McCain Opposes Graham-Cassidy and Other Things You Need to Know About Health Care Bill

Protesters in Phoenix at the offices of Senators John McCain and Jeff Flake, angry about an earlier health care bill.
Protesters in Phoenix at the offices of Senators John McCain and Jeff Flake, angry about an earlier health care bill. Jim Louvau
Update: This morning Republican Senator John McCain announced he wouldn't support the Graham-Cassidy health care bill. In a statement, he asked that Congress work together to create a bipartisan approach to the issue.

"I cannot in good conscience vote for Graham-Cassidy," The Senator tweeted.

This doesn't mean he was happy about being the guy to say no to the repeal supported by many Republicans and Arizona Governor Doug Ducey.

"I take no pleasure in announcing my decision," he stated.

Let's be honest. Health care can be a baffling amalgamation of insurance jargon and political power plays.

After four different failed Affordable Care Act repeal plans this summer, you thought it couldn't get worse.

But it did. Last week, a new, Hail Mary-style health care bill popped up in the Senate.

A group of Republicans, including Senators Lindsay Graham of South Carolina and Bill Cassidy of Louisiana, released details of a 141-page health care bill they say would give power to the states. It would replace the Affordable Care Act, better known as Obamacare.

Critics say this last-ditch legislative effort is more radical than previous versions of ACA repeals, citing concerns about scraping individual and employer mandates, ending Medicaid expansion, and ending federal funding for Planned Parenthood for a year. Supporters say it would take the power out of Washington, putting the ball in the court of states and patients.

However essential, so much of health care is confusing and clinical. To simplify things, here's a breakdown of what Arizonans like you should know about the Graham-Cassidy bill.

1. Arizona will feel the cost

States that have expanded Medicaid stand to lose the most under Graham-Cassidy. Arizona is one of those states. Back in 2013, we expanded access to the health insurance program for low-income folks. This meant people with incomes between 100 percent and 138 percent of the poverty level became eligible for Medicaid under Governor Jan Brewer. Because of this, extra federal money was allocated to Arizona to subsidize the expansion.

But Graham-Cassidy would end the expansion funding, turning it into a block grant — a fixed amount of federal funding each year — according to Will Humble, the executive director of the Arizona Public Health Association.

The legislation would essentially take all the money that's been allocated to the expansion and subsidies, put it in a pot, take out a chunk to cut government spending, and then distribute it back to the states, which could use the money as they see fit.

This means Arizona, along with 34 other states, would actually lose federal aid, while others that didn't choose to expand Medicaid would get a boost.

The states will have a fixed amount of money per Medicaid enrollee, with a per-capita cap starting in 2020. States could also choose to receive Medicaid funding as a block grant, regardless of how many participants are in the program.

Translated, all of this means those who are covered by the expansion could lose insurance immediately and Arizona loses a chunk of its federal funding. Seems like a lose-lose, no?

Avalere Health, a health-policy consulting firm in Washington, estimates Arizona would see an $11 billion loss by 2026 and cause about 400,000 low-income residents to lose their insurance.

No official Congressional Budget Office numbers have been released to back this number. Which brings us to the next point.

2. The Congressional Budget Office won't have the chance to break down the bill before the Senate votes

The nonpartisan CBO needs a few weeks to provide a breakdown and score for the legislation. This is a problem for some Republican Senators who want to vote on the bill in the next eight days. If Graham-Cassidy doesn't clear the Senate hurdle by September 30, it will need 60 votes instead of 50 to pass under budget rules. To get 60 votes, they'd need to convince Democrats Graham-Cassidy is a good idea. Seems unlikely.

As such, officials are talking about voting on the bill without concrete numbers from the CBO.

Critics are responding to this voting in the dark tactic like you might respond if your doctor said. "Hey, your test results won't be in for a week, but let's start with that open heart surgery today!"

"The biggest problem is that we don’t know what the impact is," Humble said. "In this case, they're considering going forward with having a vote on the bill without even knowing what it does. If you believe in evidence-based decision making, this is pretty troubling because they’re about to take a vote on something that doesn’t have an objective evaluation."

