The Persistence of Persistence

Here in Hollywood it’s good to know what’s what. In the eighties the Disney-ABC-ESPN folks bought the old El Capitan Theater on Hollywood Boulevard – a giant rococo flight of fancy from 1926 – and reopened it in 1991 with the premiere of The Rocketeer – a hoot of a movie playing on every cliché about Old Hollywood imaginable. They also bought the adjacent 1921 Hollywood Masonic Temple – now the El Capitan Entertainment Center operated by Buena Vista Theaters, a subsidiary of Walt Disney Studios Motion Pictures Distribution. Since 2003 the theater there has been the home of Jimmy Kimmel Live!

That made Jimmy Kimmel the King of Hollywood. He tapes segments on the street outside the front door. They built him a giant stage in the parking lot out back for outdoor pop bands – across the street from the Hollywood High School football field. The kids love it, and the last time Taylor Swift was a guest they built a giant stage right in the middle of Hollywood Boulevard so she could do her thing. That shut down the boulevard and all the adjacent streets, causing traffic nightmares – the show tapes at five in the afternoon. Those of us who live here were pissed – but Jimmy Kimmel is the King of Hollywood. The rest of us are just peasants.

This is his town, except Grauman’s Chinese Theater was recently purchased by a Chinese entertainment conglomerate – which is fitting – and the Church of Scientology bought up most of the remaining historic Hollywood buildings and has restored them to perfection. The preservationists are begrudgingly grateful. Those are strange folks, but they do good architectural work, so maybe this is Tom Cruz’s town. Maybe Tom Cruz is the King of Hollywood, even if he is a small irritating little man. All Scientologists are irritating.

That’s why it’s good to know what’s what. This is a struggle to control pop culture – Disney versus the Scientologists versus the Chinese and all the rest. Someone has to define what everyone thinks, or should think, about what’s funny and what’s not, and what’s cool and what’s not, and what’s important and what’s not. Political junkies and policy wonks follow the news. Evangelical “values voters” talk about what Jesus would do. Others worry about social justice. Everyone else watches the late-night shows now and then.

Someone’s got to win this thing and as Elahe Izadi, a pop culture writer for the Washington Post reports, Jimmy Kimmel made his move:

Several minutes into his opening monologue Tuesday night, Jimmy Kimmel said what so many of his viewers were probably thinking:

“Health care is complicated. It’s boring. I don’t want to talk about it. The details are confusing.”

But he went on to make the case against the latest GOP health-care proposal, urging viewers to call their representatives to lodge their displeasure and even accusing a sitting senator of lying to his face.

That’s not funny or cool, but it is important:

Kimmel spent seven minutes delivering a blistering monologue devoid of jokes but full of attacks on the Cassidy-Graham health-care bill. The late-night comic wasn’t there to get laughs. He was there to get his audience riled up – again.

His first monologue on the issue came in May, when he spoke about his son being born with a congenital heart disease and said that he wanted political leaders to make sure people with preexisting conditions could get affordable health care. It touched a chord that no other late-night comedian had managed to during the Trump era. While he and many of his peers make their distaste for President Trump clear through biting jokes night after night, it took Kimmel’s from-the-heart style to actually influence a policy debate.

The struggle to control pop culture had broadened:

The clip of Kimmel’s latest monologue went live online before his show went on air, lighting up Twitter. Interest groups immediately sent the clip out in email blasts. Democratic members of Congress pushed out the video.

“Jimmy Kimmel more effectively framed the insanity of this issue than any elected Democrat I’ve heard speak on it,” historian and Politico Magazine contributor Joshua Zeitz tweeted.

That’s the power of pop culture:

Kimmel’s approach has had an impact in part because it’s so personal. He’s publicly cried over the issue. He’s trying to make a common-sense argument, and he’s doing it during a segment where audiences expect the day’s best jokes.

His first monologue sparked a flurry of political op-eds, cable-news roundtable discussions and fact-checking. His name ended up on front-page newspaper stories about health care. Trump administration officials invoked Kimmel, and were probed with questions about Kimmel’s points.

And the irony is that on Tuesday, Kimmel went after a new proposal authored by the very senator who helped bolster the late-night comic’s role in the health-care debate: Sen. Bill Cassidy (R-La.).

Kimmel was on the attack:

Back in May, Cassidy rode the viral wave of Kimmel’s first monologue, going on cable TV news shows and insisting that with any new health-care proposal, “I ask, does it pass the Jimmy Kimmel test? Would a child born with congenital heart disease be able to get anything he or she needs that first year of life? I want it to pass the Jimmy Kimmel test.”

Then the Louisiana Republican appeared on “Jimmy Kimmel Live” himself. “Thank you for naming a test after me!” Kimmel said. “I always figured if I’d have a test named after me, it’d be for some embarrassing, sexually transmitted disease.”

