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Kevin ClarkeSeptember 19, 2017
Sen. Bill Cassidy, R-La., left, and Sen. Lindsey Graham, R-S.C., right, talk while walking to a meeting on Capitol Hill in Washington in July. Senate Republicans are planning a final, uphill push to erase President Barack Obama's health care law. But Democrats and their allies are going all-out to stop the drive. (AP Photo/Pablo Martinez Monsivais, File)Sen. Bill Cassidy, R-La., left, and Sen. Lindsey Graham, R-S.C., right, talk while walking to a meeting on Capitol Hill in Washington in July. Senate Republicans are planning a final, uphill push to erase President Barack Obama's health care law. But Democrats and their allies are going all-out to stop the drive. (AP Photo/Pablo Martinez Monsivais, File)

Any fan of American horror knows that savvy survivors never count the guy with the mask out no matter how often he has been beaten down, blown up or submerged in dark waters. Your determined Mike Meyer-ish ghoul will find a way back from the dead for another shock finale every time.

And so another effort to repeal Obamacare surfaced this week, not quite to everyone’s surprise.

Carol Keehan, D.C., the president and chief executive officer of the Catholic Health Association, was not caught completely off-guard when Republican Senators released their latest plan to turn back President Obama’s signature legislative achievement—this time without the assistance of Senate Majority Leader Mitch McConnell, who had washed his hands of the effort.

“They have been so abused,” Sister Keehan says of Senate Republicans. She suggests that after weeks of scolding from President Trump and right-wing media because of their failure to repeal Obamacare after promising to do so for years, some Republicans in the Senate felt they had no choice but to act one more time against the Affordable Care Act.

“You can see how the goading has gotten to them,” Sister Keehan says.

Does she think this latest bill has a chance to pass? In normal times, no way, she says. But in these decidedly not-so-normal times, who knows?

“You just don’t railroad something through, something you’ve just whipped together in the last couple of weeks.”

This legislative Pickett’s charge against Obamacare is being led by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. The “disastrous” plan, as Sister Keehan describes it, would end the federally funded expansion of Medicaid under the A.C.A., converting the program into block grants to states, which would have a broad authority to decide how to spend the money en route to a complete phase-out by 2026. According to a statement at the Catholic Health Association urging a “no” vote on the bill, that would mean $239 billion less over ten years than under current law, resulting in large cuts for many states.

According to an analysis of Graham-Cassidy conducted by the Center on Budget and Policy Priorities, the bill would eliminate or weaken protections for people with pre-existing conditions, allowing states to waive the A.C.A.’s prohibition against charging higher premiums based on health status and requirements for essential health benefits including mental health, substance abuse treatment and maternity care.

As with the last Republican effort to end Obamacare, cut down in July by a surprise “no” vote from Arizona Senator John McCain, Sister Keehan is troubled by the Senate’s haste on an issue of such grave national importance. “The health of the American people as well as the health of the economy is incredibly important, and you just don’t railroad something through, something you’ve just whipped together in the last couple of weeks,” she says.

“You have to be careful that you do something only after real thought and attention to the issue and not just because you got goaded into it; that’s something you teach your kids.”

Why the rush? Republican Senators need a vote by the end of September before special budget reconciliation procedures shielding the bill from a Democratic filibuster expire. This month, G.O.P. senators only need a straight majority vote; next month they would have to come up with 60 votes to move forward on an Obamacare repeal. Time and math are not on their side.

Senators Graham and Cassidy believe they are close to rounding up the 50 votes they will need to win now; Vice President Mike Pence would cast the tie-breaking vote. The vice president said on Sept. 19 that the Trump administration was "all in" on this last-ditch effort. Speaker of the House Paul Ryan has also endorsed the measure, suggesting it would earn approval in the House of Representatives. This iteration of an Obamacare repeal would then only need to make a short hop to the White House for President Trump’s signature to become the law of the land.

Sister Keehan would like the process to slow down for more serious deliberation before that happens. “We just have to stop and take a deep breath, and we need the adults in the room to follow John McCain’s advice to follow Senate procedures,” Sister Keehan says. “Senate procedures have been developed for a good reason.”

