The post below is an inventory of five separate analysis of the flow of funds between states under Cassidy-Graham-Heller-Johnson in 2026 compared to current law as projected by the Congressional Budget Office. I am collecting and collating the information.
Center for Budget Policy and Priorities is a liberal think tank. They use the 2016 budget baseline and attempt to approximate eligibility through the Current Population Survey. They analyse state funding swings in millions of dollars.
The New York Times uses Census, Kaiser Family Foundation, CBPP and CMS data to estimate per capita changes in expenditure by state in 2026.
Manatt is a program design and evaluation consulting firm. They are using 2017 as their cost baseline year with 2015 Medicare spending variations to simulate state level risk adjustment. I am using Table 1-A. They are evaluating just the change of federal flows to the state due to the block grants and not Medicaid. CBPP looks at both so it is an apples to kiwi fruit comparison.
Avalere is another consulting and analysis firm with their own estimates. They are looking at total cumulative swing with billions of dollars as their unit of account. Data is extracted from figure 1. I will just show direction as I can not merge that data consistently. If there is a figure of under $1 billion dollars, I am using $500 million as a placeholder.
Kaiser Family Foundation released their analysis on September 21. I am looking only at Table 1, which measures the change in ACA coverage elements (Medicaid Expansion and Exchange subsidies) for the time period 2020-2026.
My data is here. I show direction and size for CBPP, Manat, Avalere and direction only for the New York Times .
More analysis below the fold:
CBPP and the New York Times have the same sign in all cases. Manat goes in the same direction with 42 states when compared to CBPP/NYT and agrees with Avalere in 41 states. Avalere agrees with CBPP and NYT in direction forty eight times. Kaiser shares the direction of CBPP/NYT 46 times. Kaiser and Avalare share agreement 45 times while Kaiser and Manat agree 43 times.
Manat projects that California and New York see federal funds flow decrease by less than $5 billion per state for the block grants by $11 and $13 billion instead of the $28 and $19 billion dollars that these states would lose under the CBPP projections from the combination of block grants and Medicaid per capita caps.
There is going to be a lot of variance based on assumptions that are made for the baseline year, inflation rates, medical inflation rates and a variety of other factors. The impressive thing, to me, is the general agreement on direction by these five different methods.
Thanks for this, Mayhew.
Will spread the word.
Let’s face it — a huge part of why this legislation was proposed was to punish the states that accepted Medicaid expansion. Here in California, we’ve had a few hiccups, especially in less-populated areas of the state, but overall we’ve done very well and demonstrated that Obamacare can be used to get healthcare access to more people. And the Republicans fucking HATE that we proved them wrong.
That’s why they want to punish us, and New York, and Massachusetts, and every other state that has succeeded in getting more people health care.
I am always in awe at what it takes to do these kind of detailed analyses. Definitely above my pay grade but as a whole, humans are capable of so much. Just as I appreciate ballerinas for showing us how graceful we can be, what discipline we humans can muster, you policy analysts show us how smart we can be.
But I am discouraged today. Does it matter that we can show how awful Graham Cassidy will be if I can’t get through to any of Portman’s offices? To be fair, someone in the Cincinnati office picked up the phone and was immediately rude (You’re against? I don’t have time to talk!) and I wrote an email. But it is hard to advocate to a brick wall.
Potential cost increases by state:
– AK: $31,790
– AZ: $22,074
– ME: $16,437
– WV: $18,462
That’s simply unaffordable. https://t.co/4PG57017Vr
— AARP Advocates (@AARPadvocates) September 21, 2017
OT, but important.
This is what ICE looks like making a stop after monitoring a US citizen leaving a county courthouse.
Tell me we’re better than this.
This Akron Beacon Journal editorial is [email protected] has no biz voting for G-C. It would be awful for Ohio.https://t.co/TpJbN6jkg3 pic.twitter.com/wc5LgBa61y
— Chad Bolt (@chadderr) September 21, 2017
@Mnemosyne: I keep saying this: There are 24 House reps from New York, New Jersey and California, and that number goes up substantially if you add Pennsylvania and Illinois. Something like 44. Those five states are screwed by this bill and they make the difference between Republicans retaining power. Right now, this bill is in the Senate, and that’s where energy should be directed by people living in NV, CO, WV, OH, PA, AK, ME, and AZ. But really, it’s not too early to call the offices of Darrell Issa and his fellow travelers ALL OF WHOM VOTED FOR THE HOUSE VERSION and ask whether they now represent the interests of Alabama, Mississippi, Texas, etc. rather than the California voters who put them in office. Same for Macarthur who was instrumental in getting the House version passed, along with Peter King and all of their band of merry traitors to their own states. PA is really gerrymandered, but this is the kind of body blow that might defy gerrymandering.
