Sen. Bill Cassidy William (Bill) Morgan CassidyCoushatta tribe begins long road to recovery after Hurricane Laura Senators offer disaster tax relief bill Bottom line MORE (R-La.) deserves some credit.

When other Republicans hid over the May congressional recess, Cassidy was one of only two Senate Republicans to hold a town hall — where he took questions from those angry over congressional efforts to repeal and replace the Affordable Care Act. Given that he was shouted down at a February town hall he had to know the May forum wouldn’t be easy.

And Cassidy, a gastroenterologist, has at least tried to come up with concrete ideas to replacing the Affordable Care Act. Initially he partnered with moderate Sen. Susan Collins Susan Margaret CollinsJeff Flake: Republicans 'should hold the same position' on SCOTUS vacancy as 2016 Trump supporters chant 'Fill that seat' at North Carolina rally Momentum growing among Republicans for Supreme Court vote before Election Day MORE (R-Maine). His current effort is actually prime-sponsored by Sen. Lindsey Graham Lindsey Olin GrahamMomentum growing among Republicans for Supreme Court vote before Election Day Video of Lindsey Graham arguing against nominating a Supreme Court justice in an election year goes viral Warning signs flash for Lindsey Graham in South Carolina MORE (R-S.C.), and also co-sponsored by Sen. Dean Heller Dean Arthur HellerOn The Trail: Democrats plan to hammer Trump on Social Security, Medicare Lobbying World Democrats spend big to put Senate in play MORE (R-Nev.), and Sen. Ron Johnson Ronald (Ron) Harold JohnsonThe Hill's Morning Report - Sponsored by The Air Line Pilots Association - White House moves closer to Pelosi on virus relief bill Second GOP senator to quarantine after exposure to coronavirus GOP-led panel to hear from former official who said Burisma was not a factor in US policy MORE (R-Wis.).

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Regrettably, practice hasn’t made perfect. The latest bill would not only convert into fixed block grants the federal monies made available to states for Medicaid expansion, but would also, as has been true of other Republican efforts, attack the “traditional” Medicaid that pre-dates the ACA.

It would do so by converting the federal matching of state funding into a hard cap per Medicaid beneficiary, with that cap, over time, starving funding for those with disabilities and the elderly in long-term care settings. In this regard it resembles the failed Better Care Reconciliation Act offered by Senate Majority Leader Mitch McConnell Addison (Mitch) Mitchell McConnellMomentum growing among Republicans for Supreme Court vote before Election Day Trump expects to nominate woman to replace Ginsburg next week Video of Lindsey Graham arguing against nominating a Supreme Court justice in an election year goes viral MORE (R-Ky).

Over a decade, my little state of New Hampshire would lose $410 million, according to one analysis updated today, while Cassidy’s Louisiana would lose a staggering $3.2 billion. The co-sponsorship by Heller, who has managed to be on all sides of ACA repeal — at one point incurring a threat from President Trump and attacks from a Trump-sanctioned group — suggests he has lost all interest in being re-elected, as Nevada would lose $639 million.

The legislation would create disparate winners and losers, with no apparent logic as to how heavily its ax falls. In an exclusive to Breitbart News, Utah Gov. Gary Herbert praised the bill as “a vast improvement over the Affordable Care Act” — his state would actually gain $313 million from current federal Medicaid funding by robbing other states.

Cassidy has airily dismissed the necessity of a Congressional Budget Office analysis, saying “I just don’t care about the coverage numbers,” claiming the CBO’s methodology is inaccurate. He has also expressed no worry over the fact that under his bill the block grants would cease in 2027 and require congressional reauthorization.

In remarks last month before the Press Club of Baton Rouge, Cassidy made it clear that the ACA was perhaps the least of his concerns — stating that “the traditional Medicaid program is a huge problem.” His candor reveals an objective to cut the Medicaid program, dating to 1965, that serves millions of seniors across the United States in nursing homes and in home-and-community-based settings for less than actual cost. Hardly out-of-control, Medicaid spending on nursing home care only went up 1.1 percent nationally in 2015.

Cassidy did note that he had carved out “blind and disabled children” from the bill’s cuts. As my association represents a 26-bed facility for children with profound disabilities, I should perhaps be grateful for this magnanimity on Cassidy’s part, but can’t help but worry about this latest attack upon over 4,100 Medicaid patients in our nursing homes in a state with the nation’s second-oldest population.

Time is running out for Cassidy. The Senate parliamentarian has ruled that a repeal and replacement can only pass using budget reconciliation, which takes just 50 votes, through September 30.

Brendan Williams is the president/CEO of the New Hampshire Health Care Association, which represents 90 long-term care facilities. Williams is also an attorney, former Washington state deputy insurance commissioner and former Washington state representative.