The Senate Majority Leader, Mitch McConnell, R-Ky., has pulled the latest iteration of Trumpcare from the Senate agenda, spiking a bill on Tuesday that would’ve hurt Oregon more than any other state, per capita.
Trumpcare 5.0, which was putt together by Sen. Bill Cassidy, R-La., and Sen. Lindsey Graham, R-S.C., would have rewarded the states that have turned down Affordable Care Act’s Medicaid expansion money, essentially evening out the federal support to places that earlier forfeited a chance to bolster their healthcare systems and provide healthcare for their neediest residents.
An analysis from the New York Times, compiling Medicaid money and insurance subsidies, found Oregon would lose $2,600 per person, the nation’s biggest loser. An estimate from the Oregon Health Authority and the Department of Consumer & Business Services put the total figure at $8 billion to $13 billion.
“Revisions to [Trumpcare] included in the Graham-Cassidy proposal could result in similar, or even higher, coverage losses, maintain dramatic cost shifts to Oregon taxpayers, and increase disruption and instability in the individual health insurance market by requiring Oregon to create a new infrastructure to use federal block grants in just two years,” according to the state analysis released late Monday afternoon.
After three Republicans balked at their own party’s previous attempt to repeal and replace Obamacare in July, leaving Trumpcare 4.0 to die on the Senate floor, it appeared Republicans were finished with their quest to repeal Obamacare. President Donald J. Trump seemed ready to move onto his next goal, massive tax cuts.
A bipartisan group of lawmakers, including Oregon’s Rep. Kurt Schrader, D-Canby, put forward a solution that would fix the most obvious flaws with Obamacare while allowing Republicans to relax requirements placed on employers.
But Congressional Republicans seem intent on testing Albert Einstein’s theory of insanity -- doing the same thing over and over again and expecting different results.
By Tuesday, McConnell was forced to kill the unworkable Graham-Cassidy bill when three Republicans -- Sen. John McCain of Arizona, Sen. Susan Collins of Maine and Sen. Rand Paul of Kentucky -- once again joined a united Democratic caucus in opposing the legislation.
Unknown Unknowns
The Cassidy-Graham legislation appeared even more drastic and draconian than earlier attempts to repeal and replace Obamacare. It would have canceled the ACA Medicaid expansion and forced individual states to decide whether to allow health insurers to once again charge sick people higher premiums for pre-existing conditions. States could also choose to strip coverage of pregnancy or mental health.
The latest bill would have ended both the mandates for large employers to provide coverage and for individuals to buy coverage if they aren’t covered otherwise, and it would have ended the cost-sharing subsidies that make it possible for working-class people to afford to use their coverage.
Most healthcare interests had already opposed earlier versions of Trumpcare, from canaries in the coal mine like AARP to more conservative groups like the American Hospital Association, but this time even the BlueCross BlueShield Association and America’s Health Insurance Providers stepped into support Obamacare and opposed Graham-Cassidy, openly warning it would lead to single-payer national health insurance and doom their industry.
Oregon’s analysis was cursory largely because Cassidy-Graham created so many unknowns and would have left the state Legislature just two years to decide what to do with its remaining federal funds. Should Oregon maintain its high Medicaid coverage or continue to subsidize private insurance for those making slightly higher incomes? Would it be able to balance both without shutting the door on whole classes of people?
Even as the state now balances extending Oregon Health Plan coverage to unauthorized immigrant children with maintaining in-home care supports for disabled children, legislators would be forced to make many more Solomonic choices.
About 350,000 people could lose coverage they receive through the Oregon Health Plan, while another 100,000 might no longer be able to afford individual health insurance. Federal subsidies gave qualifying Oregonians in this market an average of nearly $4,200 a year.
Rewarded ACA Opponents
The biggest winners under the new plan would be Mississippi and Alabama, essentially rewarding these two states for denying Medicaid coverage to their large low-income populations, which are disproportionately African-American.
As reward for this institutional racism, each state would net more than $1,000 per resident in a block grant compared to their current Medicaid and insurance subsidy levels. Cassidy-Graham gives each state the choice of using that money to subsidize private insurance, offer Medicaid coverage, or both.
In contrast to Alabama and Mississippi, Oregon seized the opportunity presented by the Affordable Care Act and aggressively signed up as many people as possible for Medicaid. Oregon advanced a coordinated care system that is built on per-capita funding, which allowed it to maximize the money it could receive for Medicaid.
Oregon also received more money because it is one of the poorest blue states, which are disproportionately wealthy. All but one of the 12 richest states voted for Hillary Clinton, while she won only one of the poorest 20 states. Oregon is one of only four blue states with median incomes below the national average.
The Affordable Care Act was built to provide money for healthcare to people below 400 percent of the federal poverty level, people who ironically are more likely to live in Republican-dominated states. But Oregon, which is both Democratic and has a median income is below the national average, embraced Obamacare and stood to gain from the law more than other blue states.
With a median income of $54,000, Oregon had a higher share of people who would qualify for both Medicaid and insurance subsidies than wealthy Maryland, where the median income is $76,000 and the state would lose about $1,300 per person under Cassidy-Graham, half as much as Oregon per capita.
Sen. Paul claimed he opposed Cassidy-Graham because it did not go far enough to return the American healthcare system to its pre-Obamacare state, but it was likely not a coincidence that Kentucky would have been nearly as big a loser as Oregon. Kentucky is one of the poorest states in the union, with a median income of $45,000, but like Oregon, it also had a Democratic governor who embraced the Affordable Care Act, leading to one of the largest drops in uninsured.
The Bluegrass State would have lost about $2,000 for every man, woman and child in the state compared to what it receives from Obamacare.
Reach Chris Gray at [email protected].
