Graham-Cassidy’s cuts are confusing. Let’s make them simple.

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You’re going to hear a lot about “numbers” in the next few days.

Senate Republicans are defaulting to “I’m looking at the numbers” to explain why they haven’t yet decided on the Graham-Cassidy bill.

Sen. Lisa Murkowski (R-AK) wants to see numbers for her state. So does Sen. Shelley Moore Capito (R-WV). Add Sen. Rob Portman (R-OH) to that list.

There’s good reason for that: Graham-Cassidy creates a block-grant program that will affect states very differently depending on whether they expanded Medicaid under Obamacare. Expansion states are likely to see their funding reduced and redistributed to non-expansion states through the block-grant formula.

For Murkowski, Capito, Portman, and others — Republicans representing Medicaid expansion states, which saw hundreds of thousands of their poorest citizens get coverage through that program — the numbers are going to be important.

But numbers are funny. They can, particularly in a field as complex as health care, do just about anything you want them to.

For now, the left-leaning Center on Budget and Policy Priorities has put out a state-by-state report showing deep funding cuts for many states, including Alaska, Ohio, and West Virginia. That’s about all that’s available in the public sphere.

But we know Sen. Bill Cassidy (R-LA) has his own numbers. He had spreadsheet after spreadsheet for a presentation he gave to reporters on Friday. He has also openly disputed the CBPP numbers, after his own state’s health secretary used them to warn that he was hurting Louisiana.

But we can make this simple. A little-noticed provision in Graham-Cassidy makes clear that some states are expected to see an increase in the uninsured under this bill because of the funding cuts.

Under the plan, states that receive less funding under the block-grant formula would be allowed to draw more money from an existing program known as DSH. DSH — disproportionate share hospitals — directs funding to hospitals that see a high number of Medicaid and uninsured patients.

Cassidy, as he explained his bill, said this was very intentionally an attempt to offset the funding losses to some states under the block grant.

“We work hard, through a variety of mechanisms, to offset this loss,” he told us Friday. It also appeared to be the basis for his claim that a state like West Virginia would be made whole under the bill.

But there is another way to look at it: The only reason you would need the DSH funding is if you expect an increase in the uninsured rate. That’s the underlying purpose of the DSH program.

As Craig Garthwaite, a health economist at Northwestern University, put it, the very existence of that provision is “admitting that this is gonna increase the number of people who are uninsured and those people are still gonna go to the hospital.”

It is “an acknowledgement that less funding for states will mean more uncompensated care for hospitals, who will then need additional funds to not bear such a financial burden,” Chris Sloan, who has analyzed the bill for Avalere Health, an independent consulting firm, told me.

Sloan added that when you compare the DSH funding to what some states could lose under the block-grant formula, “the magnitude of the money isn’t close.”

There is one other big thing to keep in mind: Even if Graham-Cassidy makes an effort to prevent hospitals from taking a hit if they see more uninsured patients, that DSH funding doesn’t really help those people who might become uninsured under the bill.

Uninsured people might be able to go to the hospital and get treatment, and the hospital will be compensated for providing them care. But it will still be harder for the uninsured person to afford to go to the doctor, or pay for a prescription, or do other things for their medical needs short of going to a hospital.

They also lose the well-documented mental benefits that come with knowing you’re protected from medical bankruptcy.

“The most damaging effect of lower insurance coverage is the reduction in financial security and access to care for the newly uninsured. Increasing DSH funding does nothing to address these problems,” Matt Fiedler at the Brookings Institution told me.

To bring it back to the numbers: Cassidy wants to argue that the DSH funding will offset the losses that some states face under his bill’s block grant. He claims to have the math to prove it.

But when you unpack the bill itself, it is a tacit acknowledgement that Graham-Cassidy will lead to fewer people having insurance in those states. It is baked into the structure of the legislation.

It will be up to Republican senators to decide whether that really counts as making their states whole.

Insurance premiums versus wage growth and inflation. This stunned me: Look at how much more insurance premiums and the share of premiums that workers pay have grown over the past two decades, compared to growth in earnings and overall inflation. Read more from the Kaiser Family Foundation.

With research help from Caitlin Davis

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