By Paul Rosenberg, Senior Editor
A last-ditch GOP attempt to “repeal and replace” Obamacare which would deprive tens of millions of Americans of healthcare collapsed on Sept. 26, as Senate Majority Leader Mitch McConnell announced they would not pursue a vote on the measure. The ability to act with a simple majority in the Senate — which Republicans could not muster — expires at the end of the fiscal year on Sept. 30.
The frenzy of the past two weeks only serves to underscore how severely the politics of healthcare remains in flux. Yet, the Donald Trump administration still seems fully committed to doing everything possible to undermine Obamacare in order to build the GOP case that it’s “a failure.”
On Sept. 13, Democrats struck back by going on offense. Sen. Bernie Sanders introduced his Medicare-for-All Bill, along with 16 cosponsors. The sponsors included several potential presidential candidates for 2020: Elizabeth Warren, Kamala Harris, Kirsten Gillibrand and Cory Booker.
At the same, Republicans formally announced their now-abandoned, last-ditched attempt to “repeal and replace Obamacare,” which some, including cosponsor Sen. Lindsey Graham, portrayed as a direct response to Medicare-for-All.
“This is the only process left available to stop a march toward socialism,” Graham told reporters the following week.
The logic was questionable.
“It’s weird that Graham […] are making the argument it’s their bill or single payer,” MSNBC’s Chris Hayes tweeted. “It’s the opposite! Killing ACA paves way for SP.”
Above all, people want health care for their families. The means are secondary. If Medicare-for-All is the only way they can get it because Republicans have destroyed everything else. That’s what they will demand.
In fact, one health insurance group — America’s Health Insurance Plans — cited “potentially allowing government-controlled, single payer healthcare to grow” as one reason for opposing Graham’s bill.
Failing the Jimmy Kimmel Test
But it was Graham’s cosponsor, Sen. Bill Cassidy, who drew far more attention when talk show host Jimmy Kimmel called him out in a monologue on his Sept. 19 show.
“This guy, Bill Cassidy just lied right to my face,” Kimmel said.
Conservatives then attacked Kimmel for his lack of expertise. Virtually all the experts in the field lined up against the bill and the GOP refused to hold any hearings to receive their testimony.
But Kimmel’s real function was to draw attention to the deeply unpopular sneak attack the Republicans were trying to pull of before an aroused public could notice. He succeeded.
Kimmel first became involved on May 1, when he opened his show with an emotional 13-minute monologue on the birth of his son with a life-threatening heart defect, who was doing fine thanks to the high-quality medical care Kimmel could afford. At the end, Kimmel urged Americans to come together and hold politicians accountable for their healthcare decisions, saying it wasn’t a partisan issue.
“If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make,” Kimmel said. “That’s something that whether you’re a Republican or a Democrat or something else, we all agree on that, right?”
On May 5, Cassidy told a reporter that a bill would have “pass the Jimmy Kimmel test” in order to gain his support.
“I want to make sure folks get the care they need,” he pledged.
On May 8, Kimmel had Cassidy on his show.
“Since I am Jimmy Kimmel, I would like to make a suggestion as to what the Jimmy Kimmel test should be,” Kimmel said. “I’ll keep it simple. No family should be denied medical care, emergency or otherwise, because they can’t afford it. Can that be the Jimmy Kimmel test, as simple as that?”
Cassidy agreed.
“Tell the American people to call their senator to endorse that concept,” he said.
Cassidy went on to add some further commitments after that, all of which, Kimmel noted, he had now abandoned.
“This new bill actually will pass the Jimmy Kimmel test, but a different Jimmy Kimmel test,” Kimmel said. “This one, your child with a pre-existing condition will get the care he needs, if and only if his father is Jimmy Kimmel. Otherwise, you might be screwed.”
Kimmel then recalled what Cassidy had promised.
“These were his words,” Kimmel said. “He said he wants coverage for all, no discrimination based on pre-existing conditions, lower premiums for middle class families and no lifetime caps. And guess what? The new bill does none of those things.”
