September 10: You Aughta Know This Week

The big story this week was the Senate hearings on the fate of the Affordable Care Act, with the sham bipartisan hearings holding our attention while Senators Graham and Cassidy quietly bought votes for their repeal plan.

1. Andy Slavitt breaks it down in USA Today.

There is competition — yet another partisan effort to repeal the ACA, led by Republican senators Lindsey Graham of South Carolina, Bill Cassidy of Louisiana and Dean Heller of Nevada. Though it is out of touch with public sentiment, their proposal has one new thing its sponsors are hoping will make a difference — financial payoffs to the states of senators whose votes they are courting.

The first draft of Graham-Cassidy-Heller looks like the same repeal-and-replace plans Americans soundly rejected in poll after poll. It would end both Medicaid for people slightly above the poverty line and tax credits for people buying coverage in the individual market, replacing both with a capped block grant that would gradually shrink until it disappeared altogether. The plan also makes deep cuts to Medicaid, weakens federal protections for people with preexisting conditions, and introduces Medicaid caps which limit the spending on low-income kids, seniors and people with disabilities. 

But it’s not Graham-Cassidy-Heller’s unpopular policies that are expected to make a repeal effort successful. The secret weapon is a cynical redistribution of federal money from mostly urban, blue states that have expanded Medicaid to rural, red states that did not.

2. Topher Spiro laid out the order of events required for the Graham-Cassidy Repeal to pass.

Here we go! He needs 1) markup (to get McCain) 2) CBO score 3) parl review 4) 50 votes 5) floor time 6) House passage–all before Sept. 30.

Let’s break this down.

First, in order to get Senator McCain to sign off, Cassidy needs the bill to go through committee markup, in order to meet McCain’s bipartisan ideal.

Second, the CBO must score the bill, which will provide an estimate of the number of people who will lose health insurance. Spoiler alert: This number will be north of 20 million by 2027 because it is a full rollback of the Medicaid expansion in the ACA. Hence one reason this is the repeal bill.

Third, the Senate parliamentarian must sign off that the bill and its various elements meet the standard for budget reconciliation, meaning they have a fiscal impact.

Fourth, the bill needs 50 votes in the Senate, so that Vice President Pence can roll over in his limo and cast a deciding vote allowing this bill the 51 votes it needs under budget reconciliation rules. This means two Republicans can vote no, and given that Sen Heller of Nevada is listed in some places as a co-sponsor, I’m guessing Senators Collins and Murkowski are the projected no votes. Although the bill attempts to buy their votes with pork for their states, too.

Fifth, there are several bills that need to be passed before the end of the fiscal year, September 30, so it’s unclear time can be made for this bill in the first place. And obviously the Dems can in theory slow everything down in order to run out the clock.

Finally, the House must vote on the bill and pass it to get it to 45’s desk for a signature.

3. I wrote a monster piece about why health care is so expensive.

4. Another plan with a complicated name: Kasich-Hickenlooper repair bill gains steam, but buried deep within the article you see Kasich talking about dropping maternity care as an essential benefit. How did you get here, Kasich?

5. In the latest autism news, Buzzfeed reported last week that 50% of scientific autism articles are fake news. And you wonder why I started a blog.

6. In other social justice news, 45 announced on Tuesday, September 5, that he would be ending the Deferred Action on Childhood Arrivals, or DACA, program in six months and appeared to give Congress instructions to create a permanent program. Then he sent out several confusing and contradictory tweets that suggest if Congress can’t get it done, 45 may handle it himself. Of course, he doesn’t know how a bill becomes law, so no one is counting on it. 

Protests lit up all over the country, and this was my favorite.

7. Hurricane Irma is going to destroy Florida and yet the poor, disabled, or both may not have a way to escape. NPR had a story about the reality of evacuating while poor.

“I’m alright with my medicine and stuff,” said Johnson. “So the main thing I’m worrying about is surviving.”

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