Greenstein Statement on CBO Report on Cassidy-Graham Bill

The lack of sufficient time for the Congressional Budget Office (CBO) to produce its normal comprehensive analysis with respect to the Cassidy-Graham bill underscores the dangerous and ill-advised process Senate Republican leaders are embarking upon to advance this legislation. They are pushing the Senate to pass a bill that would have profound consequences for tens of millions of people across the country, as well as for an industry that makes up more than one-sixth of our economy, without a full CBO analysis of the bill’s impact on health coverage, on access for people with pre-existing conditions, on premiums and out-of-pocket costs, on the stability of the individual market, or on states’ ability to adequately finance and run their Medicaid programs.

Fortunately, CBO was able to conduct some analysis, and the results aren’t flattering to the legislation.  CBO concluded that the Cassidy-Graham bill would result in millions more Americans being uninsured, would cut federal Medicaid funding by about $1 trillion over the next ten years, and would force states to eliminate or roll back protections for people with pre-existing conditions in order to prevent the collapse of their individual insurance markets.

In addition, even without a full CBO analysis, a range of independent experts have concluded that the Cassidy-Graham bill would likely be at least as damaging — and in some ways, probably more so — than previous Republican repeal bills.  Cassidy-Graham goes beyond previous “repeal and replace” bills because its main “replace” element — its inadequate, hastily designed block grant to replace the ACA’s Medicaid expansion and its subsidies for private-market coverage — would end after 2026.  Furthermore, the bill also goes beyond the pure repeal legislation the Republican Congress passed in 2016 (which President Obama vetoed) because Cassidy-Graham not only repeals the ACA’s main coverage expansions — without any replacement after 2026 — but also imposes a hefty Medicaid cut (the bill’s Medicaid cap) on top of that.  That’s why some analysts have concluded that the bill likely would ultimately result in at least as many Americans losing coverage as CBO estimated would lose coverage under pure repeal — 32 million people.

Rushing to a vote on such a far-reaching bill without time for lawmakers or the public to assess and understand it — and compounding that by throwing billions of taxpayer dollars around in a last-minute effort to practically buy the remaining votes needed for passage — is unprecedented in recent U.S. history. 

If this effort succeeds, health coverage for millions of Americans will not be the only casualty.  I fear that our nation’s democratic processes themselves, and the reputation and integrity of the U.S. Senate, will be diminished for many years to come.

I have been working in public policy in Washington for 45 years, and I have seen lots of legislative sausage-making.  But I have never seen anything like this.