- The Senate will not vote on the Graham-Cassidy bill to repeal the Affordable Care Act (ACA) this week, the bill's authors said Tuesday.
- The budget reconciliation process Republicans need to pass any repeal legislation ends Saturday. GOP leaders have pledged to continue their efforts, but it would now require procedural maneuvering, and an agreement to forego other legislative priorities.
- Graham-Cassidy would have overhauled the nation’s healthcare system, giving states immense power to create their own coverage system, but with restricted funding and precious little time to do so. It went beyond previous repeal bills in the House and Senate, and had provisions that could remove protections for people with pre-existing conditions.
The prospects of the GOP plan to repeal the ACA are looking worse than they ever have in President Donald Trump’s administration. Party leaders may not be willing to acknowledge it, but the chances of another repeal bill getting to a vote this session are very slim.
The authors of Graham-Cassidy said "it's only a matter of when" their bill replaces the ACA. Other senators, however, indicated they would rather move on to issues like tax reform.
With ACA repeal on ice, at least for now, Congress still has some pressing health matters to deal with. The deadline for reauthorizing the Children’s Health Insurance Program is this week, and at least one state has said it will run out of funding if Congress does not take action to extend the program.
Also, insurance companies are still asking for a commitment to funding cost-sharing reduction (CSR) payments. The White House has so far refused to confirm whether the payments will continue, but there is bipartisan support for allocating the funds through Congress.
The deadline for payers to decide whether they will participate in the ACA exchanges is Wednesday. Insurers say the market will only become more unstable without a decision soon on CSRs.
Sen. Lamar Alexander, chairman of the Senate health committee, alluded to this in a statement saying he would continue “to see if senators can find consensus on a limited bipartisan plan that could be enacted into law to help lower premiums” and make insurance available to those in the individual market. “I’m still concerned about the next two years and Congress has an opportunity to slow down premium increases in 2018, begin to lower them in 2019, and do our best to make sure there are no counties where people have zero options to buy health insurance.”
Although Graham-Cassidy did not attract a lot of support, those who remain intent on ACA repeal may use it as a blueprint for future legislation. Estimates from non-government agencies agreed that about 30 million people would probably lose coverage under the proposal. The Congressional Budget Office released a preliminary report on Graham-Cassidy on Monday, finding it would result in millions losing coverage, particularly after 2020. The agency said a regular analysis would require several more weeks.
The healthcare industry was fiercely opposed to the proposal, including groups representing doctors, hospitals, payers and patients. All 50 state Medicaid directors also signed on to a letter slamming the bill, as did 36 current and former state insurance commissioners.
A few healthcare executives also took the unusual step of speaking out specifically against the plan. Cleveland Clinic CEO Toby Cosgrove said in a statement the bill would “threaten the financial viability of hospitals nationwide.” Kaiser Permanente CEO Bernard Tyson said Graham-Cassidy’s block funding would “erode coverage of needed medical services and pose major issues for state budgets.”
AHA President Rick Pollack said in a statement the bill’s failure should prompt lawmakers to find bipartisan solutions for the issues facing healthcare, instead of working only within one party. “Instead of fixing the very real problems facing our healthcare system, this proposal would have only exacerbated them,” he said.