Cassidy-Graham is like previous Affordable Care Act repeal bills

Virginia estimates $1.2 billion hit to Medicaid program under latest Senate health plan

Republicans are seeking to get a bill to the Senate floor before the end of the month, enabling legislation to pass with just a majority. Health care should be a right. When the American people generally agree on an issue, such as whether human trafficking should be tolerated, it's easy for Congress to pass legislation.

If they're not ready for a restructuring as dramatic as Medicare for all, they need to fix Obamacare and stop playing politics with people's health.

The only way legislation in the Senate will ever be passed under the current philosophy is if people everywhere are willing to live under a system they consider to be less than ideal.

More optimistic Republicans, though, point to differences this time around.

So far, Iowa's two senators haven't said how they would vote. Combined with changes in the formula for calculating Medicaid spending, the long-term effect will be to give states more responsibility for the health care of their citizens, with dramatically less money.

This strategy would provide several advantages, not the least of which is that it would allow both the conservatives and moderates in the Republican Party to escape having to sign on to a deal their constituents will loathe. However, the Center on Budget and Policy Priorities, which has been critical of GOP plans, says taking the block grant and per capita provisions together, Iowa would lose $525 million in 2026.

It should be an idea attractive to Republicans who believe in less federal power. States would not have to use the funding to provide financial assistance to insurance purchasers.

It would weaken protections for people with pre-existing conditions, by allowing states to waive the ACA's prohibition against charging higher premiums based on those conditions - including maternity care, hospitalization, mental health, and substance abuse - which would allow insurers to market junk policies to their customers. It estimates the states that didn't expand Medicaid would get an average of 12 percent more.

Among the structural defects of Trumpcare 4.0: It would drastically restructure Medicaid, making it nearly impossible for states to maintain the expansion and coverage for the poor; and it would drastically reduce federal spending, turning Obamacare into a block-grant program that gives cash-strapped states the freedom to devise their own systems with few strings attached - before the block grants are eliminated entirely after 2026.

Asked Wednesday about the Avalere report, Hutchinson said through a spokesman via email: "Graham-Cassidy is a true repeal and replace bill that offers states the flexibility the governors have requested in a block grant format".

Senate Republicans defeated an effort earlier this year to repeal Obamacare.

In a September 13 letter (2 page PDF) sent to Senate Majority Leader Mitch McConnell, R-Ky., and Minority Leader Charles Schumer, D-N.Y, the organizations - the AAFP, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Osteopathic Association, and American Psychiatric Association - detailed their concerns about the proposal by Sens. Rand Paul (R-Ky.), has already said he won't support it. "They go into it thinking that if only they had more running room they could save money".

The bill's supporters claim that states will find new and improved ways to deliver health care if given control of the new, cheaper version of Medicaid. So why are Republicans trying so hard to accommodate one another?

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