Tag Archives: Graham Cassidy Bill

The newest effort to repeal and replace the Affordable Care Act (aka Obamacare, ACA) is called the Graham-Cassidy Bill. Although the actual legislation has been clouded in secrecy, there are a few fundamentals that can be shared, and we’ll present them in Q&A format. Be reminded that this reform is meant to impact approximately 1/6^th of the United States economy. We’ve done our best to prevent facts Straight, No Chaser style, so consider points that seem slanted self-evident truths and evaluate your reaction to them.

I. What’s a block grant? Let’s address both the facts and the spin. Block grants are a means for the federal government to cap expenses by taking a fixed amount of funds (typically what’s currently or historically being spent) and offering those same funds to individual states for their management. This isn’t a new idea. Republicans have been pushing block grants for Medicaid since the Reagan administration (1981). Block grants were notably used in converting welfare (Aid to Families with Dependent Children) away from an entitlement program in 1996. The spin (and the danger) is states would be allowed to manage those funds as they saw fit, which allows for either greater or lesser health protections, as well as innovation and restrictions. Simply put, states would be empowered to decide what services are offered and who would qualify for those services.

2. What would happen to Medicaid? In the block grant scenario, the amount would be capped with annual adjustments to account for inflation, but those amounts would not keep pace with the rate of medical inflation. In other words, states would eventually have less money with which to work. Furthermore, the proposal explicitly ends coverage for childless adults and ends the Medicaid expansion that occurred under Obamacare and currently covers 15 million adults. As such, there will be a massive redistribution away from states who opted into the ACA Medicaid expansion toward those that did not. Although the Congressional Budget Office hasn’t yet had time to score the Graham-Cassidy bill, in the past, it has opined that block grant proposals could cut Medicaid spending by as much as a third over the next decade. That’s not all. Most notoriously, the block grant would end after 2026. That’s right, in ten years the federal government would have to renew the grant, or states would need to replace every last federal dollar or roll back coverage even more. In other words, all funds currently assigned to Medicaid and the ACA would no longer be spent by the federal government in ten years under the currently proposed bill. Whether or not you believe in reducing costs, you should be quite concerned about the lack of market stability that represents, much less what’s going to happen to health care in 10 years. A conservative estimate is tens of millions of Americans will lose healthcare under any scenario of Graham-Cassidy.

3. How are preexisting conditions affected? Here’s the facts and the spin. Based on the best information available, states would be required to “offer” services to those with preexisting conditions. However, remember that services are actually provided by insurance companies. This bill neither addresses pricing nor mandates affordability to those covered. Thus, a health service could be offered, but it is probable that the price of coverage will become so high for the high-risk patient and those with preexisting conditions that they’ll either elect to or not be able to pay the cost. The nuances here allow competing interests to claim both that pre-existing conditions are or are not going to be covered.

4. Is this supported by the medical and public health communities? How about the public? Every conceivable apolitical sector, from hospitals, insurance companies, health organizations and the public are speaking out against this proposal. On Saturday, a joint press release was signed by multiple prominent medical organizations and insurance companies, united in opposition to the bill. Signing healthcare entities included the following: American Medical Association, American Academy of Family Physicians, Federation of American Hospitals, American Hospital Association, American Health Insurance Plans and the Blue Cross Blue Shield Association. Here is a quote from the press release: “While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable healthcare market that provides access to high-quality care and affordable coverage for all… The Graham-Cassidy-Heller-Johnson bill does not move us closer to that goal. The Senate should reject it.” Only 24 percent of Americans support Graham-Cassidy, according to a new poll released Thursday by Public Policy Polling. Meanwhile, the public supports retaining the Affordable Care Act over replacing it with the proposed Graham-Cassidy bill by 56-33 percent in a new ABC News/Washington Post poll.

5. What’s going on with Obamacare (Affordable Care Act/ACA) these days? It actually is very much intact, although multiple executive orders have been enacted to weaken it (that will further the appearance and reality that it is flawed). The Trump administration has reduced advertising funds by 90% to announce enrollment, but you should know enrollment for 2018 starts November 1 and ends December 15.

6. Are there any women’s health concerns? It is implicit in the effort to rollback delivery of healthcare to the states that politics will play a role in multiple issues, including those of women’s health. It is explicitly of note that the Graham-Cassidy proposal eliminates federal funding to Planned Parenthood for one year.

7. How can I express my concern? What follows is an exhaustive list of contact numbers for your Senators. Media reporting suggests the number of calls hasn’t been close to that of previous efforts to repeal the ACA, so if you have a voice to share, you have until week’s end (Friday) to be heard.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
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