- Senate Majority Leader Mitch McConnell has set a vote next week for the latest proposal to repeal the Affordable Care Act (ACA), Politico reported. The bill, named after its key sponsors Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), would result in about 30 million people losing coverage and would reduce federal funding to states by $215 billion in the next 10 years, according to analyses released this week.
- The bill would restrict Medicaid funding and create a block grant program for states to fund coverage. That funding, which is less than current ACA spending, would expire in 2026. Also, states would be able to eliminate the ACA’s protections for people with pre-existing conditions and could also end required essential health benefits.
- The proposal faces extremely stiff opposition within the healthcare industry. Organizations that have expressed disapproval include the American Hospital Association (AHA), American Medical Association (AMA) and America’s Health Insurance Plans (AHIP) and AARP. Kaiser Permanente CEO Bernard Tyson wrote a blog post criticizing the proposal.
It’s difficult to find many big proponents of the Graham-Cassidy bill who aren't named either Graham or Cassidy. The myriad industry groups opposing the bill say it would increase the uninsurance rate, lead to increased premiums and higher out-of-pocket costs for consumers, destabilize the individual market, give too much power to state governments and take away protections for people with pre-existing conditions.
The main concerns of the AHA and AMA are the expected coverage losses that would result. The Congressional Budget Office has said it would need several weeks to develop a full analysis of Graham-Cassidy, and will only have time to determine whether it follows procedural rules under budget reconciliation. Outside agencies, though, have estimated about 30 million Americans would lose coverage under the proposal.
AHA CEO Rick Pollack said in a statement lawmakers should be working on more bipartisan solutions to challenges in the healthcare system. “This proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term,” he said.
America’s Essential Hospitals objects to Graham-Cassidy in part because, unlike earlier repeal proposals, it does not provide systematic relief from planned disproportionate share hospital cuts. It allows for partial relief in some states.
The severely restricted funding could force states to reduce provider reimbursement or cut certain benefits or coverage groups, according to an analysis by the Kaiser Family Foundation.
Graham-Cassidy goes beyond the ACA repeal plans that failed in July. In addition to ending Medicaid expansion and changing the program’s funding to a block grant format, it sets a per-capita cap. It prohibits Medicaid from covering childless adults and limits state spending on traditional Medicaid to 15% of the block grant funding allotment.
The Center for American Progress estimates coverage losses could be even higher than 30 million people because of the funding restrictions and lack of flexibility. “Under capped funding, states that experience faster Medicaid cost growth, whether due to natural disasters, health crises, or economic or demographic trends, would no longer see their federal assistance grow accordingly,” the report reads.
Payer groups have been less vocal than providers throughout the attempts in Congress to repeal the ACA, but they have come out strongly against Graham-Cassidy. AHIP and the Blue Cross Blue Shield Association both sent letters to lawmakers expressing their displeasure.
Under the plan, federal funds would eventually be redistributed across states based on low-income population, and the HHS secretary would have wide discretion to make other adjustments. That would lead to wildly different funding amounts for different states.
As before, the bill’s chances hinge on a few still uncommitted senators, including the three who brought down the last proposal to come to a vote — Sens. Lisa Murkowski of Alaska, Susan Collins of Maine and John McCain of Arizona. None of the issues those lawmakers objected to previously have changed, but political circumstances may have.
McConnell is pushing forward with a vote because the clock runs out on ACA repeal Sept. 30. It’s unclear how the legislation might fare in the House, but the White House has expressed support.