The U.S. Senate could vote as early as Wednesday on Sen. Bill Cassidy’s bill to overhaul America’s health care safety net. It’s a bill that few understand, but with massive implications for patients, health care providers and state economies. It’s opposed by virtually every major health care trade association and patient advocacy group. And it’s being rushed through Congress in an effort to meet an arbitrary Sept. 30 deadline. As Noam Levey of the Los Angeles Times reports, this is not how things used to function when America was a more rational place:

Under normal circumstances, Congress takes years to develop complex legislation that involves large sums of money and affects millions of Americans. The legislation creating Medicare, for example, which was signed by President Lyndon Johnson in 1965, was first introduced eight years earlier and studied and debated extensively. Similarly, bills creating the Children’s Health Insurance Program, which President Clinton signed in 1997, and the Medicare Part D prescription drug program, which President George W. Bush signed in 2003, underwent years of committee hearings and study. Even the Affordable Care Act, which President Obama signed on March 23, 2010, after a last-minute scramble by Democratic leaders to get the votes, had been debated and analyzed for more than 15 months.

With Senate Republicans still shy of the 50 votes needed for passage (Vice President Mike Pence would break a tie), the bill was rewritten over the weekend to add extra money for Kentucky, Alaska and Arizona. POLITICO obtained a draft of the revisions, which include a deal sweetener for Alaska, home state of GOP holdout Lisa Murkowski.

Profiles in courage

While the Cassidy-Graham bill has spawned near-unanimous opposition from national health care provider groups, it’s a slightly different story closer to home. The Advocate’s Bryn Stole tallies reaction from the state’s hospitals, insurance industry, and manages to track down a little-known group representing health insurance agents.

Jeff Drozda, CEO of the Louisiana Association of Health Plans, which represents the health benefits industry, including managed-care companies that cover more than 1 million Medicaid recipients, said his group is optimistic the Cassidy-Graham bill could address issues in the health insurance markets. But Drozda said he’s also concerned about some of the language in the bill, particularly its impact on the roughly 435,000 Louisianans covered under the Medicaid expansion. Drozda, who has a meeting with Cassidy in Washington this week to discuss this bill and other issues, said he remains hopeful some language in the proposal could be tweaked. … “We agree that change is needed. The ACA is not working as it is,” said John Maginnis, spokesman for Blue Cross Blue Shield of Louisiana, which did not take a position on the bill. “We applaud Sen. Cassidy for being willing to take action in proposing changes to improve the individual health insurance market.”

Closer to home, more than 100 activists rallied against the Cassidy-Graham bill on the steps of the state Capitol on Sunday. LBP’s Nick Albares was there, as KATC-TV reports.

Debating the surplus

Louisiana legislators aren’t used to hearing good news about the state’s finances. So reports that the state finished the last fiscal year with an estimated $140 million surplus were met with only guarded optimism, as the debate begins over what to do with the extra money. The AP’s Melinda Deslatte reminds readers that it won’t do much – if anything – to offset next year’s $1.5 billion fiscal cliff:

Under Louisiana’s constitution, surplus dollars can only be spent on certain one-time expenses, like debt payments, construction work and coastal projects, not ongoing agency expenses and continuing programs. At least 10 percent of any surplus is supposed to pay down retirement debt, and a quarter of a surplus is earmarked for the state’s “rainy day” trust fund. Lawmakers could try to indirectly use some of the surplus money to help with the upcoming shortfall, by paying down debt early so they can spend fewer state tax dollars on debt payments a year later. But that would only be a short-term and small-dollar fix in the scope of the gap. Edwards and lawmakers are locked in the same ongoing debate about whether to renew the expiring taxes, raise other taxes or make deep budget cuts that they’ve been having for the last year. No consensus has been reached so far.

Winning a war on drugs

America has spent hundreds of billions of dollars fighting the “war on drugs” –  a battle that has filled up jail cells, enriched police departments and done precious little to actually reduce the flow of drugs or the ravages of addiction. Few know the price of these policies better than Louisiana, which incarcerates more people, per capita, than any other government in the world. The nation of Portugal tried a different approach more than 15 years ago – with dramatically different results. The New York Times’ Nicholas Kristof reports:

Portugal undertook a monumental experiment: It decriminalized the use of all drugs in 2001, even heroin and cocaine, and unleashed a major public health campaign to tackle addiction. Ever since in Portugal, drug addiction has been treated more as a medical challenge than as a criminal justice issue. After more than 15 years, it’s clear which approach worked better. The United States drug policy failed spectacularly, with about as many Americans dying last year of overdoses — around 64,000 — as were killed in the Vietnam, Afghanistan and Iraq Wars combined. In contrast, Portugal may be winning the war on drugs — by ending it. Today, the Health Ministry estimates that only about 25,000 Portuguese use heroin, down from 100,000 when the policy began. The number of Portuguese dying from overdoses plunged more than 85 percent before rising a bit in the aftermath of the European economic crisis of recent years. Even so, Portugal’s drug mortality rate is the lowest in Western Europe — one-tenth the rate of Britain or Denmark — and about one-fiftieth the latest number for the U.S.

Number of the Day

79 – Number of congressional hearings in the House of Representatives on the Affordable Care Act before it passed. The Cassidy-Graham “health care” bill gets its first and only hearing in the U.S. Senate today. (Source: Noam Levey, Los Angeles Times)