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Wall Street Journal / Life - Entertain

Graham-Cassidy vs. The Swamp

If the bill is so bad, why do lobbyists need to wage a phony campaign against it?


James Freeman

Whatever else it does, the health reform crafted by Republican Sens. Bill Cassidy and Lindsey Graham shifts money and power out of Washington. And the swamp is not pleased. But as angry as Beltway inhabitants are to see this idea get a fair hearing, their reaction suggests that the substance of the bill isn’t all that bad. How else to explain their argument against it?

In recent days, bill opponents have focused on demonstrating that just about every big lobbying group that traditionally influences federal health policy is dead-set against Graham-Cassidy. Insurance companies don’t like it. Neither do hospital chains. And neither do well-funded nonprofit organizations named after diseases.

The Washington Post has helpfully compiled a list of all the seemingly well-intentioned interest groups that oppose the Graham-Cassidy reform. A reporter who set out to make a list of all the seemingly well-intentioned associations, foundations, coalitions and councils that helped create an unaffordable entitlement state with limited patient choice might end up with a similar list.

But as influential as all the members of the Beltway health policy establishment are, in recent days one organization on the list has been particularly celebrated by Graham-Cassidy’s opponents. On Thursday night former Obama health policy boss Andy Slavitt tweeted: “BREAKING: The bipartisan Medicaid Directors from all 50 states just issued this negative statement about Graham-Cassidy. Big. Very unusual.”

Mr. Slavitt included a picture of a letter from the board of something called the National Association of Medicaid Directors, which purports to represent officials from all 50 states plus the District of Columbia and five U.S. territories. This organization did indeed issue a letter critical of the bill, which would seem to be big news. If lawmakers craft a plan to transfer money and authority to states and every single state rejects the idea, that’s a fairly good indicator that there’s something wrong with the plan.

But interestingly, the picture of the letter tweeted by Mr. Slavitt last week does not appear to include a bolded statement that now appears at the top of the current version of the letter on the group’s website:

This statement represents the consensus of the NAMD Board of Directors, but is not intended to communicate the unanimous position of all 56 members.

So, we’re actually talking about an opinion that is definitely shared by officials from 11 states plus American Samoa. Wait, that’s not quite right, because there’s that vague word, “consensus.” The vote on the board was not unanimous. “Consensus for us is defined as a 2/3 super majority vote of the Board members. We have 12 members and so an affirmative vote of at least 8 is necessary for us to declare that a consensus of the Board. Which is what the Graham Cassidy statement was,” writes the organization’s Matt Salo in an email.

In just a few days the story has moved quite a distance from Mr. Slavitt’s declaration of a 50-state landslide, which was such striking news—albeit fake news—in part because more than a dozen governors have endorsed Graham-Cassidy. This raises the question of who exactly the National Association of Medicaid Directors is representing, if not executive branch officers in state government, reporting to duly-elected leadership.

If the outfit is expressing the personal views of un-elected people who work in state government and not necessarily the official policies of the people that voters did elect, then voters shouldn’t be forced to pay for it. Via email, Mr. Salo describes his group’s funding this way:

About 20% comes from state agency dues, which are paid by the Medicaid agency and not the individual directors About 25% comes from a couple of grants/contracts with foundations (Commonwealth Fund and Robert Wood Johnson) Most of the rest comes from proceeds of the Fall conference we put on in November each year... Of the 900+ attendees we have at the conference, only about 100 or so are state government employees. We tend to waive the registration fee for them in a lot of instances, but if not, I suspect it’s the agency paying for it. The remaining attendees span the gamut of “everybody else” in the health care system, and I suspect most of them have their employer pay the reg fee.

If the association is willing to put out statements like the one it issued last week, it will find plenty of swamp-dwellers willing to pay the fee.

As for Graham-Cassidy, its impressive accumulation of enemies has this column thinking it must have significant upside for both taxpayers and patients.


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