The most recent attempt to repeal and replace the Affordable Care Act (ACA), often referred to as ObamaCare, is the Graham-Cassidy Bill. The proposal from Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) has used federal block grants to let states shape their own healthcare policies.
The Graham-Cassidy proposal was halted on Tuesday afternoon, after Senate Majority Leader Mitch McConnell announced that there would not be a vote. This came shortly after several republican senators announced they would not vote in favor of the measure.
The Graham-Cassidy plan received criticism across the board, from late night talk show host Jimmy Kimmel to Massachusetts Governor Charlie Baker. Kimmel used lengthy monologues on his show to point out the flaws of the policy, and even called out Senator Cassidy for “lying to [his] face.”
In a Senate Hearing for the Health, Education, Labor and Pensions (HELP) Committee, Senator Al Franken (D-MN) asked Gov. Baker if the Graham-Cassidy Bill is one that he would support for Massachusetts. Gov. Baker said no.
“The proposal would negatively affect the Commonwealth of Massachusetts, and we could lose billions over the course of four or five years,” said Baker. “The way this proposal is designed could result in losses for other states like Massachusetts. The problem I have with the Graham-Cassidy proposal is that it assumes the cost of healthcare across the country should be the same everywhere. To promote the idea that you could build a block grant around this structure is just inaccurate.”
Senator Rand Paul (R-KY), who is a very vocal opponent of the ACA, announced he would vote no on the Graham-Cassidy Bill as he believes it does not do enough to repeal ObamaCare.
Senator John McCain (R-AZ) announced on Sept. 22 that he will vote against the Graham-Cassidy Bill. This came as a surprise to some given McCain’s relationship with Graham, whom he has characterized as his “illegitimate son.”
McCain asked that instead the Senate should spend their time working towards a bipartisan solution.
On Monday, Senator Susan Collins (R-ME) announced she would be voting against the proposal. In a statement, the Senator said that “Maine still loses money under whichever version of Graham-Cassidy bill we consider.”
These three republican “no” votes tipped the scale against the bill’s passage.
The U.S. Senate is split 52-48 with a Republican majority, necessitating a few senators to vote against the republican caucus on certain measures. Senators Lisa Murkowski (R-AK) and Collins voted several times with the democratic caucus when it comes to republican efforts to repeal and replace.
Senator McCain joined them in July with his historic thumbs-down “no” vote against the Healthcare Freedom Act, more commonly referred to as the Senate “Skinny” Repeal bill.
Some Senate democrats have rallied behind an effort led by Senator Bernie Sanders (I-VT) to pass S.1804 Medicare for All Act; a single-payer healthcare bill. Sixteen Senate democrats have co-sponsored this piece of legislation, including Senator Elizabeth Warren (D-MA).
National Public Radio had a very detailed analysis explaining that the Medicare for All plan would make the federal government the “single payer” of healthcare for all American citizens. The bill eliminates cost-sharing such as copayments, besides the prescriptions of mostly generic drugs.
Representative John Conyers (D-MI) has been pushing for a similar type of Medicare for All bill during every legislative session in the House of Representatives since 2003. Analysts question if there would be sufficient government funding to cover a Medicare for All bill, even with increased taxes.
The efforts towards repealing and replacing the Affordable Care Act were a shared goal of republicans throughout the 2016 election, and resulted in legislative action in May. The House of Representatives passed the first attempt at repeal and replace with H.R.1628, the American Health Care Act (AHCA).
These pieces of legislation usually require a score from the Congressional Budget Office (CBO), as healthcare makes up about one-fifth of the entire U.S. economy. The CBO is a non-partisan government agency that provides analyses for how Congressional actions will affect the U.S. economy.
The CBO announced that while the AHCA would reduce the federal deficit by $119 billion by 2026, it would do so by leaving 23 million uninsured. The CBO also stated that premiums would go up by 20 percent starting next year; and one in six Americans would lose insurance; largely poor people and those with pre-existing conditions.
The “Skinny” Repeal bill received an only slightly better CBO score. It gave more flexibility to states, prohibited federal funds from being used on abortion services for a year, threatened Medicaid funding, and would leave 16 million uninsured by 2026, as reported by The Hill. The preliminary CBO score for the Graham-Cassidy Bill all but convinced Senator Collins to vote against the proposal.
Chairman of the Senate HELP Committee Lamar Alexander (R-TN) and Ranking Member Pat Murray (D-WA) have spearheaded a bipartisan effort to fix the ACA. They have held several hearings throughout September with state insurance commissioners, governors, and other stakeholders to understand what must be amended in ACA.
The ACA requires that all Americans have healthcare coverage, and since its passage, coverage has in fact increased in the U.S. The healthcare mandate makes it so that when individuals file their taxes, they must prove that they have healthcare, or are required to pay a penalty.
The HELP Committee is seeking to improve the Section 1332 waiver of ACA; giving states more flexibility to develop healthcare plans that will work better in their states. The sec. 1332 waiver has very stringent requirements to ensure that those who received healthcare under the Affordable Care Act still have the similar coverage at an equal or lesser price. The waiver has been successful in places like Alaska, with more states like Massachusetts and Minnesota applying.
The HELP Committee advocates amending the application process which is difficult for states with part-time state legislatures, has unclear application requirements, and no defined application deadline.
The Committee will also likely seek to reinstate funding for Navigator Program and advertising campaigns. The Trump Administration has cut the funding for this program by 90 percent. The program works to educate mainly young people about the importance of healthcare, and the options they have.
Young people are the least likely to buy healthcare, but have the greatest impact on insurance pools and lowering premiums, due to their greater likelihood to be healthy.
The Senate HELP Committee is also working to address the need for re-insurance pools, and extend cost-sharing reduction payments in the ACA.
Either way, if Americans want to maintain coverage and accessibility, without paying a higher cost for healthcare coverage in the coming year, Congress needs to act, and act quickly.
At the end of September, the budgetary rules allowing for simple majority votes during the reconciliation period will end. Senate republicans will either push for a bill by creating a reconciliation period in fiscal year 2018, or starting early next year in negotiations for 2019.
