Republicans Try Another Healthcare Bill
Republicans in the Senate considered another bill this month to repeal the Patient Protection and Affordable Care Act, also known as the ACA or Obamacare. Senate Majority Leader Mitch McConnell of Kentucky announced that this latest bill will not go to a vote on the floor after it became apparent that the bill did not have enough votes to pass. But the Senate still has until September 30 to try to pass the bill with 51 votes under the budget reconciliation process.
The newest plan is commonly referred to as the Graham-Cassidy bill after two of its sponsors, Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. The Graham-Cassidy bill would make major changes to the current health care system, giving the individual states:
- more power to control how money from the federal government is spent on healthcare and
- more flexibility to eliminate consumer protections, including for people with pre-existing conditions
As news outlets and members of Congress continue to read the bill, new possible effects of its passing are coming to light. The Congressional Budget Office has released only a partial estimate on an early version of this bill. That estimate shows the government would save $133 billion a year by 2026, but that millions of people would lose their health coverage. The full report will not be ready for a few weeks, but Republicans want to pass it this week, before that information is available.
Republicans tried to move this through as quickly as possible, which limited debate and committee hearings where problems with bills are normally found and addressed. After September 30, this or any other health care bill will need 60 votes to pass the Senate, and would require the support of at least some Democrats. Whether you have concerns about this plan, the ACA or what may come in the future, it is important to call your Senators and let them know about your experiences and concerns.
The ACA helps people with low incomes to get health insurance coverage, most notably by expanding eligibility for Medicaid and providing subsidies for people buying individual insurance plans. The Graham-Cassidy bill will end both these programs at the end of 2019, and give most of the funds currently spent on them to the states as block grants. In a block grant, individual states get a lump sum of money each year. The federal government provides general guidance about where that money should go, but each state will decide how best to use those funds towards those ends. Under the Graham-Cassidy bill the grant money will have to be put towards at least one of these options
- helping people at high risk of needing health care get coverage
- helping cover out of pocket healthcare expenses for individuals
- keeping premiums and markets stable
- creating programs to help people get healthcare coverage or
- paying providers for health services
But that does mean that states can choose to direct all the money to hospital and not to provide health insurance coverage to individuals who would be losing coverage through Medicaid or individual insurance.
Federal funding for healthcare will lower nationwide, but some states will see much larger cuts than others. The Graham-Cassidy bill plans to balance funding overall by cutting the amount of money given to the 31 states (plus Washington D.C.) that expanded Medicaid, like Ohio, Arizona and Pennsylvania, and giving it instead to states like Texas that did not expand the program.
A revised version of the bill was released on Sunday, September 24, with additional funds for select states. These funds would go to states that expanded Medicaid after 2015, states that set up a program under the ACA’s innovation waiver and certain states with high poverty rates. These are seen by most as a way to get the support of reluctant Senators, in particular Sen. Lisa Murkowski of Alaska who voted against the last Republican health care bill. Alaska would get more money from the federal government as a result of this revision.
These grants will end in 2027 unless Congress votes to renew them.
Along with the power to use federal block grants how they see fit, states will also have greater authority under the Graham-Cassidy bill to end important protections from the ACA.
The Essential Health Benefits are 10 benefits insurance plans must at least partly cover under the ACA that the Graham-Cassidy bill would allow states to eliminate. These include emergency services, prescription medicines and maternity care. Without this requirement insurers can offer cheaper plans by cutting coverage for expensive services you may need, like maternity care or chemotherapy medicines. States could also allow companies to put limits on how much they would pay for health care, leaving people with the highest healthcare bills on their own for any services after they hit that level.
States can allow insurance companies to charge people with pre-existing conditions, like breast cancer, more for the same insurance plans. Insurers will also be allowed to charge even higher rates based on your age. Right now, a company can only charge older people 3 times what it charges a younger enrollee. Graham-Cassidy lets them charge older customers 5 times more.
Under the revised bill, states would also have control over out-of-pocket maximums. Right now, the ACA limits how high insurance companies can set that limit on the most you would have to pay for health services if you are insured. But under the Graham-Cassidy bill, states could allow insurers to sell plans with higher maximums.
The Medicaid expansion would end under the Graham-Cassidy bill, leaving millions of people without coverage.
In addition, the model for funding Medicaid overall would be changed and states would see significant funding cuts. As in the Better Care Reconciliation Act, the bill that failed to pass the Senate this summer, Medicaid funding from the federal government will no longer be tied to the healthcare people actually need. Instead, the federal government will give each state a block of money based on the number of people enrolled. These block grants would not be connected to the growth of healthcare costs from year to year. So, starting in 2024 states will have to pay more from their state budget (rather than using federal money), to cut services, cut people from the program, or both.
The requirement that people get health coverage or pay a fine and the penalty for employers with more than 50 workers that don’t provide an insurance option will be repealed as part of this bill. Earlier Republican plans had other programs to discourage people from dropping coverage, but the Graham-Cassidy bill offers no replacement, leaving it to individual states to make their own programs. The danger is that if people in good health decide to not purchase health insurance, prices will go up, putting more of a financial burden on people who have a pre-existing condition and need to keep coverage. If prices go up enough, more people may leave the market, which can push prices up even more or cause companies to end those plans.
Senate Majority Leader Mitch McConnell has cancelled plans to vote on the bill this week, but things could change quickly. Now is the time to bring concerns to your Senators.