes. Even as such a Senate floor vote looms in the immediate future, there have been no public hearings, and the Congressional Budget Office has not presented its analysis and projections of the impact of this bill (and the only CBO report that can be released before 9/30 relates not to who loses coverage… just on what the federal budget impact of the bill will be).

Citizens of California and New York, with much higher costs of living, would be devastated under this bill; federal healthcare funding in California would drop by an estimated $57,547 per person while New Yorkers would see a loss of about $33,058 per capita. No other state even comes close. For many red states like Wyoming and South Dakota, the bill is a wash, dropping funding less than $1,000 over a decade. It’s no secret that this proposed legislation has been deliberately crafted to punish states that voted for Democrats while protecting those that voted for Republicans.

The only signal this seems to send is that red states and blue states should not be in the same country… a horrible statement from Senate Republicans. At a time when Americans need reasons to bond together – evidenced by the massive cooperation among left, right and center in response to the recent hurricane disasters – Senate Republicans are becoming the poster-“boyz” for permanent polarization, the kind of lines in the sand that spawned the Civil War.

But even for red states with larger urban populations and significant uninsured and lower income residents, they too were aghast at the powerful negative impact of this hasty and ill-conceived legislation. “Eleven governors, including five Republicans and a pivotal Alaskan independent, urged the Senate on Tuesday [9/19] to reject a last-ditch push to dismantle the Affordable Care Act.

“But Republican leaders pressed toward a showdown vote. And they choked off separate bipartisan efforts to shore up health insurance markets under the Affordable Care Act, hoping to give Republican senators no alternative but to vote for repeal.” New York Times, September 19^th. This bill is truly a cruel and crushing piece of heartless greed, intended to generate additional federal money for the GOP plan to cut taxes for the rich. Screw the little guy… again.

I’m Peter Dekom, and I am deeply ashamed by the above last-ditch efforts and wondering precisely what it means to be an “American” these days.