This week, Senate Republicans have been struggling to cobble together at least 50 votes in support of its latest, and perhaps last, effort to pass an Obamacare replacement bill. It's known as the Graham-Cassidy bill, named after its two co-authors, South Carolina Senator Lindsey Graham and Louisiana Senator Bill Cassidy, and although Arizona senator John McCain's recently announced opposition puts it in dire straits, it's not quite over yet. Which means this is still a very important question: Who would lose health insurance under Graham-Cassidy, and just how many people would stand to be harmed by it?
It'll still take one additional GOP senator coming out publicly against the bill ― assuming everyone keeps their word ― to scuttle the legislation. The two most likely senators to do this are Lisa Murkowski of Alaska and Susan Collins of Maine, the former of which is reportedly being heavily pressured to agree to support the bill.
But, you might wonder: What would the proposed law actually do? When it comes to the single most important question regarding a replacement ― namely, the number of people covered ― what impact would it have? Thanks to the breakneck pace of the GOP's efforts to get the bill passed, it hasn't even received a score from the Congressional Budget Office yet. But a recent analysis from the Brookings Institute, using the GOP's previous, failed health care proposals plans as a foundation, is not encouraging.
According to the analysis, Graham-Cassidy's passage could result in 32 million fewer Americans being covered by 2027, an eye-popping number that's even worse than the estimates the CBO landed on for the previous GOP bills, the American Health Care Act, and the Better Care Reconciliation Act. This depends on whether the future Congress would reauthorize the spending laid out in the bill; if it did, the estimate drops to a still-harrowing 21 million fewer Americans insured.
More over, the analysis found that a full 15 million of those people would lose their insurance in 2018 and 2019, a huge short-term loss that would only get worse in the years to follow. The exact nature of who would be losing coverage is a little hard to say for a certainty, given that part of Graham-Cassidy would re-route Obamacare's federal funding into block grants to be given to the states to determine how to use. Some states with predominantly Democratic leadership are likely to use that money differently than, say, a Republican-led state would.
That said, given that the bill would also include deep cuts to Medicaid, and given that it would also fail to ensure essential coverage for people with pre-existing conditions the clearest answer is one you might have expected: the people who'll be most hurt by the bill, and who'll be most likely to lose their insurance, are the very people who need it most. Medicaid recipients, low-income individuals and families, and yes, people with previous medical histories that Obamacare had previously protected from price-gouging.
Millions of people with pre-existing conditions, for example, could find themselves facing an insurance market where the coverage they need, although technically available to them, is prohibitively expensive.
While Graham-Cassidy nominally covers people with pre-existing conditions, it also allows states to grant waivers to insurance companies, which could ultimately be used to jack up premiums on people who have significant medical histories and need comprehensive coverage. For a sense of perspective, according to a recent study from the Center for American Progress, a full 130 million non-elderly American adults have pre-existing medical conditions.
It's also been estimated that the bill would cut Medicaid funding by a staggering $1.1 trillion between 2020 and 2036. And, presumably in an effort to sweeten the deal to secure Republican votes, it's traditionally Republican states that'll come away with increased funding, while traditionally Democratic states will face the deepest cuts.
For example, the state that stands to benefit the most from Graham-Cassidy is Texas, which would net an estimated $35 billion in 2026, according to a recent analysis from Avalere Health. California, on the other hand, would lose $78 billion.
So, in short, there you have it. According to a pair of recent studies ― although not from the non-partisan CBO, because the Republicans are trying to rush the bill through before the office can even score the bill ― Graham-Cassidy would strip somewhere from 21 million to 32 million Americans of their health insurance, cut funding to Medicaid by more than $1 trillion, and distribute federal funds in such a way that Republican-leaning states are hit less hard than Democratic-leaning ones.
For what it's worth, however ― and it's still too soon to say for sure ― the bill might be circling the drain right now. If either Collins or Murkowski come out against it, and McCain and Paul hold firm, the Republicans will fall short of the 50 votes they need.