The two then had a pleasant exchange. “Obviously, this is someone who cares about people’s health,” Kimmel said. Cassidy got applause from Kimmel’s audience after he urged people to call their lawmakers, Democratic or Republican, and ask them to work on an “American plan.”

“We’ve got to have insurance that passes the Jimmy Kimmel test,” Cassidy insisted.

That was a mistake:

Five months later, Kimmel went back on air to call out the senator. “This guy, Bill Cassidy, just lied right to my face,” Kimmel said Tuesday.

“Stop using my name. Okay? Because I don’t want my name on it,” Kimmel continued. “There’s a new Jimmy Kimmel test for you – it’s called the lie-detector test. You’re welcome to stop by the studio and take it anytime.”

As Kimmel highlighted, the bill gives states near total power on how to govern their health insurance markets, and it lets states apply for waivers to effectively allow insurers to charge people with preexisting conditions more.

Cassidy’s office released a statement that didn’t directly address Kimmel’s arguments. “We have a September 30th deadline on our promise. Let’s finish the job,” he said.

“I am sorry he does not understand,” Cassidy said. He also told reporters on the Hill that his proposal “absolutely” passes the Jimmy Kimmel test and labeled the monologue as a “personal attack.”

The King of Hollywood was having none of that:

Kimmel, predictably, is facing some pushback among those who also don’t think he gets the healthcare debate, or that he’s just another rich Hollywood liberal trying to lecture Americans. But the late-night host, who faced some nasty comments back in May, preemptively addressed the criticism he knew was coming – and, with a bit of humor.

“Before you post a nasty Facebook message saying I’m politicizing my son’s health problems, I want you to know: I am politicizing my son’s health problems because I have to,” Kimmel said at the conclusion of his Tuesday monologue. “My family has health insurance. We don’t have to worry about this. But other people do, so you can shove your disgusting comments where your doctor won’t be giving you a prostate exam once they take your health-care benefits away.”

This has moved beyond Hollywood – most things do – and Politico’s Dan Diamond weighs the evidence here:

Experts say that Cassidy and Graham’s bill can’t guarantee those protections and that Kimmel’s assessment was basically accurate because of the flexibility the bill gives states to set up their own health care systems. For example, health insurers could hike premiums for patients with pre-existing conditions if their states obtain waivers from Obamacare regulations – as Kimmel said.

Cassidy’s plan “would pave the way for insurers to deny coverage to people with a history of medical conditions,” five HIV/AIDS groups warned in a joint statement on Tuesday.

The bill would also roll back the Affordable Care Act’s Medicaid expansion and make other funding changes, like converting Obamacare funds into block grants and ending traditional Medicaid as an open-ended entitlement that would force states to choose whether to cut Medicaid enrollment, benefits or payments to providers – or else raise taxes.

“Graham-Cassidy, like the previous Senate ‘repeal and replace’ proposals, takes a fiscal crowbar to Medicaid’s knees,” warned Georgetown University’s Center for Children and Families. Those cuts could disproportionately affect children, program director Joan Alker added.

“Kimmel did not overstate the impact,” Alker said. “If Graham-Cassidy becomes law, there is no guarantee a child born with a congenital heart defect will get the coverage they need. It would depend on where they live, but even states with good intentions would struggle to protect children with the massive cuts to Medicaid included in this bill.”

It seems the guy from Hollywood was right, and there’s more:

The proposal’s significant cuts to Medicaid and other changes to the ACA’s regulations would lead to dramatic reductions in coverage for adults too, analysts say.

“It is likely that the bill, if enacted, would lead to a loss of health insurance for at least 32 million people after 2026,” the left-leaning Commonwealth Fund’s Sara Collins wrote in a post on Wednesday, citing Congressional Budget Office analysis of similar legislation.

But that’s a problem:

The CBO, usually the authoritative source on such questions, said Monday that it would not be able to answer them on this bill “for at least several weeks” – long after the Sept. 30 expiration of the reconciliation bill that allows Republicans to pass the measure with a simple majority.

Everyone will be flying in the dark on this, but Kevin Drum sees this:

I suppose you have to give Republicans credit for persistence: they’re now trying yet again to repeal Obamacare. The first attempt ended when Paul Ryan couldn’t round up the votes in the House. The second attempt ended when Mitch McConnell couldn’t round up the votes in the Senate. Now we have Graham-Cassidy, which is considerably worse than either of the first two. Literally its only selling point is that it’s not Obamacare.

