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Republicans promised for years to repeal and replace Obamacare. It was the essence of their rise to power.

They were humiliated that they couldn't. Their big donors were outraged. Their Obama-despising voters were defecting.

Staring down a deadline of Sept. 30, after which they'd need 60 votes instead of 51, Republicans in the U.S. Senate will repeal and replace Obamacare this time, by golly, if they can unlock--as they might--Sens. John McCain of Arizona and Lisa Murkowski of Alaska, two of the four holdouts in the 52-member GOP caucus.

Republicans are so hell-bent that they asked Sen. Lamar Alexander of Tennessee to stop working with Democrats on bipartisan fixes to Obamacare, and he said, oh, all right.

McCain is unpredictable and perhaps a good bet to say he hates that the bill is being rushed without his beloved "regular order," but that he so favors the concept of "federalism," of devolving authority to the states, that he'll go along.

Murkowski could well decide that Alaska, with that vast rural expanse that's hard to serve efficiently, is not going to be shafted any more by Cassidy-Graham than it has been shafted by Obamacare.

That would give Republicans 50 votes. Then Vice President Mike Pence would cast the tie-breaking vote to end health insurance for these millions of lower-income Americans.

As Republican thinking goes, it's those poor people's own fault if they don't have sense enough to get something voluntarily that the government had previously mandated for them.

Republicans say this bill saves money. That is quite true, although Republicans want to pass it in such a hurry that there's no time for a full scoring by the Congressional Budget Office.

If you quit automatically subsidizing health insurance for poor people, and then offer to subsidize it only if poor people go get it, and then if poor people don't go get it, as many won't, then you have saved yourself money.

Republicans are so serious about this Cassidy-Graham bill--which would convert Medicaid expansion and all federal health-insurance subsidies to block grants that states could run as they please--that even some of the often-responsible ones whose states are net losers are caving and saying the bill is swell.

I'm talking about you, Gov. Asa Hutchinson.

It turns out, he tells us, that he's been engaged in the talks on this bill, insisting throughout that the federal government not make "cost shifts" to the states in the current system of coverage.

He says he has been obliged on that insistence.

Here's what that means: The Feds will send us a block grant in 2020 big enough to fold into it everything we'd been doing. But they will subsequently reduce the rate of growth in that block grant, putting the onus on states to use their new "flexibility" to "cut costs," which is a euphemism for "cutting people."

Unlike a few more responsible Republican governors, Hutchinson is wilting to embrace a bill that rewards states that didn't make the hard and responsible decision to expand Medicaid, and harms those like his own that did. That's because the initial block grants will be based on an equalization calculation that assumes Medicaid expansion is in place, and, after that, converts to a per-capita basis.

Hutchinson is putting party over state and the state's budget over the state's poor people. But it's a political winner for him because Arkansas thinks it hates Obamacare.

What of small rural hospitals that have been fortified by insured patients where uncompensated care used to be?

Hutchinson said the other day that we could use some of the block grant to cover that uncompensated care.

Got that?

The state will make the block grant work only by people falling off the health-insurance rolls. Then the state will use these block-grant savings to pay hospitals for taking care of these people who did the state and the hospitals the kind favor of freeing up these savings by no longer having health insurance by which they could go to a doctor for a wellness check.

That's a shell game that protects hospitals, but not people.

Not to forget: Cassidy-Graham would require insurance offerings for people with pre-existing conditions, but not mandate equal premiums for them.

We'd leave that to benevolence-challenged states ... like ... well ... Arkansas.

Finally, Hutchinson told me in early August, after returning from a meeting at the White House, that he had said at that meeting that any new bill should be run through "regular order," meaning committee meetings and public hearings and amendment considerations.

Asked about that Tuesday in the context of his supporting this mad rush to pass something by Sept. 30, the governor said the Senate Finance Committee will have a meeting Monday.

That sounds perfectly perfunctory, doesn't it?

This train is running, needing only McCain and Murkowski to hop on with Asa in the rationalizers' caboose.


John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, was inducted into the Arkansas Writers' Hall of Fame in 2014. Email him at Read his @johnbrummett Twitter feed.

Editorial on 09/21/2017

Print Headline: Rush to a ruse

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