Last ditch effort by GOP to tank Obamacare looks doubtful

The long arm of politics beckons once more as the Republican party tries, for what seems the upteenth time, to repeal  the Affordable Care Act, in large part to score a victory for the moribund administration of President Trump, as he hobbles towards the abyss; where many supporters have asked themselves what good is he, if he can’t deliver on the things that they want most: the border wall with Mexico, and repealing the ACA, known to most as Obamacare.

If all politics are local, then this last ditch attempt by Sens. Lindsey Graham, of South Carolina and Bill Cassidy of Louisiana, their call to arms has become even more urgent as they want to use the budget reconciliation process, for a simple majority vote rather than wait till the end of September when they will be forced, by Senate rules, to have 60 votes to pass the proposal.

What would be jeopardized,and even, abandoned is the fate of over 22 million Americans whose access to medical care will be jeopardized, since the Graham-Cassidy bill will take the tax monies anchored to Obamacare and transfer them to the states, in dramatically reduced amounts, especially for those that took Medicaid expansion to shore up access to care.

The program, long targeted, ever since its inception, from President Johnson, by the GOP, as an entitlement program, and now seems the right time to pick it off, especially since party leadership is growing increasingly nervous about the prospects in the 2018 mid-term elections, where they could easily lose their majority status, and with the scenario of having the White House, but with minority status in Congress.

Currently, there are 70 million Americans benefiting from the program, but the bill would see low-income people immediately lose these benefits, along with the homeless, and those whose income disqualifies them from Medicaid, but who get a benefice to gain some much needed help; thus affecting many moderately low-income families.

Exactly who will lose what, and in what measure is largely up to an anticipated, but truncated, report from the Congressional Budget Office, who is expected as early as Monday to offer an analysis, in part, which prompted Senate Minority Leader Chuck Schumer to wonder aloud how any member of Congress could go to their home district and promote the bill without the facts.

With the true spirit of partisanship, Sens. Lamar Alexander and Patty Murray were forced to give up on their long-held bipartisan efforts after being shunted aside by Graham, in an effort to put this as a victory for the GOP.

In a recent statement, Murray noted, “My goal is to defeat their new proposal,” said Murray. “It’s horrendous for patients. It’s horrendous for advocates. The list is endless.”

The ramifications, both large and small, played out with Alexander who said, in his more restrained statement,”during the last month, we have worked hard and in good faith, but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leader's’ hands that could be enacted.”

But Murray sees it differently. She believes they were close to reaching a deal until GOP leadership decided to put a freeze on her bipartisan health care plan, opting for repeal and replace legislation, instead of improving the compromise bill.

If we hold any disbelief that leopards can change their spots, then this is it.

As with the last attempt, opposition from the heavy hitters has come from the American Medical Health Association, the American Health Association and others, and “The groups largely have been shut out of the process, and their opposition didn’t stop the Senate from voting on a repeal bill in July or the House passing its repeal bill in May,” reported The Hill.

“This proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term,” AHA President Rick Pollack said in a statement Tuesday; The AHA, which represents nearly 5,000 hospitals and other care providers, said the Graham-Cassidy proposal could put coverage at risk for “tens of millions” of Americans.

Lawmaker support for Graham-Cassidy is mixed at best, with Sens. Ron Johnson, Asa Hutchinson, Chuck Grassley and John Cronyn backing it, but not, are Susan Collins, Lisa Murkowski, Rand Paul,and now Sen. John  McCain.

Hovering on the bench was John McCain who, saying how close he and Graham are, and even joking that he doesn’t do anything without the other's consent, his coyness, irritating to some, sharpened the game even further, especially when Graham said, “I can’t think of anything I’ve done of consequence, politically, that hasn’t been with John.”

That changed on Friday, when McCain announced that he “cannot in good conscience” vote for the bill. McCain said he cannot vote for the bill without knowing how it will affect premiums, how much it will cost, and how many people it would help or hurt.

"Without a full CBO score, which won't be available by the end of the month, we won't have reliable answers to any of those questions." he said, in his statement.

While some might rejoice in that news, the zeal to repeal and replace Obamacare is still high on his list, lest he be misunderstood, he said "I would consider supporting legislation similar to that offered by my friends Senators Graham and Cassidy were it the product of extensive hearings, debate and amendment. But that has not been the case.”

Paul’s objections are decoupled from most of the the others because he feels that this bill does not go far enough in dismantling Obamacare, whereas some of the others are focused on the population and geography of their respective states, such as Collins, with her mostly rural population, dependent on community care centers and hospitals; all of whom would be decimated, as it would have been with the last GOP repeal attempt.

Currently there are outliers, such as Sens.Ted Cruz of Texas, and Mike Lee of Utah, who have also expressed the same sentiments as Paul, and could easily, as CNN explained, by “burnishing their reputations,” by withholding support.

Vice President Pence, along with the president, are “undeterred” in their desire to score a legislative win, and with with characteristic antagonism, the latter, issued a tweet, lambasting McCain, for his decision.  

Graham for his part has said this is a choice to rid the nation of socialism, echoing critics of the ACA, but which seems mostly an attack on the liberal progressive agenda associated with former President Obama.

The proffered solution of block grants face several problems” inadequately funded to the task of providing even basic coverage; based on state population; and lacking enough time to make assessment, based on desired outcomes. In short a deeply flawed bill.

Perhaps the most vexing aspect of the proposal are the waivers, given to states to remove protection for those that have preexisting conditions, kicking the stool from underneath those most in need.

Adding further fuel to the fire is that insurance companies would be able to charge older customers five times as much as younger ones, a departure from the current three level increase.

In what can be seen almost as payback, the bill calls for an overall dollar increase to the states (some critics are calling it a reward) to those that did not take the Medicaid expansion option, they will see substantial increases, and those did, will see decreases.

For example, Oklahoma would see a near 88 percent increase and Massachusetts would see a 10 percent decrease; along with other states such as California, and which just happen to hold large Democratic majorities.

Naked partisanship coupled with “gotcha” politics makes one wonder how much, or how little, the GOP truly cares about the health care of the nation. Writing for the Washington Post last October, Paul Waldman noted, in a succinct summary of what could have been done to fix the holes in the ACA, said that “If they were being honest, Republicans would admit that their real goal is to get the government out of the business of offering or even guaranteeing coverage, and that they don’t really care how many people are uninsured.”

Now with blood in the water, and the chances of recent support being iffy, at best, the next option for Trump is to sabotage Obamacare, which he began last month, by not renewing contracts for those companies that handled enrollment at public places such as supermarkets, and libraries.

This has now intensified and the recent news that the enrollment website would be shut down each Sunday from 12am to 12 Noon could also be a harbinger for even more sabotage; but the official reply has been that this is routine maintenance for the system, despite occurring during the enrollment period.

Lost in the shuffle or point, counterpoint, is the somewhat eponymous architect of the bill, former President Obama, who, in remarks, at an event sponsored by the Bill and Melinda Gates Foundation, in New York, this past Wednesday, said, it was “aggravating” to defend his signature healthcare law from Republican attacks.

“When I see people trying to undo that hard-won progress for the 50th or 60th time … it is aggravating.” and also that  “It’s certainly frustrating to have to mobilize every couple of months to keep our leaders from inflicting real human suffering on our constituents,” he said. “But typically, that’s how progress is won and how progress is maintained.”

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