Americans who may have found no reason to feel indebted to John McCain for enduring five and a half years of mental and physical torture as a captive in an unpopular war may find more palpable reasons to be grateful for the old soldier’s sacrifices next weekend. He may protect the right of 20 to 30 million Americans to get medical care when they need it.
McCain, who is dying of brain cancer, said Friday that he could not vote for Graham-Cassidy, the latest and final version of a repeal of the Patient Protection and Affordable Care Act that his party has long promised. The bill would demolish the nation’s health-insurance system over the next 10 years and replace it with something no one can possibly anticipate.
If only two Republican senators join him, the bill will be dead and Congress and the president will have to return to the system used to pass laws for the previous 225 years—all the country’s elected representatives doing it together. Deeply divided congresses still worked year after year to get the kinks out of Social Security, Medicare, veterans’ health care, antitrust and environmental laws. They should be able to do it, too, with the Affordable Care Act, which tried to use the country’s old commercial insurance system to extend the right to medical care to nearly everyone rather than follow the European models of socialism or government-provided insurance.
Graham-Cassidy’s sudden appearance with the backing of the nation’s biggest political donors—the Koch brothers, Mercers and the like—took everyone by surprise. Six months of failures in either the Senate or House of Representatives left the Affordable Care Act standing for some 20 million Americans who depend upon it for their medical care but badly crippled by President Trump’s promises to undermine it by denying federal support for signups and out-of-pocket expenses to help poor people afford the coverage.
Here in Arkansas, Graham-Cassidy has been particularly perplexing. Arkansas’ congressional delegation, with a rare exception here and there, has gone along with every “repeal and replace” bill, no matter how harmful to the 400,000 working people who depend upon it or how damaging to the state’s tight budget. The Affordable Care Act—Republicans called it Obamacare to rev up the popular fury over the passage of a law backed by the black president—created tens of thousands of jobs, returned many people to the workforce and infused more than a billion dollars a year into the Arkansas economy when it began to kick in four years ago. Our unemployment rate plunged to historic lows.
Gov. Asa Hutchinson, who privately or publicly opposed the earlier bills that subverted the state’s insurance system and the budget, announced his support for Graham-Cassidy because, he said, it would give the state some flexibility in dealing with Arkansas’ peculiar health problems. We are still perplexed how that could be so.
Under Graham-Cassidy, Medicaid coverage for low-income working adults would end in 2020—or at least the specific federal support. The flexibility the governor spoke of is this: His successor will have the flexibility of dealing with the state’s medically frail population—more than a million Arkansans need Medicaid coverage at least some time every year—with about a billion dollars a year less federal support. The state will have the enjoyable option of raising taxes, cutting off aid to people in nursing homes, health care for children or the blind and disabled, or else curtailing other services for Arkansans, like prisons, law enforcement or schools.
Hutchinson doesn’t seem susceptible to the terrible pressures faced by some other Republican governors who have opposed one or more of the repeal bills or the senators and congressmen who are threatened with heavily financed Republican opponents in next year’s primaries. Hutchinson is running next year and will get no serious opponent, but he can’t run again after Graham-Cassidy takes effect.
Maybe that is the explanation. He can be a loyal Republican advocate of eliminating all vestiges of the Obama presidency and not have to deal with the real consequences.
Repeal and replace has a single underlying objective. It is not better or more efficient health care. It is the premise of the Koch brothers, Mercer and of a few senators, including Rand Paul of Kentucky, who says he plans to vote against Graham-Cassidy because it does not go far enough to deny medical care to the poor. That is the premise behind it all. People who cannot afford medical care are not entitled to medical care. Gov. Hutchinson already is seeking Washington’s permission to cancel the health insurance of tens of thousands of poor people who cannot meet certain conditions like regular jobs or proof of residency, their incomes are slightly above the poverty line, or else they lack diligence in keeping up with government paperwork.
We are dismayed at the lack of honesty—could it be mere ignorance of the law and their own bill?—by the actual sponsors of Graham-Cassidy. Senator Cassidy said his big concern was that people with pre-existing conditions have to pay too much to buy health insurance. He said his bill would help them! It would help them by eliminating their protections entirely. If his bill were enacted, their premiums would skyrocket, if they could get insurance at all. He could not explain exactly how his bill would help those people. It would dump the problem on the states. Perhaps a state official somewhere could think of some way to do it without federal assistance.
As for the Arkansas budget, think of Graham-Cassidy as doing this: It will take more than $6 billion of federal aid for Arkansas health care between 2020 and 2026 and give it to Texas. Graham-Cassidy would transfer some $25 billion from states like Arkansas, Kentucky and California and hand it to the Lone Star state. Is that a great deal for Arkansas, or what?