There is a myth that one of the Sibyls (oracles) approached the last Roman king (before the creation of the Roman Republic), Lucius Tarquinnius Superbus, with several books of prophecies, asking an exorbitant price. He refused, so she burned some of the books, and again tried tried to sell Lucius the remaining books for the same exorbitant price. Again he refuses, so she burns more of the books. Again, she returns with the remaining books (sometimes it’s a single volume), and again asks for the whole original price. Afraid to lose the wisdom (for he now doesn’t doubt she will burn them all), he finally agrees.
Something similar seems to be happening with health care reform in the Senate. Having failed to sell their Patient Protection and Affordable Care Act (ACA or Obamacare) replace and repeal plan, GOP lawmakers tried to sell just repeal. Now they are offering a plan that might actually be worse than what we had before Obamacare. The hope seems to be that since the budget reconciliation process that allows them to pass the bill with only 50 votes (plus a tiebreaker from the vice president) expires Sept. 30, enough Republican senators will buy the last damn book before the opportunity is gone.
Cassidy-Graham, cosponsored by Louisiana’s Bill Cassidy and South Carolina’s Lindsey Graham, would eliminate Medicaid expansion, give money to the states as block grants would still has to go through the Congressional Budget Office, but preliminary analysis suggests that more than 30 million Americans could lose their health coverage (compared with how many would have it if Obamacare is left in place). It also allows states to theoretically opt out of popular ACA provisions such as pre-existing conditions protection (you can’t be charged more for diabetes or other ailments contracted or developed before you bought insurance) or essential services (services that the health plans have to include).
Among those essential services are mental health and substance use disorder treatment. We are in the midst of an opioid epidemic that President Trump has now declared a National Emergency, and substance use disorder and mental illness often co-occur or are considered dual diagnosis (the patient has both at the same time, one may be causing the other, and both need to be treated, preferably at the same time).
There’s no requirement that these provisions will have to be eliminated, but when you have a smaller household budget, you sometimes have to make hard choices about what services you cut. Sometimes you cut something that is necessary in order to keep something else you consider more necessary.
Cassidy-Graham seems designed to do two things: repeal Obamacare (so that the states have more control), and cut spending on healthcare. Improving healthcare outcomes or the number of people covered doesn’t seem to be a consideration at all.
