Next week, Congressional Republicans will vote on the Graham-Cassidy bill supposedly designed to “repeal and replace” Obamacare. Shockingly, they will do so without a score from Capitol Hill’s nonpartisan scorekeeper, the Congressional Budget Office (CBO). As the office led by the GOP’s hand-picked director Keith Hall warned last Monday, “CBO will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks.”
Nevertheless, there are many things we already know with a good deal of certainty about this grotesque act of right-wing political spite masquerading as health care legislation. Graham-Cassidy begins by eliminating the individual and employer insurance mandates next year, and repealing the Affordable Care Act’s insurance subsidies and Medicaid expansion in 2020. The bill then dramatically slashes currently projected Obamacare spending and divvies up what remains as block grants to the states. The states in turn can seek waivers from requiring the coverage of Obamacare’s “essential health benefits” (EHB’s) and the current ban on discrimination against those with pre-existing conditions. Estimates from Avalere Health and CBPP forecast the GOP bill carves between $215 billion and $243 billion from ACA spending over the next decade. But those block grants—which rob billions of dollars from largely Democratic-led, Medicaid-expanding states to those red states which did not—expire at the end of 2026. Unless the bill is reauthorized, the states will lose $299 billion in federal funding in 2027 alone; between 2020 and 2036, the loss is a staggering $4.15 trillion. Based on CBO estimates for similar Republican proposals earlier this year, the Commonwealth Fund warned 32 million people could lose their insurance by 2027.
Oh, and one other thing we can count on: If Sens. Lindsey Graham and Bill Cassidy get their way, thousands of newly uninsured Americans will die needlessly every year. A death toll of roughly 18,000 in the law’s first full year could approach 40,000 in 2027. The question is not whether the United States will suffer the equivalent of multiple Sept. 11 attacks every year, but how many.