Arizona Sen. John McCain gives a thumb’s down to a Republican repeal and replace health care bill July. He has already said he will vote against a new proposal. This is the last week for the Senate to consider health legislation under a rule that requires only 50 votes, instead of 60. (YouTube photo).
The Senate continues to explore legislation to repeal and replace the Affordable Care Act. Under the rules, this is the last week the Senate can pass such a measure with only 50 votes.
This is Trahant Reports.
This is the bill that won’t die. Remember in July Arizona Sen. John McCain dramatically walked on the Senate floor to cast his “no” vote.
But led by Senators Lindsey Graham and Bill Cassidy there is another version. This one has an odd twist, a plan to lift the “burden” of Native American health care off of states.
So here’s the deal now: When an eligible Native American gets services through the Indian Health system, the cost is a 100 percent federal obligation. But, if that person or family is on Medicaid they could also get care from any provider. In that case the state would have to pay its share of the cost as it does for any other citizen.
The new legislation would change that by making this cost a 100 percent federal obligation. States would be off the hook.
This is where it gets screwy.
There are legitimate state concerns — basically it’s a complicated maze to figure out a patient’s path and how the money follows. But it’s still a benefit for states because Native people are citizens and so a full-federal match for most costs is a net gain.
South Dakota (a state that did not expand Medicaid) figures to gain $795 million from a block grant program under this bill but would still lose a significant share of its health care funding between 2020 and 2026, according to the Kaiser Family Foundation.
I can’t believe I am saying this sentence, but Sen. Mike Rounds told South Dakota Public Radio that the state wins because it would get a “large chunk of funds would cover 100 percent of the health care costs for Native Americans who receive Medicaid. Right now, the Affordable Care Act requires a state match.”
This is a fraction of what the state will lose, so this is nonsense that Native health care is a burden. (Remember this cost is only for tribal citizens who do not use Indian Health Service, a small slice of the population.)
South Dakota is not alone. Arizona has also complained about its burden.
A policy advisor to the governor told The Arizona Daily Star that the Senate bill would “free the state of its financial obligations to share the cost when Native Americans get care at non-Indian Health Service facilities,” she said she “could not say what that number would total other than ‘it’s a very large number.’”
There are 52 Republicans in the Senate and already two have said no, including McCain. That means one more and this bill is over and the next round will have to include Democrats in order to meet a 60 vote requirement.
I am Mark Trahant