Commentary
By Jim Wallis 9-25-2017

The Republican Party in the U.S. Senate has in some ways stopped even trying to argue for the merits of its latest bid to repeal the Affordable Care Act.

The Graham-Cassidy-Heller-Johnson ACA repeal bill is the most radical and most disruptive plan to reorder one-sixth of the U.S. economy, in no small part due to the rush to pass something — anything — that would fulfill the 7-year Republican promise to “repeal and replace Obamacare” ahead of a critical Sept. 30 deadline this Saturday.

On Oct. 1, a new fiscal year starts for the U.S. government, forcing members of the GOP to start over with the complex budget maneuvering that would allow them to pass a bill with only 50 votes in the Senate — rather than the 60 that are generally required.

As a result, many Senate Republicans who harbored serious concerns about the substance of previous versions of ACA repeal have suddenly become far less concerned about the details of what “replace” looks like. Some, like Chuck Grassley of Iowa, have openly told reporters that while Graham-Cassidy has lots of flaws he can point to, keeping the “replace and replace” promise to GOP voters is more important than the details of the bill. Given that Graham-Cassidy has only 20 percent support in the latest poll (and less than 50 percent support among Republican voters), it seems clear that the promise Senate Republicans are trying to keep is at least as much a promise to their major donors as it is to people who voted for them.

This is an astonishingly cynical and morally irresponsible way to legislate, particularly given what outside nonpartisan experts are saying about what Graham-Cassidy would do.

  1. This bill would force all 50 states and the District of Columbia to design their own health care funding systems using an ever-shrinking pool of federal dollars, and to do so in just two years. Few policy experts believe that more than a handful of states are equipped for this enormous challenge.
     
  2. Individual states could — and would — decide to get rid of regulations that protect people with pre-existing conditions from being charged higher premiums, so long as they explain how they will offer these folks “adequate and affordable” health care. The law does not specify what “adequate and affordable” means, so it would be up to the Trump administration’s Department of Health and Human services to make those determinations. Secretary Tom Price, a longtime ardent foe of the ACA, has indicated on many occasions that he favors loosening the rules that states must follow, so this vague provision in the law is hardly reassuring for those who have survived cancer, or have asthma, or suffer from clinical depression, to give just a few examples.
     
  3. The latest draft of Graham-Cassidy bill released late last night completely removes regulations that mandate that insurance must cover essential health benefits like maternity care, prescription drugs, mental health, substance abuse, and other key protections. Instead, each state will decide what insurers must cover, leading to unpredictable outcomes and enormous inequities across the country.
     
  4. It would let states allow insurers to re-impose annual and lifetime caps on coverage, which among other things means that a baby born with serious medical conditions can reach his or her lifetime cap on coverage before leaving the hospital.
     
  5. More broadly, Graham-Cassidy’s block grants represent an enormous transfer of federal funding from mostly Democratic leaning states to heavily Republican states who refused to expand their Medicaid programs at little to no cost to them out of reflexive opposition to the ACA and President Obama.
     
  6. The latest draft of the bill contains a number of provisions nakedly aimed at pressuring Sen. Lisa Murkowski (R-Alaska) to vote for the bill. Murkowski heroically stood up against her party’s leadership earlier this summer — along with Sen. Susan Collins (R-Maine) and Sen. John McCain (R-Ariz.) — to defeat an earlier version of ACA repeal, but the White House and Senate leadership is trying everything they can to get her to go along with them this time.

Graham-Cassidy is being pushed through before the independent arbiter, the Congressional Budget Office, can do a full estimate of how many people would lose coverage under this bill or what would happen to premiums. This tactic is deliberate on the Senate GOP leadership’s part, both due to the Sept. 30 deadline and the fact that the CBO has consistently shown that GOP plans to repeal ACA would result in tens of millions fewer Americans having health insurance. Many people are also unaware that this bill, like AHCA and BCRA before it, would result in a trillion dollars being cut from Medicaid over the next 20 years, threatening the lives of some of the poorest and most vulnerable of our neighbors.

