Why the Republicans' new health-care bill is a big fat lie

My mother once told me: Never assume mendacity when stupidity is a sufficient explanation for someone's behavior. This adage is being put to the test by Senate Republicans' fourth and final bill to repeal ObamaCare.

Written by Sen. Lindsey Graham (R-S.C.) and Sen. Bill Cassidy (R-La.), this bill is so bad that you'd either have to be lying through your teeth or dumber than bricks to support it. Every argument that's being used to sell the bill is flatly contradicted by what's inside of it.

The biggest claim made by Cassidy-Graham supporters is that the bill simply redistributes money to the states, letting local governments make decisions for themselves. "Take all the money under ObamaCare and block-grant it back to the states," Graham said.

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This, paired with cuts to certain ObamaCare regulations, will supposedly give everyone what they want. "A blue state can do a blue thing, a red state a red thing," Cassidy has argued.

So is this right? Would Cassidy-Graham simply empower state governments to institute the best health-care system for their constituents?

Not by a long shot.

Let's start with those pesky ObamaCare regulations that would be cut under Cassidy-Graham.

Two of the rules are critical: One requires all insurers to charge sick and healthy people the same premiums. The other requires all insurers to offer a basic package of essential benefits. Both changes, in their own way, would mean that millions of people with pre-existing conditions would be unable to get coverage.

This flies in the face of Cassidy's personal commitment to protecting people with pre-existing conditions — i.e. the "Jimmy Kimmel test," named after the late-night host whose newborn son had open-heart surgery. To defend himself, Cassidy points to a provision requiring any state that does jettison ObamaCare's rules to provide "adequate and affordable coverage for those with pre-existing conditions." But in practice, the provision is extremely hand-wavy, and provides no definitions for "adequate" or "affordable." Most likely, it will be left up to the discretion of federal regulators, whose interpretation will change depending on which party appoints them.

State governments that are so inclined could recreate those rules, of course. "If you like ObamaCare, you can re-impose the mandates at the state level," Graham argued. That would be true — if funding levels were the same as under ObamaCare. But they won't be.

This brings me to the biggest problem with Cassidy-Graham: It's a savage cut to health-care spending disguised as redistribution.

When ObamaCare was passed, it introduced new spending to help people buy private health coverage, and to help the states that wanted to expand Medicaid. The Cassidy-Graham bill really would put that money into one giant pot of funding that's divvied up between the states. But it would be much, much less generous. When the Cassidy-Graham system starts in 2020, it would be somewhere around $30 billion lower than ObamaCare would have been. By 2026 it would be around $40 billion lower. Cassidy-Graham would also alter what proportions each state gets: Bigger slices would go to red states that didn't expand Medicaid, and smaller slices to blue states that did.

Graham argues the latter change is a matter of fairness. But expanding Medicaid was totally voluntary. All those red states could've gotten ObamaCare's new Medicaid money if they'd wanted to.

Between the end of those ObamaCare regulations, and the freewheeling experimentation allowed under the new bill, a lot of red states could easily destroy their own insurance markets. But even the states that simply want to recreate ObamaCare could only achieve a less-generous facsimile — one that couldn't provide people the same degree of affordability or access.

Vox reporter Jeff Stein pressed a number of GOP senators on this point. All he got was a word salad referencing new "efficiencies" states would find, which would supposedly allow them to deliver the same coverage for less money. No one specified what any of these efficiencies could be.

But the weirdest part of all is that these points will eventually be moot anyway: Cassidy-Graham's funding stream to states would go away entirely in 2027.

Supporters will argue the spending could always be reauthorized, which is technically true. It's unlikely any U.S. Congress would tolerate a sudden $200 billion drop in assistance to the states.

But why set up such a future problem in the first place?

Cassidy's office says the 2027 sunset is required by Senate budget rules. But this only makes sense if the bill's spending isn't matched by tax revenue. (The GOP is using a procedural tool called reconciliation, which requires that bills be deficit neutral past their first decade.) Cassidy-Graham's spending would be matched: "We're leaving in place [ObamaCare's] taxes on the wealthy, taking that money and giving it back to the governors to come up with better health care," Graham has explicitly explained.

But as written, Cassidy-Graham would basically become repeal-without-replace after 2026, plus some big cuts to Medicaid as it existed before ObamaCare's expansion. There's no reason for this, unless some group within the GOP is trying to pull a fast one on their colleagues, or they're trying to pull a fast one on all of us, hoping somehow the expiration sticks. Or they just don't know how to google "Senate reconciliation rules."

"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," one senior GOP aide told Axios. But what about the other author? When comedian Jimmy Kimmel himself (rightly) stated Cassidy-Graham fails the "Jimmy Kimmel test," Cassidy responded high-handedly: "I'm sorry he does not understand." The senator then robotically repeated that "more people will have coverage and we protect those with pre-existing conditions." Is Cassidy not aware of what's in his own bill? Did a lobbyist or rogue staffer slip all this legislative language in and Cassidy just doesn't realize what it does? Or are Cassidy and Graham themselves trying to con us?

Maybe the most likely explanation is both. Professing ignorance allows the Republicans to go on careening towards something they can sell as "ObamaCare repeal," the consequences for millions of Americans be damned.

And that's pretty mendacious.