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All 50 state Medicaid directors signed a letter on Thursday opposing Graham-Cassidy, the GOP’s latest attempt to repeal the Affordable Care Act. In a two-page letter, the bipartisan National Association of Medicaid Directors (NAMD) warned that the bill would precipitate “the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history.”

Graham-Cassidy would force states to organize their own health care systems by 2020, when the Affordable Care Act’s mandate would expire. Obviously this is an enormous task and NAMD’s directors are probably the most qualified group of individuals to explain the near impossibility of states accomplishing that feat in two years. From NAMD’s letter:

The scope of this work, and the resources required to support state planning and implementation activities, cannot be overstated. States will need to develop overall strategies, invest in infrastructure development, systems changes, provider and managed care plan contracting, and perform a host of other activities. The vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities.

Their letter doesn’t mention the drastic cuts to Medicaid that Graham-Cassidy would approve. A report from The Washington Post indicated that Medicaid’s funding would shrink by $215 billion between 2020 and 2026.

NAMD also criticized Graham-Cassidy’s lack of a Congressional Budget Office score — and it won’t get one by Sept. 30, when Republicans must vote on the bill if they want to pass it as part of the budget reconciliation process which only requires 51 votes. “Any effort of this magnitude needs thorough discussion, examination and analysis, and should not be rushed through without proper deliberation,” NAMD’s letter read. “The legislative proposal would not even have a full CBO score until after its scheduled passage, which should be the bare minimum required for beginning consideration.”

On Twitter, Senator Chris Murphy of Connecticut summarized just how unprecedented their concurrence was:

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I concur. This shit is b-a-n-a-n-a-s. Except by shit I mean Graham-Cassidy. And by bananas I mean desperate, disgraceful, and utterly depraved.