Four Republican Senators have introduced a new attempt to repeal and replace large portions of the Affordable Care Act (ACA), racing to beat a September 30 deadline to pass any such reform under reconciliation rules with a bare majority of 50 votes (plus Vice President Pence). Sens. Graham (SC), Cassidy (LA), Heller (NV) and Johnson (WI) have proposed a bill that would replace federal funds for Medicaid expansion and subsidies for individual market insurance sold in the marketplaces with a lump sum block grant for states to use for unspecified health care purposes. The bill would also repeal the ACA’s individual and employer mandates while giving states flexibility in enforcement of additional consumer protections, such as the essential benefits required to be included in health plans. Further analysis is available below.
WSHA’s position. WSHA has consistently held that any replacement for the ACA must cover at least as many Washingtonians. It is highly unlikely that this new legislation will do so. The bill is much more likely to result in drastic coverage reductions, huge budget deficits for the state government, financial harm to hospitals and ultimately worse health outcomes for Washington residents. Next week, WSHA will be leading a group of rural hospitals to advocate with our Congressional delegation in D.C.
Call to action
Senate. Please thank Washington Sens. Patty Murray and Maria Cantwell for their continued opposition to this effort. See their contact information here.
House of Representatives. The Senate Republicans have requested an expedited scoring of the bill by the Congressional Budget Office (CBO) in order to proceed to a potential vote next week. CBO will provide an estimated impact on the federal budget if the legislation were enacted, but it is unclear whether CBO will have time to develop detailed estimates of coverage levels. Due to the September 30 deadline to use reconciliation in the Senate, if the bill were to pass the Senate next week, the House would need to vote on an unaltered version of the bill. This means we may be asking members to weigh in with their house members on short notice.
According to initial analysis by the American Hospital Association, the new legislation would:
- Result in millions losing health coverage. The bill would repeal the ACA’s individual and employer mandates, a change CBO previously estimated would result in 14 million fewer insured individuals after one year. In addition, the bill would reduce the amount of funding for traditional Medicaid by transitioning financing for the program to a per capita cap model with trend factors that are generally below historic spending growth, potentially jeopardizing coverage and services for our most vulnerable.
The grant program would take money from Washington and other states that expanded Medicaid coverage to give to states that did not. It would end after seven years, potentially creating massive disruption in the health care system as millions of individuals may lose their source of coverage.
- Erode key protections and funding for patients and consumers. The bill would repeal the ACA’s Medicaid expansion, federal Basic Health Program and Health Insurance Marketplace subsidies effective Jan. 1, 2020 and establish a block grant program for states to create their own health care programs from 2020 to 2026. States could use the funds to help individuals enroll in coverage, but they also could use the funds for other health-related purposes. This change would allow states to waive many insurance rules for coverage provided through the block grant program. States could eliminate some or all of the essential health benefits and allow insurers to charge individuals with pre-existing conditions any amount in premiums, effectively pricing many individuals out of coverage.
- Would not stabilize the insurance market in the short or long term. The bill fails to fund the cost-sharing reductions (CSRs) in the short term (2018 and 2019), while providing a separate fund for insurers to help stabilize the insurance markets in 2019 and 2020 (but not 2018). CBO previously estimated that failure to fund the CSRs in 2018 would increase premium rates by 20 percent and increase the federal deficit by $6 billion that year.