So we get this:

The plan for passage is similar to Repeal 2.0: do it fast before the CBO can tell us how many people would lose health insurance if it passes. But we don’t really need the official CBO score for that since we already know that Graham-Cassidy would eliminate the individual mandate and slash spending on Medicaid. Those two things account for the vast bulk of CBO’s score, which means that its score of Graham-Cassidy will be very similar: about 23 million people would be tossed off their insurance plans over the next decade.

But could it be even worse? Sure. Graham-Cassidy also eliminates protections for pre-existing conditions, which would make insurance unaffordable for even more people.

The clever part of the Republican plan is that the public might not ever see screaming headlines about this. Even though it’s plainly obvious what Graham-Cassidy would do, mainstream news organizations aren’t allowed to just say so. They have to wait for “official” numbers.

Drum thinks that’s nonsense, because anyone can see what the Graham-Cassidy bill does:

Basically turns everything over to the states. It gives each state a chunk of money and allows them to do nearly anything they want with it.

Eliminates protections for pre-existing conditions even though it says otherwise – the trick is that although insurers are required to cover everyone, they can charge anything they like. In practice, this means a pre-existing condition will prevent you from ever getting insurance – unless you’re one of the lucky ducks in a blue state that decides to keep Obamacare rules intact. But even that might not matter, since funding in blue states would be cut way back and they probably couldn’t afford to offer Obamacare-style protections.

Slashes spending on Medicaid and turns it into a block grant.

Slashes federal subsidies and turns them into a block grant too.

Allows states to eliminate Obamacare regulations governing essential medical benefits, so this means it’s back to reading the fine print if you buy a medical policy. Maybe it covers doctors’ visits, maybe it doesn’t. It all depends on what your state’s governor decides.

Still, there’s hope:

Now, Republicans still have big problems remaining. First, the bill has to be passed within this fiscal year, which ends on September 30. That’s 11 days away. They have to get at least a preliminary CBO score so that they officially know that Graham-Cassidy would reduce the deficit (required under rules for reconciliation bills). And then they have to get the okay from the Senate parliamentarian. This could be a big problem since the parliamentarian is unlikely to agree that the new rules about pre-existing conditions meet reconciliation requirements. And if Graham-Cassidy has to be changed to require coverage of pre-existing conditions for everyone at the same price, it would blow up the bill and require a new CBO score.

The odds are against this happening within 11 days. But it’s still possible. Republicans really, really want to stick it to Obamacare no matter what the cost.

That’s the whole idea:

Sen. Chuck Grassley (R-IA) said Wednesday he could give “ten reasons why this bill shouldn’t be considered,” referring to the Senate’s final attempt to repeal Obamacare this year – but he’s still dead-set on supporting it.

Grassley said keeping Republicans’ campaign promise to get rid of former President Obama’s signature accomplishment was as important as the contents of the most recent health care bill, penned by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA).

“You know, I could maybe give you ten reasons why this bill shouldn’t be considered,” Grassley told Iowa reporters on a call, according to the Des Moines Register. “But Republicans campaigns on this so often that you have a responsibility to carry out what you said in the campaign.”

“That’s pretty much as much of a reason as the substance of the bill,” he added.

Chuck Grassley is an honest man. We promised to do something that proved to be stupid and dangerous and hateful, but we promised, so we’ll do that stupid and dangerous and hateful thing – just like we promised – and everyone will cheer – or at least those who matter to us will cheer – and even if they don’t, we can hold our heads up high. We did a stupid and dangerous and hateful thing – but we kept a promise.

Fine, but Sarah Kliff notes this:

The credit agency Fitch Ratings recently described Graham-Cassidy as “more disruptive” than the other Republican repeal bills. Edwin Park, a policy analyst at the Center on Budget and Policy Priorities, says that Graham-Cassidy is “more radical in the sense that you’re eliminating wholesale the marketplace subsidies and the Medicaid expansion.”

Robert Laszewski, a health consultant who is generally critical of the Affordable Care Act, says that “passage of this bill would create enormous market uncertainty.”

The Graham-Cassidy bill has, so far, received far less attention than the last bill the Senate considered in July or the one the House took up in May. But the reality is that this quiet bill would be far more disruptive.

There’s a reason for that:

Other key Republican health plans introduced this year actually have kept a good deal of the Affordable Care Act intact, except with dramatically less funding.

Take, for example, the Better Care Reconciliation Act, which the House passed in May. That bill certainly included deep cuts to the health law’s coverage programs, which is why the Congressional Budget Office estimated it would cause 22 million Americans to lose coverage.

But it also kept some key Obamacare programs. It envisioned a future for the marketplaces, where some Americans receive subsidies to purchase health coverage. Granted, those subsidies were much smaller than those that exist in current law, and they would only cover skimpier health plans. But they still existed under the BCRA, in a nod to how entrenched that program has become in the American health care system.

