Greater Baton Rouge Community Clinic — a virtual health clinic in Louisiana co-founded by then-doctor and now Sen. Bill Cassidy (R-LA) — closed in July 2015. It had been getting increasingly harder to get grants to fund the ‘clinic without walls,’ which connected uninsured people who needed care to providers; it was a free clinic and received no federal or state funds. After much deliberation, the clinic shut its doors.
“We felt better about closing the clinic because solutions were coming in the future,” Coletta Barrett, then-member of the Board of Directors for the community clinic, told ThinkProgress. Barrett is now Vice President of Mission at Our Lady of the Lake Hospital, Baton Rouge.
The Affordable Care Act (ACA) had been signed into law five years earlier, and legislative provisions were just kicking in. Uninsured residents could seek care through Healthcare.gov, the federally-facilitated exchange where people sign up for insurance. Additionally, John Bel Edwards (D) looked likely to win the governor’s race and one of his campaign promises was that he would expand the Medicaid program within his first week in office. (Gov. Edwards signed an executive order expanding Medicaid eligibility his second day in office.)
“The ACA did not cause [the clinic] to close — there was a correlation,” said Barrett. “It was opening up access for people the clinic saw.”
Two years later, Republicans — controlling both Congress and the White House — want nothing more than to repeal and replace current health law. Leading this month’s repeal-and-replace cause is Sen. Cassidy (R-LA), with the help of Sens. Lindsey Graham (R-SC), Dean Heller (R-NV), and Ron Johnson (R-WI). Just two months ago, the G.O.P. health bill looked dead as Republican leadership, after a devastating 2 a.m. defeat, looked ready to move on to other legislative items.
They did not move on. Republicans promised their constituents they’d repeal-and-replace the ACA, and they meant it.
Sens. Cassidy and Graham’s bill would repeal the ACA subsidies and Medicaid expansion, and replace this previous federal funding stream with a block grant program. States — with waiver authority — could also roll back essential health benefits and allow insurers to raise premiums for sick patients or those with pre-existing conditions. Additionally, the bill would make overall cuts to the Medicaid program, which provides care to low-income adults, children, elderly, and disabled. The Congressional Budget Office (CBO) estimates federal spending on Medicaid would be reduced by about $1 trillion from 2017 to 2026.
“I think he’s made a 180-degree turn.”
Sen. Cassidy has been the bill’s most ardent advocate, pitching the bill to journalists and the public, oftentimes mischaracterizing its effects. Cassidy — relative to some of his Senate colleagues — is more qualified to talk about health care. For nearly three decades, he worked to provide care for the uninsured in his home state’s hospital system before coming to Washington, D.C.
“I’ve treated folks like you,” Cassidy said to a young girl with cancer Monday night at a CNN town hall health event. Periodically throughout the course of the night, and during the Senate hearing just hours earlier, he alluded to his life-long professional career as a doctor. He knew what he was talking about because he witnessed health care disparities firsthand, he said.
“I think he’s made a 180-degree turn,” said Dr. Holley Galland, a family medicine doctor in Baton Rouge who previously worked with then-doctor Cassidy. “This bill of his is not a good example of how to take care of the community and public health.”
Galland worked with Cassidy when he created a private-public partnership to vaccinate 36,000 greater Baton Rouge area children against Hepatitis B. “He had this vision,” Galland told ThinkProgress. “He had a great determination to get those kids immunized — which is great — but alas, sounds like that great determination of his is getting him to push this bill.” And his bill would be devastating to Louisiana residents, she continued.
Cassidy’s bill currently does not have the votes it needs to pass the Senate. It also does not have the support of many from his state. Louisiana Governor John Bel Edwards (D) said he could not support his senator’s proposal. “My primary objection relates to the elimination of the Medicaid expansion program in 2020,” said the governor. More forcibly, Louisiana Department of Health Secretary Rebekah Gee outlined in a letter to Cassidy the ways the bill uniquely hurts Louisiana residents.
A newly revised draft on Sunday added language that would give Cassidy’s state an additional $750 million a year between 2023 and 2026 for having expanded Medicaid late. Even so, the respite didn’t seem to change opinion. In an email to ThinkProgress, Jan Moller of the Louisiana Budget Project said “it appears there is a Louisiana-sweetener in the revised bill. Maybe they’re trying to get that all-important Bill Cassidy vote!”
“You can be a great doctor and a lousy politician.”
Louisiana falls well below national averages in rankings of state population health. Relative to other states, residents see higher rates of diseases such as HIV, drug-related mortality, and heart diseases. A recent Commonwealth Fund study, which analyzed health indicators ranging from access to care to healthy habits, found the that Louisiana ranked 49th in the country in overall health trends. This was using 2015 data, before the state expanded Medicaid coverage to 400,000 people, many of whom are among the working poor. In 2016, Louisiana’s uninsured rate dropped to 10.3 percent in 2016; the year before, it was 11.9 percent.
“I’ve been a doctor for 25 years, caring for those who didn’t have coverage,” Cassidy said during a press conference where he revealed the Graham-Cassidy bill and outlined his vision for the country. “It is my goal to continue to bring them coverage.”
“You can be a great doctor and a lousy politician,” said Galland.
Cassidy was a great doctor according to coworkers ThinkProgress spoke to. Kathy West, who started Volunteer Health Corps., a sister clinic to Cassidy’s, called the Greater Baton Rouge Community Clinic was “genius.” His team quite literally went into working poor neighborhoods and told residents, “if you can give me your W-2 form, I will get you screened and connected with a primary care physician,” said West. Cassidy primarily worked to identify doctors that would see patients in their offices.
“He strong-armed these people — convinced every C.E.O., social worker, doctor, anyone who had anything to do with health care to work with his clinic,” said West. “He galvanized them.”
The clinic later closed, as funds dried up. Health professionals in Baton Rouge confirmed that although not every single resident who received care through the Greater Baton Rouge Community Clinic gets coverage now — largely citing health literacy obstacles — many of these residents did get insurance.
Republicans to Democrats, colleagues to former 2014 supporters, many residents are mostly befuddled by the contents of his bill and whether it reflects the man they knew. One voter and former colleague — who spoke to ThinkProgress upon condition of anonymity — said they trusted Cassidy but not the state legislators. “Our state is infamous for mishandling block grant funds,” they said citing one TANF grant that went to “other areas.” Another former colleague said, “I roll my eyes and wonder what kind of Kool-Aid did he drink.”