The first — and likely the only — hearing on the latest Republican proposal to replace the Affordable Care Act started in chaos and ended divided largely along party lines.
It may also have been for naught, as during the hearing, yet another Republican came out against the so-called Graham-Cassidy bill.
As Senate Committee on Finance Chairman Orrin Hatch read his opening statement, a dozen or more protesters — many in wheelchairs — began loudly chanting “No cuts to Medicaid! Save our Liberty.” Hatch, a Utah Republican, tried to gavel the hearing back to order, to no avail.
“If you want a hearing you better shut up,” said Hatch. United States Capitol Police removed the protesters, wheeling them out or dragging them into the hallway outside the hearing room in the Senate’s Dirksen Office Building.
The chants — now outside the room — could be heard throughout much of the 5-hour hearing. The Graham-Cassidy bill has been unpopular among many since it was introduced September 13. A host of major health care and medical organizations, consumer advocates, state governors, state Medicaid directors, and insurers, among others, have said they do not support the Graham-Cassidy proposal. Those who’ve weighed in against the bill include the AARP, American Academy of Pediatrics, American Academy of Family Physicians, American College of Emergency Physicians, American College of Physicians, American Hospital Association, Americas Health Insurance Plans, American Medical Association, BlueCross Blue Shield Association, and Federation of American Hospitals.
The bill has undergone multiple revisions—so many that during the Senate hearing, Democrat Ron Wyden of Oregon asked Sen. Bill Cassidy (R-La.) which version they would be asked to vote on in the coming days. The revisions are widely seen as a means of enticing a handful of Republicans who have said they will not support, or are leaning against, the Graham-Cassidy plan.
If the vote is taken before September 30–when a special rule expires—it can pass with a simple 51-vote majority. After that, 60 votes will be required. With 52 Republicans, the GOP has been struggling to hold even a simple majority.
Cassidy said at the hearing that the most recent revisions corrected drafting errors, but he also acknowledged that the bill had been changed to ensure that states such as Maine would get a fairer share under the proposal’s Medicaid provisions. Maine’s Sen. Susan Collins, a Republican, who was leaning against Graham-Cassidy issued a statement during the hearing that she would not support the bill.
Republicans said it was urgent to replace the ACA, citing premium increases and insurers pulling out of the exchanges. “I’m here because Obamacare is a disaster in my state,” said South Carolina Republican Lindsey Graham, who co-authored the proposal.
“Thirty-one percent of South Carolinians who signed up at the beginning of the year simply can’t afford to continue the coverage,” added Republican Tim Scott.
Democrats acknowledged that the individual marketplace needed to be addressed, but said that Graham-Cassidy went too far, and would result in a significant gutting of Medicaid. They also said that the bill was being pushed through too quickly without enough review.
“The process that has brought this TrumpCare bill to the brink of passage would be laughable if the well-being of tens of millions of Americans wasn’t in the balance,” said Democrat Ron Wyden of Oregon. Added fellow Democrat Mark Warner of Virginia, “This current process is a travesty.”
Higher Rates for Preexisting Conditions
A continuing flashpoint has been whether the Graham-Cassidy proposal would mean higher premiums for preexisting conditions.
In an analysis released during the hearing, Timothy Jost, emeritus professor at the Washington and Lee University School of Law, said the newest revision “makes protection for people with preexisting conditions very tenuous.”
The proposal “would seem to permit insurers to charge individuals with preexisting conditions higher premiums, even at renewal of their existing coverage,” said Jost. Although insurers would be required to sell to people with preexisting conditions, “it could be very expensive,” he said.
Wyden asked Cassidy directly whether preexisting conditions would be subject to higher rates. He would not answer directly.
“I think governors want to take care of people in their states,” said Cassidy later, adding that states that want to get a waiver from any preexisting conditions exclusions must provide access to quote adequate and affordable coverage. If a state does not do so, the Secretary of the Department of Health and Human Services can “pull dollars back,” said Cassidy.
Cassidy: States in Drivers’ Seats
Democrats said they were concerned that the Graham-Cassidy proposal to convert Medicaid into block grants and institute per capita caps would result in millions losing coverage and states choosing to — or having to — reduce spending on a variety of programs.
They painted a picture of states being put in an uncertain and untenable position.
“Not only are you asking states to do more with less — and calling it flexibility,” but it’s going to mean the states will have to pay the bill, said Sen. Claire McCaskill, Missouri Democrat.
Cassidy said that states would, in many cases get more money from Medicaid, and have the ability to decide what works best for their residents. And, he said, states that had chosen to expand Medicaid could continue to do so. “Folks say you are losing the Medicaid expansion dollars — you’ll get them, you’ll just get them in a flexible block grant,” said Cassidy.
Rep. Mazie Hirono (D-Hawaii), who was recently diagnosed with stage 4 kidney cancer, disagreed. The bill “punishes states like Hawaii that expanded Medicaid by cutting federal funding and redistributing it to those states that did not expand Medicaid,” said Horono, at the hearing. The proposal would mean $4 billion less in Medicaid and some 91,000 fewer people with health coverage in Hawaii, she said.
“The one thing that people should be able to count on in the richest country in the world is getting the care they need when they need it,” said Hirono.
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