This Republican Health Care Bill Is Their Most Despicable Obamacare Repeal Yet
With only days remaining for the Republicans in the Senate to use their ability to pass legislature with a simple 51-vote majority, one last effort to repeal the Affordable Care Act is underway. This has been an exercise in futility in the past, with the most recent repeal getting a dramatic thumbs-down from Arizona Senator John McCain.
It seems the Republicans can’t come to an agreement because of conflicting viewpoints. While stripping health insurance from citizens without a serious replacement for the ACA in place is unpalatable for some, others such as Kentucky Senator Rand Paul believe that it doesn’t go far enough to eliminate Obamacare. The Graham-Cassidy bill does have a chance to pass, however. With Republicans moving fast to try to push this bill through, we took a look at what it could mean for Americans and health care as we know it.
No CBO score or debate (and why that’s incredibly important)
The Congressional Budget Office is a non-partisan committee that provides analysis of bills for Congress. For bills with such a high economic impact, it’s common for the Senate to wait for a CBO score before even beginning the process of debate, amendments, and finally voting. For example, the CBO score for the ACA was given on November 18, 2009. The bill wasn’t signed into law by President Obama until March 23, 2010.
But Republicans, like they have done before with the attempted repeal of the ACA, don’t want debate or amendments. They don’t want to replace Obamacare. There will be 90 seconds allotted for debate of this bill before it is brought to a vote.
Republicans know what they’re doing isn’t popular. Back in July, polls showed that 13% of Americans supported a repeal of Obamacare without a true replacement. The more they attempt to push Graham-Cassidy through without debate or even waiting for a CBO score, the more obvious it is that what they’re doing isn’t going to be well-received.
The bill is simply “petty partisanship”
While block grants are awarded to individual states to spend as they see fit under Graham-Cassidy – taking things out of the federal government’s hands and using the guise of “states rights” – any state that expanded Medicaid under Obamacare is going to get hosed. Senator Paul sees right through that, with several Republican-run states getting extra money, while so many other states lose billions.
“They’re putting forward something that keeps Obamacare forever [but] just sends the proceeds to Republican states … So I consider this effort to be petty partisanship,” Paul said. “Just taking the Obamacare money, keeping it, and taking it from Democratic states and giving it to Republican states.”
States such as Ohio, Arizona, Colorado, Louisiana, and Paul’s Kentucky all expanded Medicaid under the ACA, which means that each state stands to lose $5 billion per year or more under Graham-Cassidy. The taxes from the ACA, which are really Paul’s biggest issue with the law, mostly just get reallocated in a way that is intended to harm blue states.
People will lose coverage
As with every version of the Republican attempt to repeal Obamacare, the initial takeaway is that people will lose health insurance. Because there won’t be any waiting for a CBO score to give an official estimate of how many people can expect to lose insurance, we have to go on the unofficial estimates. According to The Commonwealth Fund, that number is very high.
The Congressional Budget Office (CBO) has indicated that it will not release a score of the bill that includes its effects on insurance coverage for several weeks, but Senate leaders have indicated they will hold a vote without a score. The bill, however, is similar to prior ACA repeal-and-replace bills for which we do have CBO scores. Based on those estimates, it is likely that the bill, if enacted, would lead to a loss of health insurance for at least 32 million people after 2026.
Other important notes include that 15-18 million people could lose coverage in the first year alone, there is a waiver program for states that want to allow insurers to cut maternity care, and states could go back to the days when insurers were allowed to charge people with health problems higher premiums.
Pretty much every major health group is opposed
If people are looking to groups in the health care field for guidance, Graham-Cassidy has found few supporters. The American Cancer Society, The Association of American Medical Colleges, The American Heart Association, AARP, and the American Medical Association have all come out with statements against the bill. Even Blue Cross Blue Shield had the following to say:
The [Graham-Cassidy] bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions. The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans. Legislation must also ensure adequate funding for Medicaid to protect the most vulnerable.
In addition, America’s Health Insurance Plans added their own statement on the bill. They laid out several arguments against Graham-Cassidy, closing with a summary statement:
While we cannot support this proposal, we will keep working to find the right solutions that reflect the commitment we all share: affordable coverage and high-quality care for every American. By working together, we can improve health care and deliver the coverage and care that every American deserves.
Opposition from an actual health insurance company, not to mention one of the largest in the country, is quite damning. But it gives accurate scope as to just how bad Graham-Cassidy really is.
Planned Parenthood loses all funding for one year
Not surprising among the bullet-points is that Planned Parenthood would lose funding through this bill. Republicans have been after Planned Parenthood for years, attempting to make the case that federal funding goes to the health care provider to pay for abortions. The truth of the matter is that Planned Parenthood is reimbursed by the federal government for all services covered by Medicaid with the exception of abortion.
Those reimbursements would be eliminated for one year in Graham-Cassidy, and the bottom line is simply that this is an attack on women in poverty. In addition to this, a provision that provides tax credits to low-income citizens would also be eliminated in the bill. We’ve already covered that waivers could be acquired by states to allow insurers to limit maternity care, so it’s not too much of an exaggeration to say that Graham-Cassidy is essentially a war on women’s health care.
Medicaid gets slashed (and America’s elderly population will suffer)
Medicaid might be the one that gets hit the hardest in this bill. According to Avalere Health, repealing the Medicaid expansion allowed under the ACA would reduce federal funding to states by $215 billion through 2026 and by a projected $4 trillion over a 20-year period.
“The Graham-Cassidy bill would significantly reduce funding to states over the long term, particularly for states that have already expanded Medicaid,” said Caroline Pearson, senior vice president at Avalere. “States would have broad flexibility to shape their markets but would have less funding to subsidize coverage for low- and middle-income individuals.”
The ranges of change in federal funding skew as high as $800 billion in California from 2020-2036.
“A combination of slower Medicaid per-capita cap growth rates and the sunsetting of block grant funding would lead to substantial reductions in federal funds going to states through 2036,” added Chris Sloan, senior manager at Avalere. “The largest negative funding impacts of this bill to states are outside the current 10-year budget window.”
We won’t have any real answers until 2026
Even the part that Republicans are most proud of with Graham-Cassidy, the block grant funding that supposedly allows states to decide how to tackle health care on more local terms, only comes with a short shelf-life. While the money going to states creates an immediate shortfall for many, the truth is that the shortfall exists in the long-term for everyone. The block grants are only projected out from 2020 through 2026, at which point Graham-Cassidy has few answers.
Cassidy insists that given the stakes, lawmakers 10 years from now would undoubtedly approve the funding again. He compared it to the Children’s Health Insurance Program, the spending for which must be reauthorized by Congress every few years … But it is a huge risk, based on the Avalere analysis. Without additional funding, the federal spending cut in 2027 alone would be $238 billion.
The ACA may not be perfect. Most agree that improvements could be made to lower the cost of health insurance, while others think that scrapping the current system and moving toward single-payer health care – specifically, in a bill currently proposed by Vermont Senator Bernie Sanders – is the best answer. What seems clear, however, is that the repeated attempts of Republicans to rush an Obamacare repeal through Congress are bad for everyone.