Today, the Circle of Protection, of which Sojourners is a founding member, issued a press release, which reiterates the Circle’s core principles around health care reform efforts, as articulated this summer:

We favor sensible cost controls that do not deny needed care to low-income Americans. And we support measures that aim to reduce health care costs. However, these deep cuts in Medicaid would put at risk the well-being of millions of our fellow Americans—especially the weakest, the oldest, and children most at risk. We ask our leaders to consider options that do not ask our poorest neighbors to bear most of the weight of budget and health care cuts.

By any measure, the Graham-Cassidy bill fails that moral test, and indeed presents an even greater threat to Medicaid. As John Carr of Georgetown University told Circle leaders last week, “Graham-Cassidy could destroy so much of the Circle's work and hurt ‘the least of these’ more than any law passed in the last 50 years.” Consequently, many individual leaders and organizations who are part of the Circle have issued statements today about the Graham-Cassidy ACA repeal bill and broader principles for health care reform. Read for yourself those statements of concern and opposition that have come from Catholic, evangelical, protestant, black, and Hispanic church leaders.

And on Saturday, the largest organizations that represent the interests of doctors, hospitals, and health insurance companies issued a rare joint statement that amounted to a stunning rebuke of Graham-Cassidy from all the major stakeholders who provide and finance health care in the United States. The letter reads, in part:

While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable healthcare market that provides access to high-quality care and affordable coverage for all. The Graham-Cassidy-Heller-Johnson bill does not move us closer to that goal. The Senate should reject it.

We agree that the bill will cause patients and consumers to lose important protections, as well as undermine safeguards for those with pre-existing conditions. Without these guaranteed protections, people with significant medical conditions can be charged much higher premiums and some may not be able to buy coverage at all.

... We agree that the bill will result in dramatic cuts to Medicaid and a funding cliff in the future, fundamentally changing the way that states provide coverage for some of our most vulnerable citizens. This means that millions of patients will lose their coverage and go without much-needed care.

Last Friday, McCain dealt a serious blow to this bill chances by announcing his opposition — not because he disagrees with all of the bill but because he recognizes that the rushed, GOP-only process is harmful to an orderly and healthy Senate process, and to the country more broadly. However, until the Senate holds a vote on the bill that fails or we reach 12:01 a.m. on Oct. 1 (this Sunday), we have to continue to regard this last ditch partisan effort as a terrible danger to our country’s health care system and a deep threat to the most vulnerable members of our society. This is a cruel bill that violates foundational principles that many Christian churches and organizations have laid out.

Until this immediate danger has passed, it is critical that we all engage ourselves and our friends, family, and constituencies to call our senators and express a strong moral opposition to Graham-Cassidy.

As in previous health care debates, there are a handful of Republican senators who will decide the outcome of the bill, including Sens. Murkowski, McCain, Susan Collins (R-Maine), Jeff Flake (R-Ariz.), Rob Portman (R-Ohio), Jerry Moran (R-Kan.), Lamar Alexander (R-Tenn.), Cory Gardner (R-Colo.) and Shelley Moore Capito (R-W.Va). It is our prayer that millions of Christians flood the offices of their senators with visits, calls, and emails over the next few days.

Jesus tells us that how we treat the most vulnerable in society, including the poor and the sick, is how we treat Christ himself. There are different ways for a nation to organize and manage its health care system. But the moral test and the biblical test of any system is how it treats the poorest and most vulnerable — how a health care system treats those who are sick. The Senate should reject Cassidy-Graham and work toward sensible, bipartisan solutions for our nation’s health care system.

Jim Wallis is president of Sojourners. His new Audible spoken-word series, Jim Wallis In Conversation, is available now, as is his book, America's Original Sin: Racism, White Privilege, and the Bridge to a New America. Follow Jim on Twitter @JimWallis.

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