The Republican led House of Representatives passed a bill to replace the Affordable Care Act (ACA) that would leave millions without insurance and raise the cost for older Americans as well as making it close to impossible for people with pre-existing conditions to get insurance. Even the President finally attacked it and called it ‘mean’. This was after he lauded it in the Rose Garden calling it a “great plan” that was “very, very incredibly well-crafted”.

According to everything we see and hear the Senate is doubling down trying to pass something that would be worse. Analysts are saying their bill is really a tax cut for the rich paid for by cutting insurance for the poor. This is what Majority Leader Mitch McConnell (R-KY) and his Republican brethren are trying to foist on the American people.

Some Republicans are balking; some because it hurts too many, others apparently because it doesn’t screw enough people. McConnell is finding it difficult to get the 50 votes he needs to pass a bill. A few moderate Republicans seem to be truly embarrassed about what the bill would do to people in their state.

So this week the Senate Leader released a new version of his bill. He sprinkled around a few billion federal dollars hoping to get some additional support from moderates. According to Axios’s David Nather and Sam Baker that included:

• $45 billion to fight the opioid crisis.
• An additional $70 billion to help stabilize insurance markets.
• One particular funding formula was also revised to benefit just one state: Alaska, home to undecided Sen. Lisa Murkowski. The change could net Alaska nearly $750 million over the next 10 years, according to Bloomberg’s math.

The new version didn’t do anything to keep the bill from devastating Medicaid; the program meant to help the poor. Under this new McConnell bill the poor still get screwed. In fact the Senate version is even meaner in that regard than the House version. Now McConnell awaits the Congressional Budget Office (CBO) score of the bill so Senate Republicans will hear how many people will lose their insurance with this new version and how many will find their premiums increasing. But apparently even before the CBO scores the bill he still can’t get the fifty votes he needs to pass it. He only needs fifty because Vice President Pence, President of the Senate, can vote and break the tie in the Senate getting him to fifty-one.

So the game is on. Who can find another way to hurt people they can pretend is more acceptable. Lindsey Graham (R-SC) and Bill Cassidy (R-Louisiana) are trying to ride to McConnell’s rescue. In a statement Graham said about their version of the ACA repeal/replacement “Instead of having a one-size-fits-all solution from Washington, we should return dollars back to the states to address each individual state’s health care needs. Just like no two patients are the same, no two states’ health care needs are the same. A solution that works in California may not work in Virginia. These funds are already being spent on Obamacare, but instead of having Washington decide, we’ll empower each individual state to choose the path that works best for them.” What Graham, Cassidy and so many other Republicans fail to understand or purposely want to ignore, is this isn’t about what works for states, instead it must be about what works for people. States have been controlling insurance for years which is why seven Presidents have fought to move to a federal program guaranteeing basic healthcare for all Americans. Can you imagine if Social Security was a state program with different benefits in each state. Or if Medicare was a state program and seniors in every state had different healthcare benefits left to the whim of each governor.

This is what the Affordable Care Act was meant to change. It was meant to guarantee every person, no matter what state they live in, had basic and affordable health insurance. That is what the Essential Health Benefits package was about. Everyone would have coverage no matter what state they purchased their insurance in for things such as mental health and substance abuse disorders, emergency care, prescription drugs, and laboratory services among other guarantees.

Republicans won’t accept that in the United States we need to consider healthcare a right, not a privilege, and what level of insurance you get shouldn’t be dependent on what state you live in. When Lindsay Graham says “no two patients are the same” he doesn’t get it. The patient may not be the same but the disease very well could be. Whether you need care for opiod addiction, lung cancer, or maternity care, every person needs to know their insurance will cover that care and it shouldn’t matter whether they live in Mississippi or Massachusetts. The basic guarantees of your insurance coverage shouldn’t change because you might need to move to another state for a job or to care for an aging parent.

We know there are problems with the Affordable Care Act. But throwing some money at a few states and letting them take control away from the federal government will make things much worse. Your coverage will be held hostage by who the governor is or who is in your State legislature. Individuals could find themselves losing coverage because their state budget needs to be balanced each year and will find it balanced on the backs of those who can least afford healthcare or need it the most.

It is time to resoundingly defeat the insidious Republican plan to repeal and replace the ACA. Only then will clear thinking Republicans and Democrats be able to have a serious discussion and move toward a real fix for the program.