He then ticked through the list, adding just enough detail to let viewers know the basic games being played with the bill:
Coverage for all? No. In fact it will take about 30 million Americans off insurance.
Pre-existing conditions? No. If the bill passed, individual states can let insurance companies charge you more, if you have a pre-existing condition. You’ll find that little loophole later in the document, after it says they can’t. They can, and they will.
But will it lower premiums? Well, in fact, for a lot of people, the bill will result in higher premiums and as far as no lifetime caps go, the states can decide on that, too, which means there will be lifetime caps in many states.
So, not only did Bill Cassidy fail the Jimmy Kimmel test, he failed the Bill Cassidy test. He failed his own test.
“Why won’t @jimmykimmel leave policy talk to the healthcare experts?” The National Review tweeted indignantly in response, linking to an article that failed to cite a single fact that Kimmel had gotten wrong.
Experts Echo Kimmel, Not Conservative Critics
In fact, everything Kimmel said was echoing healthcare experts. The Commonwealth Fund, the Brookings Institution and the Center for Budget and Policy Priorities all said that Graham-Cassidy would lead to at least 32 million losing coverage after 2026, with first-year losses of 15 to 18 million people in 2019, according to the Commonwealth Fund.
In California alone, the UC Berkeley Center for Labor Research and Education estimated that 6.7 million Californians could lose coverage in 2027 under Graham-Cassidy. In the Harbor Area, 166,300 people would lose coverage in the 44th Congressional District represented by Nanette Barragán, and 132,000 would lose coverage in the 47th represented by Alan Lowenthal.
As for pre-existing conditions, the title of a Sept. 15 report from the Center for Budget and Policy Priorities said it all: Cassidy-Graham’s Waiver Authority Would Gut Protections for People with Pre-Existing Conditions. “While insurers would still be required to offer coverage to people with pre-existing conditions, they could offer them plans with unaffordable premiums of thousands or tens of thousands of dollars per month,” it went on to state. “For consumers, an offer like that is no different than a coverage denial.”
As for premiums, Graham-Cassidy would “increase individual market premiums by 20 percent,” the Center for Budget and Policy Priorities stated.
But older Americans would be even harder hit.
Graham-Cassidy “threatens to make healthcare unaffordable and inaccessible for millions of older Americans,” the American Association of Retired Persons warned. “For a 60-year-old earning $25,000 a year, premiums and out-of-pocket costs could increase by as much as $16,174 a year if they wanted to keep their current coverage.”
The Commonwealth Fund also confirmed what Kimmel said about many states imposing lifetime caps. Even beyond that, Graham-Cassidy involved massive Medicaid cuts which would decimate the system. In the early years, it shifted money from states that had expanded Medicaid under Obamacare to Republican-dominated ones that hadn’t. But in the long run, it reduced Medicaid funds for every state — even as its co-authors claimed to be giving states more control. A bipartisan group of governors disagreed and urged the bill’s defeat. The national board of state Medicaid directors opposed it as well.
They weren’t alone. Opposition in the healthcare field was virtually universal.
As Kimmel said in his monologue, “Don’t take my word for it. Here are just some of the organizations who oppose the Graham-Cassidy bill: The American Cancer Society, the American Diabetes Association, American Heart Association, American Lung Association, the Arthritis Foundation, Cystic Fibrosis, the ALS Association, the March of Dimes, Multiple Sclerosis Society, Children’s Hospital of LA — basically any group that you’ve ever given money to thinks this is a bad idea.”
In addition, doctors, nurses, hospitals and even insurance companies opposed it, both individually and through their most venerable institutions.
Millionaires versus Medicine
There was only one clearly identifiable constituency in favor of Graham-Cassidy: multimillionaire GOP donors. A late-June story in The Guardian, “Koch network ‘piggy banks’ closed until Republicans pass health and tax reform,” laid things out clearly:
At a weekend donor retreat attended by at least 18 elected officials, the Koch brothers warned that time is running out to push their agenda, most notably healthcare and tax reform, through Congress.
One Texas-based donor warned Republican lawmakers that his “Dallas piggy bank” was now closed, until he saw legislative progress.
