Sep 21, 2017

Cassidy-Graham's potential trillion-dollar decision

The Cassidy-Graham bill sets up a terrible decision for conservatives down the line. Photo: Alex Brandon/AP

If the Cassidy-Graham health care bill becomes law, a future Congress is likely to have a horrible decision on its hands: somehow come to agreement on how to keep federal health care funding flowing to states, which potentially costs hundreds of billions of dollars; or let states lose all of the regulatory flexibility that led conservatives to support this bill in the first place.

The bottom line: "The message to Republicans is not to run for the Senate and be in the Senate in 2026, because you'll have a whole bunch of shitty votes to be taken," a senior GOP aide told me.

The arrangement, experts said, would set up a choice between a potentially multi-trillion dollar health care package, or an almost guaranteed death spiral in the individual market along with a reversion to many the Affordable Care Act's policies.

"If Graham-Cassidy passes, it would set us up for the mother of all health care debates in 2026," Larry Levitt of the Kaiser Family Foundation said.

The key provision: The Senate's bill, sponsored by Sens. Lindsey Graham and Bill Cassidy, would convert federal health care funding into block grants to the states. The bill also would make it much easier for states to waive some of the Affordable Care Act's insurance regulations.

Experts say it also ties the two together: Regulatory waivers only apply to insurance companies that receive some money from the block grants, or whose customers do. The block grants are set to expire in 2026. If they do, the waivers would vanish, too.

Go deeper: To preserve the block grant funding and, thus, the waivers, could cost a future Congress trillions of dollars. In 2026, block grants cost $190 billion, according to a Kaiser estimate. So even at a conservative growth rate, extending the block grants for another 10 years could come with a nearly $2 trillion price tag.

Yes, but: There's a budget rule that allows congressional budget committees and the administration to weigh in on whether the Congressional Budget Office assumes the block grants are temporary or permanent spending. If CBO is instructed to assume the latter (despite the bill clearly stating the funding ends), then Congress wouldn't have to pay to continue the block grants as long as they're frozen at the 2026 amount. It would, however, still have to pass a law — a very heavy lift given the politics.

On the other hand, let's say both federal block grants and state waivers expire. This probably means all of the ACA's consumer protection regulations would spring back into place, making health insurance more comprehensive and thus more expensive. But there would be no federal funding to help people purchase coverage. This is the classic recipe for a death spiral.

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Trump announces 30-day extension of coronavirus guidelines

President Trump announced on Sunday that his administration will extend its "15 Days to Slow the Spread" guidelines until April 30 in an effort to stop the spread of coronavirus, which has now infected more than 130,000 Americans and killed nearly 2,500.

Why it matters: Top advisers to the president have been seeking to steer him away from Easter as an arbitrary deadline for the U.S. to open parts of its economy, amid warnings from health officials that loosening restrictions could cause the number of coronavirus cases to skyrocket.

Go deeperArrow38 mins ago - Health

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 5 p.m. ET: 716,101 — Total deaths: 33,854 — Total recoveries: 148,900.
  2. U.S.: Leads the world in cases. Total confirmed cases as of 5 p.m. ET: 136,880 — Total deaths: 2,409 — Total recoveries: 2,612.
  3. Federal government latest: The first federal prisoner to die from coronavirus was reported from a correctional facility in Louisiana on Sunday.
  4. Public health updates: Fauci says 100,000 to 200,000 Americans could die from virus.
  5. State updates: Louisiana governor says state is on track to exceed ventilator capacity by end of this week — Cuomo says Trump's mandatory quarantine comments "panicked" some people into fleeing New York
  6. World updates: Italy on Sunday reports 756 new deaths, bringing its total 10,779. Spain reports almost 840 dead, another new daily record that bring its total to over 6,500.
  7. What should I do? Answers about the virus from Axios expertsWhat to know about social distancingQ&A: Minimizing your coronavirus risk
  8. Other resources: CDC on how to avoid the virus, what to do if you get it.

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Trump touts press briefing "ratings" as U.S. coronavirus case surge

Photo: Drew Angerer/Getty Images

President Trump sent about a half-dozen tweets on Sunday touting the high television ratings that his coronavirus press briefings have received, selectively citing a New York Times article that compared them to "The Bachelor" and "Monday Night Football."

Why it matters: The president has been holding daily press briefings in the weeks since the coronavirus pandemic was declared, but news outlets have struggled with how to cover them live — as Trump has repeatedly been found to spread misinformation and contradict public health officials.