Mr. President, A Word About Obamacare And That Electoral Map You Like So Much...
Credit: Avalere
September 23, 2017

The Kaiser Family Foundation has a new report on the likely winning and losing states if the Graham-Cassidy healthcare bill is passed. Something jumped out at me in this Talking Points Memo story about the Kaiser report:

Overall, the report estimates, states would see $160 billion less in federal health care funding over the next decade under the proposed law, with 35 states and D.C. losing federal dollars. But Medicaid expansion states would bear the heaviest burden by far, losing 11 percent of federal support on average. Republican-controlled states that did not expand Medicaid, however, would get an average increase of 12 percent.

The biggest losers under the bill would be high population, progressive states. California, New York, and Pennsylvania would lose $56 billion, $52 billion and $11 billion dollars respectively.

California and New York, sure -- it's no surprise that President Trump and congressional Republicans would want to punish those bastions of liberal depravity. But Pennsylvania? One of the beacons of glowing red on the president's much-beloved electoral map?

A check of the Kaiser numbers also shows that Michigan -- another of Trump's red gems -- stands to lose nearly $5 billion between now and 2026.

Wisconsin didn't go for the Obamacare Medicaid expansion, so it's expected to gain nearly $3.5 billion. But another state Trump won by an eyelash, Florida, stands to lose more than $7.5 billion. North Carolina -- another close one for Trump -- is expected to lose $5.7 billion. Minnesota -- which Trump nearly won and which he probably thinks he could win in 2020 -- will lose more than $8 billion.

All so solidly red states can get more, as TPM notes:

The biggest winners would be the deep red South: Texas would see $34 billion more, and Georgia, Tennessee, and Mississippi would see $10 billion, $7 billion, and $6 billion bumps respectively over the first decade.

And these changes start taking place in ... 2020.

However, Jonathan Chait has pointed out that the law allows for tinkering with the numbers:

... starting in 2020, the secretary of Health and Human Services is authorized to adjust the formula “according to a population adjustment factor developed by the Secretary.”

The bill says that adjustment must be based on “legitimate factors,” but otherwise places no specific limitations. So, if President Trump wanted, say, to reward a political loyalist or punish a political foe, he could order the secretary to come up with any facially plausible reason to shift around money as he sees fit.... A Republican senator who gets too nosy about, say, the Russia scandal might suddenly learn that his or her state’s health-care needs were less serious than previously believed.

So maybe this will all be tweaked in the interests of salvaging Trump's 2020 electoral map.

Crossposted at No More Mr. Nice Blog

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