Thanks very much for the hard work behind this. One point, though: isn’t there really a third scenario to compare against: i.e., the one in which red state lawmakers think of their own citizens’ needs and just accept the ACA’s Medicaid expansion dollars?
@Mnemosyne: The other part is giving Red States the narrative that yes, Obamacare stank but look how much dough you are rolling in now thanks to the Republicans in Congress and Trump. We’re MAGA-ing!
Now all of us here know that is a total distortion but they are stupid selfish pricks by and large. They are going to eat that version up.
it’s very important.
How about contacting Congressmen, asking them why they would be in support of a bill that would take 9 billion away from Ohio?
Trump isn’t the only one fibbing about the GOP’s health care plan
09/21/17 12:45 PM—UPDATED 09/21/17 12:49 PM
By Steve Benen
Donald Trump declared via Twitter last night, “I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does!”
It doesn’t! It’s probably unrealistic to think the president has spent a meaningful amount of time scrutinizing the details of the legislation he’s eager to sign, but Trump’s assurance is plainly untrue. In fact, there’s no real ambiguity here: the Affordable Care Act guarantees protections for Americans with pre-existing conditions, and the GOP’s Graham-Cassidy plan eliminates that guarantee.
Of course, the president trying to deceive the public about policies he doesn’t understand is, alas, a common occurrence. What’s worth appreciating, however, is that Trump isn’t the only one selling the Republican plan with bogus claims. Yesterday, for example, Sen. Bill Cassidy (R-La.), one of the principal architects of the GOP legislation, said under his plan “more people will have coverage” than under the Affordable Care Act. Is that true? The Washington Post took a closer look:
Vox added that there is “literally no analysis” to bolster Cassidy’s claim. (The Congressional Budget Office could provide lawmakers with a more detailed analysis, but Senate Republicans aren’t prepared to wait until the full CBO score is ready.)
The Sponsors Of Obamacare Repeal Are Trying To Fool America — And Fellow Republicans
Here’s what they’re not telling you, or their colleagues, about the bill.
By Jonathan Cohn
The bottom line is that the Graham-Cassidy bill is like every other repeal proposal that’s come before Congress this year. It would mean millions more people struggling to get care or being exposed to financial hardship. And it’d most certainly hit some Republican-leaning states hard.
What Graham-Cassidy would actually do
Graham and Cassidy are telling the truth when they say their proposal turns control of the Affordable Care Act to the states. Specifically, they would transform the program into a “block grant,” giving states enormous leeway over how to spend the money that, in today’s system, goes to finance expanded Medicaid programs and subsidized private insurance.
But the proposal actually does a great deal more than simply give states more control over how to spend dollars now going to health care. It also gives them less of that money to spend.
On the whole, the block grant would be smaller than what states would receive if the Affordable Care Act remains in place. That is very much by design, because Graham and Cassidy want to reduce federal spending. But the cut would be substantial ― to the tune of $239 billion over the first 10 years, according to the Center on Budget and Policy Priorities, which so far is the only independent organization to conduct this kind of analysis.
[email protected] is all over TV grossly misrepresenting impacts of #GrahamCassidy
We made a myth/fact table debunking him
Pls share widely pic.twitter.com/Z8qtgMriv2
— igorvolsky (@igorvolsky) September 20, 2017
Here is the link:
mai naem mobile
Jeff Flake was on Colbert last night and he said that Mass and NY spend way more per capita than many other states . Is that true or was he lying? I expect NY and Mass to be a little higher because of the cost of living but Flake clearly implied they were way beyond that.
@Mnemosyne: Except one of the concerns – and a fair one – by Republicans and insurers:
They aren’t worried about ‘states’. If Vermont went single payer it wouldn’t much matter to the country. If California did, however, that’s a game-changer. We have the votes here to do it, what we lack is a plan and the cash. Block grants eliminate the need for waivers, and even if there is a shift in dollars out of the state, it would still leave California with enough money to pull some sort of single payer plan together. If the biggest state in the country, with both massive urban and rural areas, with agriculture and manufacturing and tech, high and low income, and all that is able to pull off single payer, then it would be easier (and cheaper) for any given state to do it and cheaper per capita for the country to do it. I mean, I hope the bill is defeated, but California could actually make lemonade out of this bucket of piss.
@mai naem mobile:
Lying like a muthaphucka.
New York is always expensive.
And Massachusetts is one of the premier medical hubs in the country. Had a friend who lived in Boston for 4 years – hated it, but said, if you were sick, there’s no place better in America.
