To pass the Cassidy-Graham-Heller-Johnson health care proposal — the last Republican-led effort to repeal and replace Obamacare — in the Senate, a majority of Republican senators, including two of the bill’s sponsors, would again have to vote for massive health care funding cuts to their own states, according to a recent report on the bill’s effects.
Sens. Bill Cassidy (LA) and Dean Heller (NV) are advocating to pass a bill that would cut millions, or even billions, in federal funding to their own states, according to a recent evaluation from the left-leaning Center on Budget and Policy Priorities.
The health care plan, which originated from Cassidy and Sen. Lindsey Graham (SC), would block-grant Obamacare’s existing funding, cap federal health care spending, and send the money to states to form their own health care programs. In effect, the CBPP concluded that this plan would largely redirect money from states that expanded Medicaid to states that didn’t.
Both Cassidy and Heller, who joined as sponsors to this proposal early on, come from Medicaid expansion states, and according to the CBPP report, their states would lose hundreds of millions — or, in Cassidy’s case, billions — in funding under this proposal. In Nevada, the report estimates a $257 million reduction in federal health funding by 2026. In Cassidy’s home state of Louisiana, the CBPP estimates a roughly $2.3 billion cut in federal health care funding.
Cassidy is pushing rosier numbers. According to a table released from his office, he makes it appears as though Louisiana wouldn’t see a cut at all — instead saying block grants would increase by 4 percent between 2020 and 2026. He also claims Nevada’s block grants would increase by 35 percent between 2020 and 2026.
But according to CBPP analysts Aviva Aron-Dine, Edwin Park, and Matt Broaddus, Cassidy’s numbers on the state-by-state spending level estimates have major flaws in assessing the actual effects of this bill.
“These estimates do not compare states’ funding under the proposal to what states would receive under current law, the relevant comparison. Instead, they show how each state’s funding under the proposed block grant would change over time,” they write.
Furthermore Cassidy’s estimates 1) do not take into account that the proposal puts a “per capita cap” on Medicaid, which would result in an estimated $39 billion cut in 2026, 2) do not account for changes in health care costs between 2016 and 2026 or a likely growth in the number of people needing assistance over the decade, and 3) don’t measure the effects of this proposal after 2026, when the bill would end block grant funding, increasing health care spending cuts from $80 billion in 2026 to $300 billion in 2027.
Cassidy-Graham-Heller-Johnson has not yet received an official score from the Congressional Budget Office, the nonpartisan body that analyzes the cost and coverage of bills — although Cassidy has long expressed that he disagrees with CBO’s analyses on health care.
During the first iterations of the Republican-led Obamacare repeal negotiations, proposed cuts to Medicaid funding proved to be a contentious and unpassable proposal — notably for senators from states that had expanded the Medicaid program under the Affordable Care Act. At the time, Sen. Susan Collins (R-ME), from a non-expansion state, said she wouldn’t support a bill with per capita caps on Medicaid, full stop.
At this point, Republicans in both the House and the Senate have supported proposals that could prove devastating for their state. This is no different. There’s no question Cassidy-Graham-Heller-Johnson has been gaining momentum this week, but as more reports come out on the effects of this proposal, it opens a lot of room for these Republican senators to feel the heat from their states.