The latest proposal has not been scored for its likely impact by the Congressional Budget Office—and will not be by the time the Senate will be forced to vote on the bill. C.B.O. number crunchers say they will need weeks, not days, before they can issue a comprehensive report.

That means the Senate will vote without fully understanding how the plan will affect the health care of millions of people in a system that represents nearly a fifth of the U.S. economy. The bill proposes big cuts in Medicaid and would end the A.C.A.’s requirement that most Americans buy insurance and that companies offer coverage to workers.

The C.B.P.P. reports that by 2027 the outcomes of the Graham-Cassidy bill would be virtually identical to a repeal-without-replace bill, suggesting that it would leave an additional 32 million Americans without health insurance over the next decade. Its deeper cuts to Medicaid should in fact mean that figure could be higher. The bill would result in even deeper coverage losses in the following decade.

U.S. workers covered under company insurance plans, who may have been following with only a passing interest the continuing squabbles over health care in Washington, should take notice, Sister Keehan warns. Whatever may slip past in Congress this month will have a profound effect on the cost and the quality of all health insurance, not just those plans created under the A.C.A.

As this latest putsch against Obamacare began, Sister Keehan had been working on a competing Senate negotiation to shore up the A.C.A. spearheaded by Republican Lamar Alexander of Tennessee and Democrat Patty Murray of Washington that she described as “bipartisan” and “transparent.”

That draft bill “isn’t seeking to undermine A.C.A.,” she says. “We want it stabilized until we can come up with something better…until we can do the things to improve the A.C.A. that have needed to be done since it was passed.

“That’s what we need to do. We need to build on that, but you do that by following regular Senate order and holding committee hearings and inviting everyone to get involved in the discussion,” Sister Keehan says, “and not just have 13 guys hash this out in a closet.”

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JR Cosgrove
6 years 6 months ago

America brings out Sister Keehan again and again without an analysis of the American horror that is Obamacare. As we hear again and again the scariness of the number of people without insurance. Nearly all who voluntarily will not buy insurance because it is too expensive for what they get. No where on all these America articles is there a rationale discussion of the cost of healthcare.

How about it!!!!

6 years 6 months ago

I agree with J Cosgrove.
And add that Bernie Sanders has a plan calling for Medicare for everyone. Darrel Issa has a plan calling for the Federal Employee Plan for everyone.
I am grateful to hear Obamacare will be repealed. Obamacare gave for profit insurance companies free reign to keep the actuarial tables about how expensive it is to insure the poor. And then manipulated the IRS regulations to penalize anyone who would not pay for the insurance the insurance companies way. And then legitimizes it by saying it gives care to the poor,
This new Republican plan gives all the powers to the banks to monitor the MDs collection and setting of costs. HSAs are a disaster waiting to happen. Both Obama's Plan and this new Republican one head healthcare coverage in untenable directions. Obama was repeatedly told by advisors he chose that his plan would not be affordable in 3-4 years. It should be called Obama didn't care.
Let's repeal it. Rescind the tax penalties and move forward. Will Sister Urge her people to stop taking care of the poor if they don't get the huge money from Obamacare?

J Rabaza
6 years 6 months ago

"Eighty-six percent of the nation’s $2.7 trillion annual health care expenditures are for people with chronic and mental health conditions. These costs can be reduced."

Resources are limited. Not everyone can have the best cancer treatment on the market, the best cardiovascular intervention, the best surgical procedure or post-op care, etc. Until Americans come to the realization that they can do more good to advance their health by adopting pro-active lifestyle habits (e.g. healthy eating habits, regular vigorous exercise, normal Body Mass Index of 25 or less, avoiding addictive behaviors and injurious substances, etc), not everyone is going to have access to a Cadillac Health Care System waiting to care for them.

The adage applies more so today: "an Apple a day keeps the doctor away"

We were never meant to have medical professionals available for every malady that befell us, especially when ~ 90% of chronic medical illnesses are self-inflicted.

Want great health care? Practice great self-care. It costs far less than the alternative.

John Walton
6 years 6 months ago

I invite Sr. Carol to a meeting with my employees who have seen their premiums sky-rocket and their deductibles quadruple.
I wonder if the good lady has any idea of the razor thin margins that most small manufacturing, retail and food service companies operate with. Nice when you're in the convent and someone pays all your expenses as expiation for their sins.

