Washington – The latest GOP attempt to repeal and replace the Affordable Care Act would continue to ban insurers from rejecting people with pre-existing conditions, but would make it easier for insurers to jack up the rates for those customers and for states to roll back other consumer safeguards.
The sponsors of the Senate health bill, Sens. Lindsey Graham, R-S.C. and Bill Cassidy, R-La., released a revised version of their bill on Monday that boosted the amount of Medicaid dollars that would go to four key states — Alaska, Maine, Arizona and Kentucky.
Those states are home to Republican Sens. Lisa Murkowski, Susan Collins and John McCain, who doomed the last GOP attempt to repeal and replace the ACA, and to Rand Paul, who says he won’t vote for the latest repeal attempt but is negotiating with the White House. McCain is a firm “no” on the Graham-Cassidy bill, and Murkowski says she is leaning against it. In what may be the biggest blow to the bill, Collins said late Monday she would oppose it.
Collin’s decision to come out against the bill late Monday, after the Congressional Budget Office said it would result in millions of Americans losing coverage, may doom the legislation. Republicans needed support from 50 of their 52 members in the Senate, with Vice President Mike Pence casting a tie-breaking vote.
“Sweeping reforms to our health care system and to Medicaid can’t be done well in a compressed time frame, especially when the actual bill is a moving target,” Collins said.
The revised bill shows that Connecticut would lose billions from the legislation’s revision of the Medicaid program. The Graham-Cassidy bill would change Medicaid from a program that covers everyone who qualifies, with states and the federal government sharing the cost, to one in which states receive a pre-determined amount of money from the federal government each year, in the form of a block grant.
Connecticut residents also would lose the subsidies they receive under the Affordable Care Act to purchase insurance on the state exchange, Access Health CT, which would no longer exist.
A number of Senate conservatives, including Sen. Ted Cruz, R-Texas, have expressed concerns that the Graham-Cassidy bill does not go far enough in repealing Obamacare.
So the revised bill, in an attempt to woo these conservative votes, would make it easier for states to opt out of certain Obamacare insurance regulations.
States would be able to allow insurers to set up “multiple risk pools,” which could separate sick and healthy people and drive up premiums for those with pre-existing conditions.
The revised bill also would allow states to waive the prohibition on insurers raising rates for people with preexisting conditions — without seeking a waiver from the federal government. Under the previous version, a waiver would have been required.
The revised bill also would allow states to change the federal cap on out-of-pocket costs –mainly co-payments and deductibles – for those who enroll in an insurance plan.
On Monday, Sen. Chris Murphy, who has unleashed a tweetstorm of criticism of the Graham-Cassidy bill, called the latest version of the legislation an “amazingly even more awfuler edition of the Graham-Cassidy death spiral bill.”
And Larry Levitt, senior vice president at the Kaiser Family Foundation, said, “If there was any question about Graham-Cassidy’s removal of federal protections for pre-existing conditions, this new draft is quite clear.”
Bill supporters say they want to give control of the health care system back to the states.
“My goal is to get the money and power out of Washington, closer to where people live, so they’ll have a voice about the most important thing in their life.” Graham said.
Bill supporters also seek to end a number of taxes on the wealthy, insurers, pharmaceuticals, medical device makers and others that the ACA imposed to help pay for expanded coverage.
Ending those sources of revenue forces the federal government to cut back help to the states, especially those like Connecticut that received more federal help because they expanded their Medicaid program under the ACA. Besides turning Medicaid into a block grant program, the bill would phase out the expansion money.
Undermining safeguards
Like other GOP repeal-and-replace efforts, the Graham-Cassidy bill would allow insurers to charge older people up to five times as much as a younger person for the same insurance policy. The ACA only allowed older people to be charged three times as much.
Some Affordable Care Act protections and benefits would remain, including the provision that children can stay on their parent’s policies until they turn 26 and a ban on placing lifetime caps on coverage.
But the bill would limit access to addiction treatment and reduce federal spending on public health campaigns, such as childhood vaccinations.
The bill also allows, and even encourages, states to impose a work requirement on Medicaid recipients who are not disabled, elderly or pregnant, and bans Medicaid from covering any health costs of patients at Planned Parenthood clinics. Currently, only abortion services are banned.
Over the weekend, a coalition of health provider groups, including the American Medical Association and the American Hospital Association, and the nation’s health insurers urged the Senate to reject the bill.
“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 coalition said in a joint statement. “The Senate should reject it.”
The coalition said the bill would “cause patients and consumers to lose important protections, as well as undermine safeguards for those with pre-existing conditions.”
They also said “the bill will result in dramatic cuts to Medicaid…fundamentally changing the way that states provide coverage for some of our most vulnerable citizens.” They said the individual insurance market “would be drastically weakened.”
The Senate Finance Committee held a hearing on the Graham-Cassidy bill Monday. Proceedings were halted for about 15 minutes so Capitol Police could eject protesters, some of them in wheelchairs, from the hearing room.
The hearing is part of a rushed process to hold a vote on the bill before a Sept. 30 deadline. That’s when the budget reconciliation timeline that allows the GOP to pass the bill with a simple majority and avert a filibuster will end.