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Opinion >  Column

Shawn Vestal: This year’s state-by-state horse-trading with health care is offensive

UPDATED: Tue., Sept. 26, 2017

If you need a further reason to be appalled by the congressional health care travesty, consider the current “repeal and replace” proposal in terms of the Washington-Idaho border.

Stand to the east of that line, and the Graham-Cassidy legislation sends you more – a lot more – money for health care.

Stand to the west, and – poof! – a whole lot of money vanishes.

Think of it another way: Stand on the red side of that line, and Graham-Cassidy pays you off.

Stand on the blue side, and it punishes you.

It’s beginning to seem like keeping people healthy may not be the goal here.

Just kidding! It’s not “beginning to seem” that way at all. It’s long been grossly, nakedly apparent. There have been so many dramatic failures of honesty this year, as the flummoxed congressional majority tries to worsen health care coverage while pretending to improve it, that any one example just pales. The shell game surrounding pre-existing conditions – in which the repeal-and-replacers assert that their legislation provides protections that it does not – is perhaps the most glaring example.

But as an illustration of the deep cynicism regarding human consequences, the state-by-state funding payoffs for the current Senate legislation are right up there. States that fought Obamacare get a bonus, and those that tried to make it work get a penalty.

A new analysis by the Kaiser Family Foundation attempts to evaluate the effects of the legislation, which would repeal the individual-market subsidies and Medicaid expansion of the ACA and replace them with block grants to states.

It concluded that Idaho would get a 27 percent increase in federal funding for health care over six years.

Washington would get a 16 percent cut.

And yet, within a decade, both states would see less federal money and have fewer people with health insurance, according to the Kaiser analysis (as well as every single health care organization in the nation that has taken a position on Graham-Cassidy).

In fact, Idaho’s estimated drop of 201,000 residents off the insurance rolls by 2026 is – on a per capita basis – more dramatic than Washington’s drop of 657,000.

In other words: Grassidy gives short-term increases to Obamacare-hating states, along with a lot of freedom to spend that money in other ways, and it gives big cuts to Obamacare-compliant states. Eventually, though, every state ends up with less: less Medicaid funding and fewer residents with health insurance, along with a wide range of other lousy possible ramifications framed as “innovations” – from allowing insurers to charge sick people more to putting lifetime caps on coverage.

You know what they say: A sinking tide lowers all boats.

That’s not what supporters of Grassidy say, of course. They say … whatever sounds good. Anything they want. Pre-existing conditions are protected! Premiums will go down! Ignore all those health care organizations with their doomsday predictions!

Every new iteration of the zombie Obamacare repeal train has been accompanied by straight-faced assertions contradicted by facts. It began with Rep. Cathy McMorris Rodgers and the leadership in the House and has continued through Monday’s hearing on Graham-Cassidy – a repeated insistence that the legislation will not do the things the legislation itself says it would do.

The estimated variations in state funding ostensibly arise from the fact that Idaho chose not to expand Medicaid under the Affordable Care Act, and Washington chose to expand. Expansion states saw more Medicaid funding, while those that refused – denying coverage to thousands of their own residents – did not. Supporters of Graham-Cassidy say the differences are meant to rectify that.

But the formulas are so complicated, and the outcomes so varied, that it’s impossible to view the changes as any sort of rational leveling. Furthermore, built into the ongoing negotiations are state-specific sweeteners, meant to get senators on board. Alaska, for example, was offered a chance to keep some beneficial provisions of Obamacare in exchange for a vote to take them away from everyone else.

There goes reality, hopping past satire.

This year’s political horse-trading with health has been offensively, consistently careless. However you rationalize it, imposing wildly differing circumstances on a state-by-state basis exacts a human cost – a chaos that trickles down to real live human beings.

So: An increase of $1.2 billion goes to Idaho between 2020 and 2026, while $5.3 billion vanishes in Washington.

More than $6 billion more goes to Mississippi – an increase of about 150 percent! – while more than $8 billion disappears in Minnesota. Big ups in Kansas (61 percent) and Georgia (46 percent) and big downs in New York (-35 percent) and Oregon (-32 percent).

It’s winners and losers for now, as the votes are being purchased.

If enough votes sell, everyone loses.

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