To be eligible for reconciliation I thought a bill had to have a CBO score to establish its effect on the budget. The CBO score won’t be ready this week and they plan on voting on the bill anyway. I guess I misunderstand — but weren’t they waiting for a CBO score for the other bill earlier this year, and when it came out it hurt the chances of the bill being passed? What’s different?
Saw this comment at LGM (in response to a discussion about the RW forever trying to dismantle the safety net):
@mai naem mobile: Avg subsidy is $272 per month nationally. Alaska $536, Wyoming $425, CT is $361,Mississippi $351, CA $303.
MA $187, New York $224.
New York is below the national average by a bit less than CT is over. That said, these are also the states putting in big Cadillac tax dollars along with CA to subsidize Wyoming and Mississippi. AK probably puts in a fair bit as well given the nature of their job market.
Also should be noted that states like CA also put in 10s of billions in state taxpayer funded healthcare subsidies which help reduce the outlay from the feds.
mai naem mobile
Called McCains offices on Mon and Tues and didn’t get through . Called multiple times yesterday and finally got through to the DC office and the girl was in a hurry to hang up. Called today to Phx office today and got through right away. Girl even had time to ask me for my zip . Hope this doesn’t mean that people aren’t calling.
Yes…should be asked.
From the Economic Policy Institute:
Cassidy-Graham is a horribly destructive bill. It is a ticking time bomb that will end up repealing the ACA with no viable replacement. It’s worse than even the terrible pre-ACA status quo, with Medicaid cuts falling on the backs of the poorest American families. It is structured explicitly to juke a CBO score, putting off its most savage cuts until 2027. Since they cannot start the huge Medicaid cuts right away (again, juking the CBO score means they need to wait 10 years), the architects of Graham-Cassidy put in provisions to make the next 10 years a completely partisan redistribution of shrinking federal government funding from blue to red states.
“Graham-Cassidy: Maybe the worst Republican health proposal yet”
I was just reading about the bill’s elimination of all Obamacare spending in 2026, and it occurred to me – is this bit intended to play games with deficit neutrality for their forthcoming tax cut bill? It’s the only thing I’ve heard about in the bill that has that time frame. It makes me think about how under reconciliation tax cuts that aren’t deficit neutral can’t be permanent (renewal vote after ten years), so maybe having that spending end right at that mark will allow them to make tax cuts permanent, without taking the political hit for cutting spending now. Can someone more knowledgeable confirm/debunk?
Evil on top of evil…
@Redshift: You should link that for David.
Evil on evil, and plausible. I would not put anything past these sociopaths. Many of them have likely studied how to game the system, for years, and take advantage of their vehicles as they occur.
ETA: Best to you, for your health. May that become a pre-existing condition that is no longer a condition.
I don’t think that’s really true. The primary purpose of the legislation is and remains to cut spending to pay for a massive tax cut. Graham-Cassidy is a little bit cleverer than previous versions in that it’s designed to do that while still marginally boosting spending in states that declined expansion so it might look like a decent deal to those states’ senators.
@Ohio Mom: I spoke with Portman’s office in Cleveland and they were very polite. Said he was still deciding. I listed who all was against the bill including the governor and myself of course and many health orgs. Staffer asked for my info again and said he would pass on to the senator.
Its how the Not At All Ambiguously Gay Duo is selling it to their fellow Republicans.
Taking money away from blue states and giving it to uncooperative red states is one of the upsides of their plan, according to them.
The CBO score used to justify the bill for reconciliation will not have actual numbers in it, but under the rules will technically qualify as such.
There’s still the need to deal with Prop 98 mandates, which have been one of the biggest things standing in the way of single payer. Like it or not, adding that much spending would require amending the state constitution, so it isn’t going to happen easily or quickly.
I hope Mayhew sees your comment, and writes more.
If you tweet, could you tweet it to:
Maybe they can answer the question for you.
9 BILLION DOLLARS
that’s how much Ohio will lose.
I don’t say this enough – maybe we as a community don’t say this enough – but I am so glad we have you here at Balloon Juice doing this kind of work and analysis.
FWIW I’ve been calling our R senator, the Governor; I’ve even called Collins and Murkowsky to thank them for saving us once before and to save us again.
Both Florida and Texas, huge states, are recovering from hurricanes, and *now* is when these guys are trying to pass this legislation.
Its not possible that is is ideology…its all greed — gotta get those tax cuts; destroying Medicaid is just icing on the cake.
@rikyrah: I called all three of my Rep’s offices yesterday. They are still answering the phone, unlike Portman’s crew. The Rep is a tea-partied so calling him is a fool’s errand.
Portman did vote No on one of the three votes this summer. If you squint and turn your head at just the right angle, it is almost possible to imagine him voting No.