Before tackling single-payer, save Obamacare - By E.J. Dionne Jr.
By E.J. Dionne Jr. Opinion writer September 17 at 7:50 PM
Before supporters of universal health coverage get all wrapped up debating a single-payer system, they need to focus on a dire threat to the Affordable Care Act likely to come up for a vote in the Senate before the end of the month.
The latest repeal bill is an offering from Republican Sens. Lindsey O. Graham (S.C.) and Bill Cassidy (La.) that would tear apart the existing system and
replace it with block grants to the states. Block grants flows of money for broad purposes with few strings attached are a patented way to evade hard policy choices. All the tough decisions are kicked down to state capitals, usually with too little money to achieve the ends the block grant is supposed to realize.
Because Graham and Cassidy are civil interlocutors and have sounded more reasonable than many of their Republican colleagues in talking about health care, there is an unexamined assumption that their proposal must be more sensible than other approaches to repeal. But its not. In fact, it would be disastrous. In certain respects, its even worse than earlier repeal measures, which at least
kept some of the structure of Obamacares subsidies in place. This bill would simply blow them up.
It would also shift money around in ways that would, on the whole, hurt states that have been trying to get health coverage to their less-affluent residents. A report on the bill by the Center on Budget and Policy Priorities, a think tank devoted to the interests of less-advantaged Americans,
concluded:
In general, over time, the plan would punish states that have adopted the Medicaid expansion or been more successful at enrolling low- and moderate-income people in marketplace coverage under the ACA. It would impose less damaging cuts, or even raise funding initially, for states that have rejected the Medicaid expansion or enrolled few low-income residents in marketplace coverage.
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