WASHINGTON — A late-night skewering by comedian Jimmy Kimmel of the health care overhaul being pushed by Sen. Bill Cassidy, R-La., and the senator's round of replies on cable TV news painted two fundamentally different descriptions of the plan.

In Tuesday's opening monologue, the "Jimmy Kimmel Live" host lit into Cassidy, charging that the senator’s proposal to repeal and replace the Affordable Care Act, or "Obamacare," would strip accessible health insurance from millions, as well as jack up rates and potentially deny coverage altogether for those with pre-existing medical conditions.

“He is wrong,” Cassidy fired back Wednesday morning on Fox News, disputing nearly every claim Kimmel made about the plan the night before. “It will increase coverage and it will protect those with pre-existing conditions, particularly for those in states that have not had the benefits of Medicaid expansion.”

On Wednesday, Kimmel fired back again, doubling down on his criticism of the bill. He mocked Cassidy’s claim that he “does not understand” the bill and called the proposal “the worst health care bill yet.”

Can't see video below? Click here


The contentious back-and-forth between Kimmel and the Louisiana Republican senator highlights far broader confusion over the precise implications of the 140-page bill and how little is settled about its impact on state budgets, health insurance markets and government-backed medical care for the poor and disabled.

The core idea of the plan is relatively simple. It would leave many, but not all, of the health care law's taxes in place but repackage the billions of federal dollars in funding for the Medicaid expansion and insurance subsidies on the individual exchanges into flexible block grants for states.

Doing so means federal dollars from states that expanded Medicaid — including Louisiana — would generally be redistributed to the 19 non-expansion states — like Mississippi and Texas — through a  complex formula devised by Cassidy along with the plan’s co-author, Sen. Lindsey Graham, R-South Carolina, and co-sponsors, Sens. Ron Johnson, R-Wis., and Dean Heller, R-Nev.

Though the bill has been in the works since July, its full text was publicly released just a week ago. Senate Majority Leader Mitch McConnell intends to hold a vote next week, just ahead of a Sept. 30 procedural deadline for it to pass the U.S. Senate on a simple-majority vote.

Fine print

The finer print in the plan, however, has left backers and critics firing back and forth on a number of points. Chief among them is whether Graham-Cassidy would open the door to insurers charging those with health conditions higher premiums or deny them coverage, a much-maligned practice that was outlawed by the Affordable Care Act.

The Graham-Cassidy plan keeps protections for those with pre-existing conditions — but with one notable, and contested, exception. The bill allows individual states to seek waivers from that and other regulations, potentially allowing insurers to charge sick people more for insurance.

Opponents, including Senate Democrats, have seized on that language to rail against the bill. Kimmel highlighted the loophole in charging that Cassidy’s plan flunks the so-called “Jimmy Kimmel Test,” a standard Cassidy himself devised following a tearful plea by Kimmel earlier this year to maintain the health care law's safeguards. Kimmel was inspired to speak out after his newborn son's costly surgery for a heart defect. 

“This guy, Bill Cassidy, just lied to my face,” Kimmel said Tuesday night. 

Cassidy vehemently denies that, pointing to language that would require any state seeking a waiver to demonstrate how it will “maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions.”

That language doesn’t rule out higher premiums or limited coverage, however, and hinges in part on the interpretation of “adequate and affordable.”

Counting coverage

Just how to calculate the scale of the cuts — and what baseline to compare them to — has also proved contentious, with critics and proponents each pointing to figures that differ in some cases by billions.

The nonpartisan Congressional Budget Office, a government office charged with evaluating the impact of proposed legislation, hasn’t yet analyzed the proposal. The CBO hopes to have a preliminary report next week, but estimates of how many people might gain or lose coverage under the plan — or its effect on the federal deficit — won’t be ready for several more weeks.

Cassidy, Graham, Johnson and Heller have repeatedly touted numbers compiled by Cassidy’s office showing many states pulling in more dollars under the plan.

But think tanks opposed to the health care overhaul rejected those figures, claiming they distorted the proposed law’s actual impacts and significantly understate the size of the likely cuts to states and, therefore, how many people will stay insured.

Cassidy and Graham are using “extremely misleading numbers and arguments,” analysts with the left-leaning Center on Budget and Policy Priorities said Monday in a conference call with reporters. The think tank has roundly criticized the plan in several recent reports, predicting it would cause millions to lose health insurance and lead to staggering cuts in federal health care dollars for many states.

Avalere Health, a consulting firm, released its own analysis Wednesday, predicting the Graham-Cassidy plan would slash more than $215 billion in federal health insurance funding through 2026 — and even more after that. Its study was funded by the liberal Center for American Progress.

Projections for Louisiana are a case in point. Cassidy has said on several occasions that Louisiana would break roughly even in terms of federal health care funding under the proposal. The Center for Budget and Policy Priorities, however, found Louisiana stood to lose more than $3.2 billion in federal funding over the next decade. Avalere Health painted an even gloomier picture, pegging the drop in federal dollars at $8 billion over that time period.

Cassidy has blasted the calculations, telling a reporter with The Advocate on Tuesday that the CBPP report was a “total hit piece.”

The group, Cassidy said, “misrepresent numbers all over the place” and is a “left-wing organization which is trying to sabotage (Graham-Cassidy) because they want to protect Obamacare.”

Part of the gaping difference between the numbers appears tied to how the size of cuts or increases are calculated. Many of Cassidy’s numbers apparently compare the size of future block grants to the amount of money states received in 2017.

Other groups analyzing the proposal have compared those figures to the amount of money states are projected to receive under current law, factoring in likely significant growth in Medicaid spending. Doing so makes the block grants — which won’t grow as quickly as federal healthcare funding under current law — appear far less generous in comparison.

Cassidy, Graham, Johnson and other backers of the proposal, however, have described Medicaid and the Affordable Care Act as wildly unsustainable, with spending growth destined to crowd out all other federal budget priorities. Cassidy called the program a “black hole” while speaking at the Baton Rouge Press Club in August.

Graham, pitching the proposal on the floor of the U.S. Senate on Sept. 14, likened Medicaid expansion dollars to “crack cocaine” for budget-conscious state governors. “The system is going to collapse in Washington. There is not enough money to keep it afloat.”

“This is a chance for you, at the state level, to have control over funds,” Graham added, “and for us to be as flexible as we possibly can be in our designing systems that make sense for your states.”

Follow Bryn Stole on Twitter, @BrynStole.