Sen John McCain (R-AZ) may have torpedoed yet another Republican bill that overhauls the Affordable Care Act (ACA), a bill also opposed by the healthcare industry, or at least groups that purport to represent it.
McCain announced today that he could not support a bill sponsored by Sen. Bill Cassidy, MD (R-LA), Sen. Lindsey Graham (R-SC), and others without a full report by the Congressional Budget Office (CBO) on how the measure would affect healthcare coverage and insurance premiums. With one other Republican, Sen. Rand Paul (R-KY), a definite ‘no,’ Senate Republicans cannot afford any more defections in their quest for the 50 votes needed for passage (Vice President Mike Pence is counted on to cast the tie-breaker). The party enjoys a 52-seat majority. Yet several other Republican Senators who joined McCain in quashing the last GOP repeal-and-replace bill may line up with him against the Graham-Cassidy bill.
The CBO says it won’t have an estimate of the bill’s impact on coverage or insurance premiums until several weeks from now. However, the agency plans to issue an analysis early next week of how it impacts the federal budget, presumably before the Senate votes. Supporters have pushed for a vote next week before the September 30 expiration of a parliamentary manuever that makes the bill filibuster-proof — and lowers the threshold for victory to 50 ayes.
Major healthcare groups like the AMA (AMA), the American Hospital Association, America’s Health Insurance Plans, and the American Nurses Association have warned that the Graham-Cassidy bill would roll back coverage gains and consumer protections achieved under the ACA. They also fault Senate Republicans for not wanting to wait for a full CBO report on the measure’s ramifications.
In a nutshell, the legislation would take money earmarked for ACA provisions such as premium subsidies and Medicaid expansion, give it to states in the form of block grants through 2026, and let them spend it on their own reforms. The bill also would limit once open-ended federal contributions to state Medicaid programs by converting them to block grants or capping them on a per-capita basis — states can take their pick. The individual mandate to purchase coverage as well as Medicaid expansion would go by the wayside.
The bill, as Lindsey put it recently, “breaks (the) Obamacare mold by sending money and power back to the states, and closer to patients, to deliver quality healthcare.”
Some policy analysts have crunched the numbers to come up with projections that resemble those for previous Senate Republican measures to repeal and replace the ACA. The consulting firm Avalere Health estimates that under the Graham-Cassidy bill, states would receive $215 billion less in federal funds through 2026, with states that had expanded Medicaid taking the biggest hits. And up to 18 million people could lose coverage in 2019, and more than 32 million after 2026, when the temporary ACA-financed block grants expire, according to the Commonwealth Fund.
Commentators all around also point to the ability of states to let insurers drop once essential benefits like maternity care, and base premiums on health status — meaning pre-existing conditions. That isn’t possible now under the ACA.
Follow Robert Lowes on Twitter @LowesRobert
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