As the latest rushed attempt to end the Affordable Care Act (ACA) collapsed last week, it took with it another casualty: U.S. Sen. Bill Cassidy's reputation. Cassidy, a mild-mannered physician, had insisted for months that he would hold President Donald Trump to his campaign promise that any health care replacement would have to be affordable, cover pre-existing conditions and insure more people. None of that made it into the GOP's latest repeal effort. The "Graham-Cassidy plan," sponsored by Cassidy and South Carolina Sen. Lindsey Graham, was widely agreed to be the worst repeal bill of all.
It was slammed by major medical organizations, some health insurance giants, physicians' groups and hospitals for its plan to turn over responsibility and most funding to the states while phasing out Medicaid dollars entirely. This was the bill that Cassidy and Graham sought to push through Congress in little more than a week.
Worse for them, the Graham-Cassidy plan was highly unpopular among voters. Only 20 percent of Americans approved of it, according to a CBS News poll. Not even half of Republicans thought it was a good idea. While 87 percent of respondents in the CBS News poll thought insurance companies should be required to cover pre-existing conditions (as did a whopping 79 percent of Republicans), Graham-Cassidy offered little protection; insurance companies would have been free to raise premiums to the point where they would be unaffordable to the majority of Americans.
Yet Cassidy felt comfortable enough to put his name and reputation on the line to defend it. Earlier this year, he appeared with late-night talk show host Jimmy Kimmel and declared that any legislation would have to pass a "Jimmy Kimmel test," named for Kimmel's advocacy for insurance that includes pre-existing conditions following the birth of his son, who has heart problems. When Kimmel noted that Graham-Cassidy met none of Cassidy's benchmarks, Cassidy claimed Kimmel didn't understand the measure. Other Republicans grumbled about Hollywood injecting itself into the dialogue — except it was Cassidy who happily appeared on Kimmel's show months before and appropriated Kimmel's name to promote the bill.
Even more brazen was the argument that the bill failed because Democrats didn't want to work on it in a bipartisan fashion. The GOP has vowed to undo the ACA since 2010 and has had seven years to come up with a workable replacement. That never happened, even as Republicans control both houses of Congress and have a president seemingly eager to undo the ACA no matter the details. After seven years of touting "repeal and replace," congressional Republicans delivered neither.
The ultimate irony: Cassidy's home state of Louisiana would have fared among the worst under his signature bill. Gov. John Bel Edwards and Health Secretary Rebekah Gee both wrote to Cassidy, outlining the gains the state has made since accepting Medicaid funds, including hundreds of thousands of newly insured citizens in one of the least healthy states in the nation.
"First, do no harm" often is cited as a fundamental tenet of medical practice. Graham-Cassidy would have done a great deal of harm to Americans had it passed. Instead, its only harm has been to Cassidy's reputation. Going forward, the admonition should perhaps be, "Physician, heal thyself."