Under latest health-care bill, red states would benefit disproportionately – Washington Post

 In U.S.
The latest Republican proposal for curtailing the Affordable Care Act was assembled with such haste that it may get a vote before a full cost estimate is finished. But it is not a new idea.

At its core, the bill introduced by Sen. Bill Cassidy (R-La.) and Sen. Lindsey O. Graham (R-S.C.) would implement a decades-old conservative concept, capping the amount that taxpayers spend on Medicaid and giving states full control over the program. As he’s sold the legislation to conservative governors and activists, Graham has described it as a possible triumph for federalism, and a way to end the progressive dream of universal health care managed from Washington.

“Let’s get back to the basics of being conservative,” Graham said in a Saturday interview with Breitbart News. “We take the money that we would spend on Obamacare in Washington, and we block grant it to the states.”

What’s new, thanks to the Affordable Care Act, is a discrepancy in state-by-state funding that would be flattened out by the block grants. Most states used the ACA’s funding to expand Medicaid; some Republican-run states, liberated by the Supreme Court’s decision to make the funding optional, did not. As a result, 14 of the 15 states that would stand to gain from block grants are run by Republicans; Democratic megastates including California, New York and Massachusetts would lose billions of dollars, a feature both Graham and Cassidy have talked up to conservatives.

Sen. Lindsey O. Graham (R-S.C.) said President Trump “is very excited about this state-centric health-care system” on Sept. 19. (The Washington Post)

“We will either have to kick hundreds of thousands of people off of health care, or we will have to dramatically increase taxes,” said Sen. Chris Murphy (D-Conn.), in one of a string of Monday night floor speeches by Democrats.

“No longer will four blue states get 40 percent of the money,” said Graham to Breitbart. “A state like Mississippi, they get a 900 percent increase. South Carolina gets 300 percent.”

Graham, elected in 1994’s “Republican revolution” to his first term in the House, was present for Capitol Hill’s first serious block-grant campaign. In 1995, in one of many attempts to devolve power from Washington, congressional Republicans teamed up with governors to both cap Medicaid spending and chop up the program’s funding in “MediGrants,” for each state to apply to their own designs.

The proposal died after President Bill Clinton — using one of the pens Lyndon Johnson used to enact Medicaid — vetoed it, denouncing the “wrongheaded cuts” favored by Republicans.

“The president has to realize that Lyndon Johnson’s Great Society has failed,” said Newt Gingrich, then the House speaker.

The block-grant concept remained in conservative thought, and reemerged in 2010, when Rep. Paul D. Ryan (R-Wis.), then a ranking member of the House’s tax-writing committee, included the idea in a flashy “Roadmap for America’s Future.” In 2011, newly elected Gov. Scott Walker (R-Wis.) joined a delegation of conservatives in Washington to testify for the wisdom of devolving Medicaid to states.

Senate Republicans are trying to revive the momentum to overhaul the Affordable Care Act with the Graham-Cassidy proposal. Here’s a rundown of the plan, and the rush to pass it. (Jenny Starrs/The Washington Post)

“It’s the biggest challenge out there,” Walker said of state Medicaid spending. “We have maintenance efforts that require us to maintain things by the federal government when we have other things that would work better to manage those costs.”

Barack Obama’s own veto plan made the block-grant dream futile. This year, Ryan included the idea in the American Health Care Act, the House’s vehicle for “repealing and replacing” the ACA.

“Medicaid, sending it back to the states, capping its growth rate, we’ve been dreaming of this since I’ve been around — since you and I were drinking at a keg,” Ryan told National Review Editor Rich Lowry in March. “We’re on the cusp of doing something we’ve long believed in.”

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