The BCRA also sharply reduced funding for the Medicaid expansion. Right now, the federal government covers 90 percent of the cost of this program. The BCRA would have reduced that funding down to a lower match (each state would have a different match rate, and they vary between 50 to 70 percent).

The future that Graham-Cassidy envisions is much, much different. This bill would not give states the option to continue the Medicaid expansion at a lower match rate. It would not mandate that middle-income Americans receive financial help to purchase insurance coverage. Those programs would end in 2020.

Instead, Graham-Cassidy would lump together all the money spent on these two programs across the country – about $1.8 trillion according to the Congressional Budget Office. It would dial back that spending significantly, like other plans: cutting it by $239 billion between 2020 and 2026.

Then, going much further than other Republican plans, it would use a new and complex formula to redistribute money from states that expanded Medicaid to those that do not participate in the program. States would be able to use this new lump sum for all sorts of things.

That sort of means that every state would have to develop a new healthcare system from scratch, for their state alone, with far less money now, and no federal money later.

Graham-Cassidy makes the unexpected decision to classify this new pot of funding as temporary rather than permanent, and have it sunset in 2027. Cassidy’s office argues this is necessitated by Senate budget rules, but analysts who have looked at the bill say that isn’t the case at all…

The Medicaid spending in this bill, for example, is funded as a permanent program rather than a temporary one. This isn’t a choice you see made in other Republican repeal bills.

The result is a massive cliff in 2027, where this lump-sum health program disappears entirely, amounting to a $299 billion cut in just one year.

There’s much more, but it comes down to this:

Graham-Cassidy isn’t moving forward because it’s centrist. It’s getting traction because it’s the last option left. The senators who back this bill have sold it as a compromise plan. They say it’s a way to return power to states, giving local governments more control over how they spend federal dollars.

“Instead of a Washington-knows-best approach like Obamacare, our legislation empowers those closest to the health care needs of their communities to provide solutions,” Graham said in a statement. “Our bill takes money and power out of Washington and gives it back to patients and states.”

Except … it doesn’t do that. The Graham-Cassidy plan hurts patients by squeezing and upending the health care system, which helps explain why 16 major patient groups came out against the proposal on Monday.

“Affordable, adequate care is vital to the patients we represent,” that group, which includes the American Heart Association and the March of Dimes, said in a statement. “This legislation fails to provide Americans with what they need to maintain their health.”

This, however, is a matter of persistence:

This bill isn’t about building a health care system that works better or returns power to states. It’s about moving forward because it is the last bill on the table and there is apparently still a strong drive among Republican senators to pass a bill before their September 30 deadline.

Or, as Sen. Pat Roberts of Kansas told Vox’s Jeff Stein recently, “You need a car to get into, and this is the only car there is.”

That’s an odd metaphor, but that’s persistence, or the persistence of persistence. Republicans had been trying to repeal Obamacare since 2010 – and yes, the Affordable Care Act was passed fair and square, long ago, by both houses of Congress, and survived a major Supreme Court challenge too, and then a few more. It is the law, and there are normal procedures for repealing a law. You find the votes to pass something else in its place, but if you don’t have the votes, you don’t have the votes. They tried that fifty or sixty times, knowing that would go nowhere – but now, finally, they have votes – and their guy in the White House to sign what they come up with. They’ve been promising their voters they’d finally do this, and now they can keep their promise.

Trump won the election partly on the promise to repeal and replace Obamacare. He had a solidly Republican House and Senate, but every alternative they came up with was loathsome. Twenty or thirty million Americans would lose their health insurance, and the cost of health insurance for everyone else would skyrocket. They knew they were pushing nonsense. Their last alternative died in the Senate. They couldn’t find even fifty Republican votes for it. Vice President Pence was waiting in the wings to break any fifty-vote tie, as vice presidents can do. He left early. Donald Trump had insulted John McCain one too many times – or McCain knew nonsense when he saw it. He cast the deciding Republican vote against that last alternative.

This one will fare no better. Obamacare offered light central planning of a system that subsidized the purchase of now-standardized healthcare policies from the for-profit insurance industry – paid for by slightly higher taxes on the rich. It was an awkward half-free-market hybrid that also included expanding Medicaid to cover those who couldn’t afford even the subsidized policies, but it worked, and is working. Half the nation knows that now. Everyone knows that now. Jimmy Kimmel knows that now, so everyone knows that now.

Perhaps that’s why Republicans hate Hollywood. Someone out here is always deciding what’s funny and what’s not, and what’s cool and what’s not, and what’s important and what’s not. Politicians don’t get to decide that. Perhaps pop culture is the culture. Jimmy won this one. The persistence of persistence lost. It just wasn’t cool.