Graham-Cassidy Health Bill

What’s the issue? After the failure of the last two Republican-led Affordable Care Act (ACA) repeal and replace efforts, Senators Lindsay Graham and Bill Cassidy have proposed another plan to repeal and replace the ACA, know as the Graham-Cassidy bill. They need to pass the bill by September 30th, after which time they will need 60 votes to avoid a filibuster. This week they only need 51. John McCain and Rand Paul have announced their opposition to the bill, meaning if one more Republican comes out against it, the bill will fail. However, Graham and Cassidy made some last minute revisions to the bill over the weekend in an effort to win over the Republicans who are currently wavering. In short, the bill could still pass.

Why do I care? The Graham-Cassidy bill is radically different from the other Republican efforts to replace the ACA. It cedes most control over healthcare from the Federal Government to the states, converting money that would have been spent on the ACA into federal block grants with very few restrictions for the states. Here are some of the biggest dangers of the bill:

• Pre-existing conditions and essential coverage. Senator Cassidy has claimed that the Graham-Cassidy bill would continue to offer protection for those with pre-existing conditions, but lawyers who have studied the bill see it differently. According to the lawyers, states would only have to present a plan to cover people with pre-existing conditions, but that plan would not have to meet any standard. Additionally, the bill would allow people with pre-existing conditions to be charged much more for health insurance, and would also allow the cost of individual plans to increase each year, meaning that someone who get cancer or diabetes, say, could see their insurance cost skyrocket. The bill also removes the requirement for essential benefits coverage that requires all insurance plans to cover things like hospitalization, prescription drugs, and maternity care. I’ve discussed why these essential benefits are important on a previous blog, available here.
• Cost of insurance. Graham-Cassidy removes many of the protections from the ACA that are meant to keep the cost of insurance down including the individual mandate (which would be removed retroactively to 2016), the tax credits meant to subsidize the cost of insurance for those who need it, and lifetime caps on healthcare spending. For more on why these protections keep down insurance costs, read my blogs about the previous efforts to replace the ACA here and here.
• Medicaid. Like the AHCA and the BCRA, Graham-Cassidy ends the Medicaid expansion set-up under the ACA and imposes spending caps for Medicaid recipients. I have written previously about how this would disproportionately harm mothers, children, the elderly, the poor, and those with disabilities. This time, the bill also shifts money from states that opted in to the ACA’s Medicaid expansion (and are mostly Democratic) to states that did not (and are mostly Republican). The National Association of Medicaid Directors has released a statement opposing the bill.
• Timeframe. Even if the content of Graham-Cassidy were sound, the bill gives states only two years to prepare to receive these block grants and be on their own for setting up a health care system that makes the most sense of their states. Many experts agree that this simply isn’t feasible.

In addition to these changes, the block grants would expire and be subject to Congressional renewal in 2027. The Brookings Institution estimates that these changes coupled with uncertainties about the future would cause 15 million Americans to lose health care in just the next two years. These dangers are so pronounced that the American Medical Association, American Academy of Family Physicians, American Hospital Association, Federation of American Hospitals, America’s Health Insurance Plans, and the BlueCross BlueShield Association released a joint statement condemning the bill, and urging the Senate to reject it.

What you can do if you care too:

1. Call your Senators and tell them to vote against the Graham-Cassidy bill. It is especially important to call those who are considered to be on the fence, including: Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado, Susan Collins of Maine, Ted Cruz of Texas, Mike Lee of Utah, and Lisa Murkowski of Alaska.
2. Vote. Some republicans acknowledge that this isn’t a perfect bill, but they consider it their last chance to fulfill their campaign promise to repeal the ACA. Put people in office who are not beholden to that promise. Add the midterm elections to your calendar (November 6th, 2018) and check your voter registration deadlines!
3. Donate to progressive political campaigns. Republican donors (both large donors and grassroots donors) are mad that the ACA has not yet been repealed, and are withholding donations as a result. Show politicians that sensible health care policy is even more lucrative. If you don’t have a specific campaign in mind, consider ActBlue, a platform that helps progressives fundraise.