Repeal and replace redux

Just when you thought the Republican plot to destroy the Affordable Care Act had been thwarted, Senate Republicans are angling to swing the ax again. Their new proposal is, if anything, even more draconian than their previous attempts to strip millions of Americans of health insurance coverage. Yet because the public isn’t paying close attention to the issue the way it was just a couple of months ago, this time the ACA’s opponents could actually succeed in killing the most significant expansion of health insurance coverage in a half-century.

The bill in Congress sponsored by Sens. Lindsey Graham, Bill Cassidy, Ron Johnson and Dean Heller would turn back the clock on virtually all the protections built into the current law that make health care coverage affordable for low-income Americans. It would allow insurers to deny coverage to those with pre-existing conditions, waive the requirement that everyone buy insurance, slash federal premium subsidies and gut the Medicaid program — all the while covering fewer people than the legislation that failed in a dramatic late-night Senate vote in July.

And like all previous Republican-backed health insurance “reforms,” the heaviest burden would fall on the country’s most vulnerable people.

The current bill’s sponsors tout their effort as a “moderate” reform meant to shore up the country’s health insurance policies by giving states more control over how health care dollars are spent. But in truth the scheme they’re promoting is anything but measured. Not only would it encourage states that have that have refused to expand Medicaid to further cut programs, it likely also would result in a massive transfer of federal health care dollars from predominantly blue coastal states to rural Republican states. The math is complicated, but the bottom line is that states that refused Medicaid expansion would actually end up being rewarded for denying coverage to their citizens. No wonder Gov. Larry Hogan was quick to oppose his own party’s bill; by his reckoning, the Graham-Cassidy bill would cost Maryland more than $2 billion a year.

Surveys have repeatedly shown that large majorities of Americans don’t want to see the current system scrapped in favor of one that covers fewer people and makes health insurance more expensive. Yet that’s exactly what the Graham-Cassidy bill would do, which is presumably why its sponsors are racing to enact it into law before the nonpartisan Congressional Budget Office can even analyze its economic impact and cost on the tens of millions of Americans who stand to lose their insurance coverage.

Naturally, the whole process is being driven by politics — specifically by a bit of Senate procedural chicanery that allows that chamber to pass legislation with a simple majority rather than with the 60 votes normally required to end debate. But that window closes at the end of the month, so Senate Majority Leader Mitch McConnell is putting the squeeze on his caucus get the job done quickly, never mind that hardly any of his colleagues even know what’s in the bill.

More generally, Republicans are still smarting over their inability to fulfill a seven-year-old campaign promise to “repeal and replace” Obamacare, something that becomes more difficult to achieve every year despite the fact that the GOP now controls both chambers of Congress and the White House. Senator McConnell is already so badly on the outs with President Donald Trump that the two are barely on speaking terms; another defeat of the party’s “repeal and replace” gambit likely would sour their relations to the point where not much of anything gets done.

Yet Republicans seem determined to try. That’s why it’s important for the public to remain vigilant. The GOP has staked its future on undoing President Barack Obama’s legacy, but voters need to make clear that they don’t want to go back to the days of coverage limits, denials for pre-existing conditions and ballooning numbers of the uninsured.

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