In making a last-ditch effort to repeal the Affordable Care Act, Republican leadership in the U.S. Senate has advanced a bill — called Graham-Cassidy for its two primary sponsors — that is more draconian and would deny or put access to health care beyond the means of even more Americans than any of the other previous pieces of legislation.
It can’t even be considered “repeal and replace.” When Congressional Republicans couldn’t come up with a way to replace the ACA, otherwise known as Obamacare, and deliver on even basic promises to preserve protections for pre-existing conditions, those drafting Graham-Cassidy daydreamed of giving up altogether on that effort and letting the states figure it out.
As proposed, the legislation would repeal the ACA’s expansion of Medicaid and end the subsidies and cost-sharing payments that have funded or kept coverage affordable for millions of Americans, which President Trump has repeatedly threatened to end himself. It would also end the individual and employer mandates and minimum requirements on what insurance plans must cover.
Rather than continue to fund the expansion of Medicaid, the bill rolls that funding into block grants for the individual states, leaving each state to determine who will be covered and for what, as well as allowing states to make the call on whether individuals would face higher premiums for pre-existing conditions.
Washington, like other states that expanded Medicaid under the ACA, would face a loss of about $10 billion between 2020 and 2026, compared to current levels of federal spending, according to a study released recently by Avalere, a health care consulting firm.
But even that funding could be temporary. The bill only provides the block grant funding through 2026. After that point there’s no provision, no promise of continued federal funding for the states. In the end, Avalere says in its report, Washington state would see a loss of federal funding of up to $110 billion between 2020 and 2037. Nationwide, for all 50 states, that loss would represent $4.15 trillion by 2037.
There’s been a headlong rush to get to the bill passed before Sept. 30, exactly because that’s the deadline the Senate faces to pass it with only a simple majority. Which is why the Senate isn’t waiting for a report from the Congressional Budget Office to estimate its effects on how many Americans would lose coverage. Which is why at most it will face one committee hearing with no opportunities for expert testimony from the medical and insurance communities who have overwhelmingly urged the Senate to reject the bill. And which is why, even if it does pass the Senate, it can only stand for an up or down vote in the House, with no opportunity for amendments.
That’s not the regular order that Sen. John McCain urged after he cast the deciding vote against the “skinny repeal” in late July, and that may have been his thinking Friday morning in announcing he could not support Graham-Cassidy. With no Democrats supporting the bill, it can lose the support of only two Republicans and still pass.
Sen. Rand Paul of Kentucky announced his opposition earlier. Sen Susan Collins of Maine is leaning against. And Alaska’s Sen. Lisa Murkowski is on the fence, according to a count of support by The Hill.
McCain may have again foiled Senate Republicans’ attempts to end Obamacare.
“I believe we could do better working together, Republicans and Democrats, and have not yet really tried,” McCain said in a statement Friday.
Actually, they have tried to a certain extent. Or had, until this most recently flirtation with denying health care coverage to millions.
After the “skinny repeal” failure, Sens. Patty Murray, D-Washington, and Lamar Alexander, R-Tennessee, held four hearings before the Senate’s Health, Education, Labor and Pensions to find agreement that would stabilize insurance markets and make the ACA work better for everyone, including getting better controls on increasing premium costs.
Alexander, the committee’s chairman, and Murray its ranking Democrat, have a history of bipartisan cooperation, having successfully reformed the No Child Left Behind program into the Every Student Succeeds Act in 2015.
Negotiations on insurance market stabilization had progressed, until last week when Alexander announced he and Murray had reached an impasse, that they had “not found the necessary consensus among Republicans and Democrats.”
Murray, in her own statement, challenged Alexander’s contention: “We’ve held hearings, we’ve had discussions that included over half the Senate, and we’ve negotiated in good faith for weeks to try (to) achieve, as Chairman Alexander puts it so well, ‘a result’ for our constituents.”
Murray’s office confirms that the senator had made concessions to Republican requests to give states greater flexibility regarding the ACA.
Those talks ended last week when GOP arm-twisting led Alexander to announce the “impasse.”
Murray, following McCain’s announcement on Friday, said she was ready to return to the table. “I remain confident that we can reach a bipartisan agreement as soon as this latest partisan approach by Republican leaders is finally set aside.”
Summer is over, and with it Republican daydreams of turning over to the states the sole responsibility of assuring health care coverage for Americans.