Chuck Kotlarz
6 years 6 months ago

“It is no accident that the countries that led the fight against mortality are those with the best and earliest data.” Angus Deaton, Nobel prize winner

The U.S. can insure all for less; we have the “data”. For example, Russian life expectancy ranks 110 out of 183 countries. Several right-to-work states rank closer to Russia than California. None of the twenty-eight-right-to-work states has a life expectancy higher than California.

In 2016, the majority of OECD’s thirty-six countries spent less than half of the U.S. per capita level on healthcare. Only three OECD countries (Norway, Luxembourg and Switzerland) spent more than sixty percent of the U.S. level.

Stuart Meisenzahl
6 years 6 months ago

Just once you should start comparing the economic and health status of a State BOTH BEFORE AND AFTER IT ADOPTED A RIGHT TO WORK LAW. Has it ever occurred to you that a State might adopt a "right to work law" to attract new businesses precisely because it was already poor or declining economically .....and consider what that existing declining status means to the value of the statistics you recklessly bandy about?
So let me cite a statistic devoid of its context: "California has five times more homeless people than the largest " right to work state" ( United States Interagency Council on Homelessness 2016).

Chuck Kotlarz
6 years 6 months ago

Stuart, since 1960, the U.S. life expectancy ranking has fallen below fifteen more countries. Adding twelve more Right-To-Work states since 1960 apparently did not help.

With affordable health care for all and a $15/hour minimum wage, perhaps more Californians could pay the rent.

Stuart Meisenzahl
6 years 6 months ago

Us life expectancy is based on all 50 States.....divining a decline/ failure to arrest a decline based on "right to work States" taking into account various dates of passing right to work laws etc, etc is not even statistically feasible. A junk statistic.
By the way I didn't cite the homeless rate to knock California but only to demonstrate the utter uselessness of these pseudo- statistic based arguments.

Scotty G
6 years 6 months ago

Is this the same Sister Keehan, CEO of Catholic Health Association, who is compensated in excess of $1M per year (over $1.3 million according to tax records filed in 2013)?

Is this the same Sister Keehan who Obama credits as one of the main forces behind the passage of Obamacare and even told her he loved her?

Remember Jonathan Gruber, one of Sister Keehan's conspirators in passing Obamacare?
He stated, "the stupidity of the American voter . . . was really, really critical for the thing to pass." So we shouldn't be upset with Sister Keehan. Shame on us stupid American voters for allowing Obamacare to pass.

Jim Lein
6 years 6 months ago

Why rush it through before the actual provisions are known? This is too important for that. It seems more a game of gotcha than legislative deliberation over what is the best way of providing health care to all Americans. Let the numbers be run and examined and discussed--and the public informed--before action is taken. Both sides have some good ideas and some not so good. Legislation rather than petty and partisan gamesmanship is called for.

Martin Meehan
6 years 6 months ago

Fifty-two percent of Americans now favor Obamacare. The majority of Americans do not consider this program of be a 'horror.' Twelve percent of Americans are in favor of the Republican replacement plan, which has not been openly discussed on the floor or the Senate nor fully examined for its cost and coverage.

Under the proposed plan states can obtain a waiver so that those with pre-existing conditions are not covered, or are covered only by extremely expensive plans. Those with conditions such as cystic fibrosis or muscular dystrophy, for example, will likely not be able to afford reasonable coverage for their disease.

We may have bipartisan progress on Dreamers (DACA), debt ceiling and tax reform. Let's also have bipartisan discussion and action on how to improve health care for Americans.

James Haraldson
6 years 6 months ago

Why would anyone value the opinion of Sister Keehan, one the most consequential accessories to mass murder in human history?

JR Cosgrove
6 years 6 months ago

Maybe the authors on America that write about healthcare should read

JAMA Forum: The High Costs of Unnecessary Care


JR Cosgrove
6 years 6 months ago

I had a close friend who went through chemo for colon cancer and told me that his doctors admitted that many of their tests and procedures were done solely to avoid any semblance of malpractice. The real culprit in healthcare cost is the trial lawyers and guess which political party they support.

There is also something called "low valued care" which adds significantly to the cost of healthcare.

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