Third and State

Mitch McConnell and his Republican allies have one more trick up their sleeves to try to get some health care bill through the Senate. This week they will seek a vote to proceed to debate on the bill passed in the House on the understanding that there will be a process, colloquially known as voterama, in which a series of votes on one or more substitutes to the bill, or amendments, will be introduced. That is, Senators are being asked to proceed to debate without any clear idea what final bill they will eventually vote on.

I will say more about the process in a moment. But first I want to urge you to join the Insure PA / Protect Our Care phone bank to ask people in those states with Senators who are unsure about their position to call those Senators and ask them to vote no. (You can call Senator Toomey, too, but he pretty clearly has decided he cares far more about tax cuts for the rich than health care for Pennsylvanians.)

Now that the Senate Republican effort to repeal and replace the Affordable Care Act has failed, let’s take a step back and understand why no bill based on the Republican approach to health care could have been fixed enough to reduce the pain to levels acceptable to a majority of Republicans in Congress, let alone to the American people. 

The basic design of the bill was deeply flawed from the perspective of anyone who thinks that America has a responsibility to guarantee quality, affordable health care to all. The design only made sense if one, instead, seeks a politically palatable way to reject that responsibility and reduce federal health care spending in order to cut taxes on large corporations and the rich.

What started as a bill to repeal the Affordable Care Act (ACA) became a bill to partly repeal the health insurance regulations and subsidies for insurance purchased in the individual marketplaces, fully repeal the Medicaid Expansion, and radically restructure – and drastically reduce – funding for traditional Medicaid.

The Manatt Health Group and the Robert Wood Johnson Foundation have released a new study of the impact of the Senate health care bill, the Better Care Reconciliation Act of 2017, on the states. Their estimates of the impact of the bill confirms our recent study showing that Pennsylvania will suffer devastating reductions in federal funding for Medicaid.

The new study provides two sets of estimates of how much federal funding each state loses – one if the state keeps the Medicaid Expansion and a second if it does not. According to the study, if Pennsylvania eliminates the Medicaid Expansion in 2021, the state stands to lose $30.1 billion in federal funding between 2020 and 2026 – $25 billion as a result of the elimination of federal funding for the Medicaid Expansion, and $5.1 billion as a result of the impact of per capita caps on traditional Medicaid.

I’m not just a practitioner of political rhetoric, but also a connoisseur of it. I can appreciate a good argument and a well-turned phrase put forward by our ideological opponents. And, rather than get disturbed by what the other side says, I take their best work as a challenge. But what truly does get me angry is when our opponents not only lie, but do so with arguments that are insulting to the intelligence of the people we are trying to influence – the citizens of Pennsylvania and America.