EDITORIAL: Rob Portman approaches another chance to do what he says

Sept. 20--U.S. Sen. Rob Portman has made much of his desire to see changes in the Affordable Care Act that improve access to health coverage. The Cincinnati Republican shares stories about Ohioans facing costs beyond their reach, denied, essentially, the insurance they deserve. At the same time, he has been a team player, sticking with his caucus leadership even as it advances legislation far short of what he says he wants.

Soon, Portman may get another chance to provide the profile in courage he has ducked, or match actions to his words.

U.S. Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina are pushing the latest version of repeal and replace. Actually, in this instance, the better description is repeal alone, the legislation representing a return to the days before the Affordable Care Act, and even worse, given the proposed reductions in Medicaid.

Cassidy and Graham began their effort not too long ago talking about a moderate alternative. Now the bill may be the most extreme put forward by Republicans in Congress.

Consider that it would end the marketplace subsidies that help those with low incomes to pay for health insurance. It would eliminate the enhanced federal matching funds for the Medicaid expansion. Instead, states would receive a block grant at a reduced funding level, and the block grants would expire in 2027.

Add to the equation that federal funding for traditional Medicaid would move to a per-capita basis, the annual increase below the projected inflation rate for health care. The Center on Budget and Policy Priorities calculates that Ohio would see a reduction in federal funding of $2.5 billion in 2026 and then $10.2 billion in 2027, when the block grant ceases.

That translates to fewer with health coverage, more than likely exceeding the 32 million nationwide projected earlier by the Congressional Budget Office. The Cassidy-Graham bill not only would end the individual mandate. It would ease protections for those with pre-existing conditions, allowing states to shrink "essential benefits."

Ohio would feel the squeeze as the legislation routes resources from Medicaid expansion states to those that did not participate, punishing, in effect, states for doing the right thing.

Disrupt the individual market. Whack Medicaid, the poor and vulnerable harmed, one of two children in Ohio covered by the program. Why are Portman and colleagues moving in this sorry direction? They face a deadline of Sept. 30, when their authority to act with 51 votes expires.

The trouble is, Republicans promised repeal yet still haven't come together on a coherent and workable replacement. Now they are rushing to do something, casting aside hearings, debate, CBO scoring or what goes into crafting sound legislation.

They also are missing an opportunity in the bipartisan work of U.S. Sen. Lamar Alexander. Unfortunately, the Tennessee Republican has watched the collapse of his effort to repair the insurance exchanges. It did so despite the urging of governors, Democrats and Republicans, who recognize a way to achieve what Rob Portman says he wants -- improved access to adequate and affordable health care.

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