Next week, Republicans in the Senate will take what may be their final chance to repeal the Affordable Care Act. Even apart from its politics, this bill, known as Graham-Cassidy after its sponsors, is a policy nightmare. And those Republicans? Most of them barely know what's in it, and couldn't care less.
As such, it is the perfect and final expression of the GOP's nihilism and cruelty on this issue.
"You know, I could maybe give you 10 reasons why this bill shouldn't be considered," Sen. Chuck Grassley (R-Iowa) told reporters, offering an excellent summation of the Republican perspective. "But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That's pretty much as much of a reason as the substance of the bill." Who cares what it does or how many people it will hurt?
And most Republicans have no idea. "If there was an oral exam on the contents of the proposal, graded on a generous curve, only two Republicans could pass it. And one of them isn't Lindsey Graham," a senior GOP aide told Axios' Caitlin Owens. "Apparently no one cares what the bill actually does," a Republican lobbyist told Vox's Dylan Scott. Yes, that's what their own side is saying. You can see it when senators get asked questions about the bill — they don't talk about specific provisions other than their vaguely understood notion that it sends power back to the states, and can't begin to explain what it would actually do. Grassley's assertion is at the heart of it: They told their base that they'd repeal ObamaCare, and this sort of repeals ObamaCare, so they'll vote for it.
But let's be clear: Graham-Cassidy is an incredibly radical plan that would cause even more upheaval in the American health-care system than the ACA itself did — and it's being considered in the space of a couple of days, with a comically brief floor debate, no full assessment from the Congressional Budget Office, and no hearings to get expert perspectives on its effects (though they're going to hold a single hearing in the homeland security committee, for some reason, with Graham and Cassidy giving testimony).
So what does the bill do? It eliminates the subsidies the ACA gives to people to purchase insurance, and revokes the expansion of Medicaid that allowed as many as 16 million Americans to get insurance. It replaces the subsidies and Medicaid with a block grant, a chunk of money given to states to do whatever they want with — and the value of those grants will shrink over time, inevitably leading states to kick people off Medicaid and scale back benefits. States can't do that now, but under Graham-Cassidy they'll have the "flexibility" to do so. Because of that, it essentially forces all 50 states to create their own health-care systems from scratch. It takes away the ACA's protections for people with pre-existing conditions, allowing states to apply for waivers that would let insurance companies jack up your premiums if someone in your family gets sick. And it eliminates the ACA's requirement that insurance cover essential benefits like emergency care, maternity care, and mental health.
Try to think of a problem with today's health-care system that this bill would solve — or even not make worse — and it's almost impossible. Which may be why its sponsor Bill Cassidy is in a war of words with a late-night comedian, and losing desperately as he tells one lie after another about what his bill does.
But there's one other provision the authors put in to sweeten the pot for GOP senators. When the block grants are allotted, money will be taken away from the (mostly Democratic) states that accepted the Medicaid expansion and given to the (entirely Republican) states that didn't. As David Weigel of The Washington Post reported, "Democratic megastates including California, New York, and Massachusetts would lose billions of dollars, a feature both Graham and Cassidy have talked up to conservatives."
Think about that for a moment. Their pitch to fellow Republicans is, hey, we know this bill will be brutal for Americans and their health care. But it'll be even more brutal for Americans in states that vote for the other party! How cynical do you have to be to make that your selling point?
The irony is that as much as Republicans fear not keeping their promise to repeal the ACA, the absolutely worst outcome for them from both a policy and political perspective is if Graham-Cassidy actually becomes law. It would be a nightmare for Americans, with millions losing their coverage and tens of millions losing the protections they currently enjoy. That would fuel a spectacular backlash that could well deliver Democrats the Congress and the presidency — whereupon they'd be ready and eager to enact true universal health care, even something resembling single payer.
Should that happen, Republicans will beat their breasts in anguish — and they'll have only their own soulless cruelty to blame.