Sen. Bill Cassidy (R-LA) has a truth-telling problem.
After late night host Jimmy Kimmel delivered an impassioned monologue Tuesday night, saying Cassidy “lied right to my face” when he told Kimmel that every American should have certain health benefits, Cassidy appeared on all three cable news networks Wednesday morning to defend himself. The senator spent those interviews unleashing a blizzard of untruths so thick with new falsehoods that it was difficult to keep track.
Cassidy either has no idea what’s in the massive overhaul of the American health care system that he is selling or is willfully trying to deceive the American people.
Cataloging all of Cassidy’s lies was not an easy task. But we did our best. Here is our best count of all the falsehoods, misrepresentations, and downright dirty attempts at deception that Mr. Cassidy deployed this morning.
The “more people will be covered” lie
- “There will be more people covered under the Graham-Cassidy-Heller-Johnson amendment than are under status quo.” – Cassidy on MSNBC
- “Under Graham-Cassidy-Heller-Johnson more people will have coverage.” – Cassidy on CNN
The central feature of Cassidy’s Trumpcare bill is massive spending cuts — a total of $4 trillion in cuts by 2036. These cuts include hundreds of billions of dollars in rapid cuts to Obamacare spending in 2020 through 2026, followed by a swift sunset of all of that funding in 2027. Additionally, Graham-Cassidy places a cap on Medicaid spending and then reduces the real value of that cap over time, slowly phasing out the Medicaid program entirely.
In total, the bill “would lead to a loss of health insurance for at least 32 million people after 2026,” according to The Commonwealth Fund, a foundation focused on health policy.
Graham-Cassidy uses several different mechanisms to achieve its massive cuts. First, it eliminates the Affordable Care Act’s tax credits helping people with moderate incomes afford health insurance, as well as Obamacare’s Medicaid expansion. These programs are swapped out for a block grant which is less generous than the programs it replaces.
Then, in 2027, the block grant disappears, leaving people who depend on the cut Obamacare funding for their health care with nothing.
Graham-Cassidy also places a cap on Medicaid spending. Although the value of this cap increases in absolute dollars every year, it does not grow fast enough to keep up with the projected rate of Medicaid inflation. By 2026, this ever-shrinking cap will reduce Medicaid spending by 8 percent in addition to the elimination of the Medicaid expansion. Then, with each passing year, Medicaid will lose more and more value until it is practically worthless.
The “pre-existing conditions protections” lie
- “We protect those with pre-existing conditions” – Cassidy on MSNBC
- “We protect those with pre-existing conditions. If a state applies for a waiver it specifically says the state must establish there is adequate and affordable coverage for those with pre-existing conditions.” – Cassidy on Fox News
- “We protect those with pre-existing conditions.” – Cassidy on CNN
Under the Affordable Care Act, insurers in the individual market may not deny coverage to people with pre-existing conditions or charge them higher premiums because of their health condition.
Graham-Cassidy, however, allows states to obtain waivers from the later requirement — so, while insurers technically would not be able to deny coverage outright, they would be able to charge such exorbitant premiums that the insurance would be rendered unaffordable.
According to a Center for American Progress analysis, a 40-year-old with metastatic cancer would be hit with a surcharge of over $140,000. (Disclosure: ThinkProgress is an editorially independent news site housed at the Center for American Progress.)
The provision permitting such waivers, moreover, potentially allows insurers to raise premiums “as a condition of enrollment or continued enrollment under the plan.” Thus, Graham-Cassidy could allow an insurer to raise premiums to unaffordable levels the minute someone becomes sick, effectively cutting off their insurance the moment they need it.
Cassidy defends these waivers by claiming they can only be granted if a state plans to provide “adequate and affordable” coverage to people with preexisting conditions, but that is not what his bill says. Though the words “adequate and affordable” do appear in Cassidy’s Trumpcare bill, they appear in a section governing what states must include in their waiver applications. Such applications must explain “how the State intends to maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions if such waiver is approved.”