3. Arizona will be in charge of creating a concrete policy

Proponents of Graham-Cassidy say the bill would give the states more leeway to decide how they use federal money. And it's true. It would be virtually up to Arizona to decide what the state prioritizes, policy-wise.

And longtime health care lawyer Joel Wakefield says this approach could be disastrous. As he sees it, if the best minds in the country can't come together and figure out a solution that would keep costs down while allowing everyone to access health insurance, how can the states do better?

"On a federal level, they've had all the resources — they've had eight years — to try to figure out a good way to do things," Wakefield said. "Now, I don't want to get in trouble, because we have very smart people in Arizona and we are pragmatic problem solvers, but somehow in the next three years, we would need to create a system that would, all of a sudden, be able to help people with no additional federal money? That is a really hard policy thing to do. There are not a lot of easy answers."

Humble argues it might be easier to come up with policies on a state level because it involves less compromise.

"Taking into consideration of legislators and senators from both conservative and liberal states, as you drill down, it's less diverse in terms of their political views," Humble said. "They can make decisions without considering what other states say. Nationally, it involves compromise, but giving the power to the states makes it easier, in a sense, because states are more ... homogeneous."

4. Governor Doug Ducey is here for this bill

Ducey pre-emptively threw his support behind the bill, calling it the "best path forward to repeal and replace Obamacare." The endorsement from Ducey caused the bill to gain traction because health care power player and sometimes maverick Republican Senator John McCain said he wouldn't consider the legislation without approval from Arizona's governor.

5. Senator John McCain still has some concerns

Back in July,  McCain put the kibosh on a previous "skinny repeal" of the Affordable Care Act. He cast the deciding vote against the legislation, along with Republican Senators Susan Collins of Maine and Lisa Murkowski of Alaska.

The bold move came as he returned to the Senate after a mid-July surgery to remove a blood clot that was associated with an aggressive brain cancer.

Most recently, McCain said he was "deeply disturbed" by the lack of regular order on the bill, CNN reported. He says he's still looking at the legislation carefully.

click to enlarge Which way will U.S. Senator John McCain vote on the Graham-Cassidy health care bill? He's not saying yet. - MIRIAM WASSER
Which way will U.S. Senator John McCain vote on the Graham-Cassidy health care bill? He's not saying yet.
Miriam Wasser
6. Senator Jeff Flake hasn't read all of the bill

In an interview this morning on MSNBC's Morning Joe, it was revealed that Flake flaked out on some of his homework. Mike Barnicle asked the Republican, who's shown support for the legislation, "Have you read the current bill that you're going to be voting on?"

"We're, uh, I've read a lot of it," Flake responded. "We're all looking at it."

7. The Goldwater Institute agrees that health care should be left to the states — not late-night hosts

In a Goldwater blog post, Director of Healthcare Policy Naomi Lopez Bauman agreed that the Graham-Cassidy legislation isn't perfect. But  neither is the Affordable Care Act, she says. Bauman laid out some faults with the Obama-era insurance plan, including, but not limited to, high premiums and deductibles and creating longer wait times to access care.

While she was at it, she called out late-night host Jimmy Kimmel for using his show as a platform to "lambaste" Cassidy.

The legislation garnered extra attention after Kimmel slammed the policy and its champion Cassidy for lying "right to my face."

Kimmel became something of health care crusader back in May after he gave a tearful monologue about his son, who was born with a heart defect that required surgery.

The star began to understand the gravity of an Obamacare repeal — and that it could take thousands of dollars out of the pockets of parents like him. Cassidy later appeared on Kimmel's show and vowed to fight to make health care more affordable for those who needed it.

“[Cassidy] proposed a bill that would allow states to do all the things he said he would not let them do,” Kimmel said during his September 20 show.

"The Graham-Cassidy proposal is certainly no silver bullet, and in many ways it may not offer much relief to the many shortcomings facing our health care system." Bauman wrote. "We need solutions that give individuals control over their health care decisions and allow them to select options that best meet their own needs and preferences, rather than 'federal government knows best' dictates."

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Molly Longman