“Get Obamacare repealed and replaced, get tax reform passed,” said Doug Deason. “Get it done and we’ll open it back up.”
The Koch network’s budget for 2018 was $300-$400 million — a lot of motivation for lawmakers, regardless of what anyone else wants. But polling on Graham-Cassidy was brutal when it finally arrived on Sept. 21. PPP found 24 percent of respondents favoring Graham-Cassidy, and 50 percent opposing it, with 27 percent “not sure.” That was followed a few days later by a CBS News Poll, which found 52 percent disapproval and just 20 percent approval. Even Republicans fell short of giving majority approval.
On Sept. 22, Arizona Sen. John McCain announced his opposition, leading many to conclude the bill was dead. Some last-minute tweaks were made in hopes of buying off one or two votes, but after the Congressional Budget Office released its score on Sept. 25, Maine Sen. Susan Collins announced her opposition as well. That same day, when the Senate held its only public hearing on the bill, 181 protesters were arrested, most of them disability activists with ADAPT, a national grassroots community that organizes disability rights activists. Videos of them being arrested quickly spread across social media. Graham-Cassidy appeared to be finally dead.
The Road Ahead
No one knows for sure what’s next, but there are at least three things to keep your eyes on.
First, to look out for is the continued undermining of the Affordable Care Act. Trump has repeatedly threatened to destabilize the ACA marketplaces by abruptly halting subsidies to insurers. His Health Department has used taxpayer funds intended for advertising to encourage Obamacare enrollments and spent them on ads promoting the law’s repeal. His administration signaled that it might not enforce the tax penalty for those who don’t sign up for insurance. Then, in late summer, it cut Obamacare’s advertising budget by 90 percent, as well as cutting funding for the law’s outreach groups by 40 percent. Such sabotage efforts are only likely to get worse over time.
Also watch the bipartisan efforts to fix Obamacare. Despite GOP propaganda to the contrary, Democrats have never pretended that Obamacare was perfect. No major piece of legislation ever is. After the GOP’s first few efforts to kill Obamacare failed, lawmakers in both houses started working on bipartisan efforts to address issues that both could agree upon. These were halted in September as GOP leadership sought to force its members to fall in line. But now that Graham-Cassidy has failed, there could be a revival of these efforts.
Third, and perhaps most importantly, there’s the Medicare-for-All discussion. It’s not going to become law anytime soon, but it is already changing the conversation and altering the realm of the possible for the future. A Kaiser Family Foundation poll in June found that there’s now a 53 percent majority supporting it, with independents’ support at 55 percent, up 12 percent since 2008/9. Support among Democrats — at 64 percent — will surely rise if the leading 2020 primary candidates all support it. And with a majority of independents supporting it, it could be a key campaign issue in the general election, regardless of who the Democratic candidate is.
Of course, nothing is certain. The Kaiser poll found that support could be shifted in both directions. Arguments against — raising taxes and giving government too much control — could raise opposition as high as 62 percent, while arguments in favor — reducing administrative costs and ensuring healthcare as a right — could increase support to 72 percent. But the longer the current state of endless struggle continues, the more opportunity there is for single-payer arguments to advance.
Critics have argued that “Medicare-For-All” is a dangerous idea for Democrats, just the same as “repeal and replace” was for Republicans. But it’s an argument that’s full of holes. Yes “Medicare-For-All” is a slogan, just like “repeal and replace.” But that’s where the similarities end. “Repeal and replace” was just a slogan. There was never any unified concept of what it stood for. “Medicare-For-All” is a concept rooted in the existing Medicare system that can be implemented in a variety of ways.
By giving concrete form to the ideal of universal healthcare — something every other advanced nation takes for granted — Medicare-For-All also encourages other ideas that might actually achieve the same result. Shifting the debate from the endless finger-pointing of where it is now to “how do we cover everyone?” is arguably the biggest shift in healthcare thinking that our country can make. It’s what the “Jimmy Kimmel test” is all about. In that sense — as a concept, at least — “Medicare-For-All” is an idea whose time has come.