Yet, while applications must contain this information, the bill does not appear to have any meaningful enforcement mechanism against states that fail to maintain coverage for people with preexisting conditions. To the contrary, the provision of the bill governing the waivers themselves is written in mandatory terms. The Secretary of Health and Human Services “shall waive” the preexisting conditions protections provided that the state’s application “includes a request for such a waiver” and an explanation of how it intends to protect people with preexisting conditions. The state’s only explicit obligation is to come up with a plan, not to come up with a successful plan — or even to execute the plan it carries out.
It is also worth noting that, in Gonzaga University v. Doe, the Supreme Court placed strict limits on when a private party can sue to enforce a statute that places obligations upon a third-party or on a state. It is unlikely that judges will read Gonzaga to allow private individuals with preexisting conditions to sue states that come up with inadequate plans to protect people with such conditions.
The “helping states bypassed by Obamacare” lie
- “There will be billions of dollars of coverage for, working families in states like Maine, Virginia, Missouri, Florida and elsewhere, states that have been bypassed by Obamacare.” – Cassidy on MSNBC
- “States like Maine, Virginia, Florida, Missouri — they’ll be billions more dollars to provide health insurance coverage for those in those states that have been passed by by Obamacare.” – Cassidy on CNN
- “Our families will pay less under the Graham-Cassidy-Heller-Johnson amendment in states like [Louisiana, Massachusetts] once the governors implement those plans.” – Cassidy on MSNBC
Cassidy’s claim that people in certain states that were “bypassed by Obamacare” will be better off under his bill includes two lies wrapped into one.
What states like Maine, Virginia, Missouri, and Florida have in common is that they chose not to expand Medicaid under the Affordable Care Act after the Supreme Court held that this ACA provision would be optional for states. But that was their choice — or, at least, the choice of their elected leaders. Any state may elect to expand Medicaid; the law as originally drafted intended for every state to expand the program.
So it is simply false to claim that these states were “bypased” by the Affordable Care Act. They were offered the same choice that every other state was offered, and they decided not to take free federal money that would provide health coverage to some of their most vulnerable residents.
In the short term, Graham-Cassidy rewards states that declined the Medicaid expansion and punishes states that accepted it by pooling together most of the money that was paid out under the expansion and dolling it out evenly to all 50 states. Thus, expansion states wind up worse off while some non-expansion states wind up better off in the short term.
Recall, however, that Graham-Cassidy’s block grants simply vanish in 2027. Thus, while states like Virginia or Missouri might be better off for a few years (Maine, it turns out, is slightly worse off), all of this funding goes away after a few years and every single state is left with nothing.
The “sick children will have the coverage they need” lie
- “[T]he state has the ability to provide coverage so when the child has a problem the parents have the coverage that the child’s problems can be addressed” – Cassidy on Fox News
- QUESTION: “So any child born with a congenital heart disease would get everything he or she needs?” CASSIDY ON MSNBC: “Absolutely.”
Here, Cassidy is largely repeating earlier lies and applying them to children. A child born with a congenital heart disease will not get “everything he or she needs” under Graham-Cassidy, in part because Cassidy’s bill could subject that child to discrimination for their pre-existing condition. Even if that child’s state elects to protect people with pre-existing conditions, Graham-Cassidy’s sharp spending cuts may make the child’s insurance unaffordable.
The “low-income seniors and people with disabilities will have the coverage they need” lie
- QUESTION: “So your bill, Dr. Cassidy, as I understand it, cuts coverage for low-income seniors, children and people with disabilities.” CASSIDY ON MSNBC: “That’s not true.”
Similarly, Cassidy’s claim that his plan does not cut coverage for low-income seniors and people with disabilities is also false.
Though Medicare is the primary program providing health care to seniors, many low-income seniors also rely on Medicaid to cover services (such as long-term nursing care) that are not covered by Medicare. These seniors will face cuts due to Graham-Cassidy’s Medicaid phase-out, although the program phases out Medicaid more slowly for seniors and people with disabilities that it does for many other beneficiaries.
Additionally, many people with disabilities are covered either by the Medicaid expansion or by subsidized health plans purchased in the Obamacare exchanges. These individuals could lose their coverage entirely due to Graham-Cassidy’s steep cuts.