What makes the Graham–Cassidy attractive to Republican senators is threefold:
- First, its block grants to the states, so Republicans can claim to support federalism
- Second, they can tell their base that they are destroying Obamacare and Medicaid in one shot
- Third, it really, really hurts blue states, especially California and New York
When asked about it in interviews, both Cassidy and Graham have made attempts to excuse that last part, claiming that the bill penalizes only states that have an “inefficient healthcare delivery system” or that the distribution of funds is somehow “fair.” But that’s true only if fair means working out a plan to specifically harm states that went along with the ACA’s Medicaid expansion.
Most states used the ACA’s funding to expand Medicaid; some Republican-run states, liberated by the Supreme Court’s decision to make the funding optional, did not. As a result, 14 of the 15 states that would stand to gain from block grants are run by Republicans; Democratic megastates including California, New York and Massachusetts would lose billions of dollars, a feature both Graham and Cassidy have talked up to conservatives.
Get that? Hurting California, New York, and Massachusetts is a feature that the authors of the bill are using to sell it to conservatives—Sign here, kill Democrats.
“No longer will four blue states get 40 percent of the money,” said Graham to Breitbart. “A state like Mississippi, they get a 900 percent increase. South Carolina gets 300 percent.”
Those four blue states also have considerably more than 40 percent of the people participating in the current plan, something that could be changed by simply implementing the plan in more states. What Republicans have done is take the funding, including that from states that expanded Medicaid, then redistribute it across all states. The result is a plan that would reward the states that were deliberately cruel to their own people, by giving them the money taken from the states that tried to set up more equitable systems. It’s not just the Screw Blue Act, it’s the Screw You For Trying To Help Act.
We haven’t won the battle to save health care yet. Republicans are STILL pushing to repeal Obamacare. Call your senators at (202) 224-3121 and urge them to vote “NO” on any repeal bill. (After you call, please tell us how it went.)
The map shows how the formula under Graham–Cassidy generates winners and losers. California, as the most populous state that had rolled out expanded Medicaid, is the big loser—with federal funds falling by $78 billion. Texas leads the team of states that hadn’t implemented the Medicaid expansion, which now get to divide the spoils. A handful of Republican states including Cassidy’s own Louisiana take a hit from the bill. But he apparently feels that watching West Coast and New England states take an enormous blow for the sin of trying to help their people makes it all worthwhile.
Killing the ACA, crippling Medicaid, and giving blue states a kick that will take away health care from millions. That’s the kind of combination that conservatives find hard to resist.