Skip to main content
Monthly Archives

September 2017

Reviews Are In: Graham-Cassidy Would Devastate Alaska

The reviews are in for Graham-Cassidy, the latest iteration of the GOP’s secret, partisan health care bill which would raise costs, lower choices, eliminate protections for pre-existing protections and gut Medicaid. There is perhaps no state which would fare worse than Alaska, which could see a 65% percent reduction in federal funding and cost increases to the tune of $31,790 more per year in premiums and out of pocket costs for a 60-year old making $25,000 per year starting in 2020. Alaska Governor Bill Walker said yesterday, “Alaska would fare very, very poorly. Nothing has been brought to my attention that would increase my comfort level.”

Just take a look at the headlines…

Alaska Dispatch News: State analysis predicts a rough road for Alaska under GOP health care legislation

The Midnight Sun: Alaska would lose 38 percent of federal health care funding under Graham-Cassidy

Fairbanks Daily News-Miner: Medicaid directors, including Alaska’s, sign statement critical of GOP health bill

NBC KTVU 2: Alaska DHSS releases preliminary analysis into Graham-Cassidy’s impact on Alaska

State of Reform: Alaska Commission on Aging comments on Graham-Cassidy

Daily News Miner: Studies: GOP health care proposal could prove costly for Alaskans

KTVA: Mother: Healthcare repeal could mean ‘difference between life and death’

Daily News Miner: Walker airs concern about latest GOP health care bill

Protect Our Care Statement on Trump Administration’s Continued Health Care Sabotage

Washington, D.C. — During a webinar this afternoon, HHS announced that HealthCare.gov would be offline 5 out of the 6 Sundays during the upcoming open enrollment period. This means that during the shortest open enrollment period ever, HealthCare.gov will be down for 3 full days. Today’s announcement follows recent decisions by the administration to cut navigator funding by 40 percent and the outreach and advertising budget by 90 percent.

“This is outrageous. It’s clear that even if Republicans continue to fail to repeal the Affordable Care Act that the Trump administration will go to any lengths to sabotage the law,” said Brad Woodhouse, Campaign Director for Protect Our Care. “From destabilizing the health care market by threatening not to pay cost sharing reduction payments to undermining open enrollment, the Trump Administration will pursue every tactic to undermine health care no matter how many Americans it hurts. The American people are sick of it — they oppose repeal and they will hold President Trump and Republicans in Congress accountable for sabotaging their health care.”


Frist, Wilensky, Daschle, Slavitt Join Growing Chorus Calling For Bipartisan Process On Health…

To: Interested Parties

From: Brad Woodhouse, Protect Our Care Campaign Director

Date: September 22, 2018

Subject: Frist, Wilensky, Daschle, Slavitt Join Growing Chorus Calling For Bipartisan Process On Health Reform; Condemn Reckless Rush On Graham-Cassidy Repeal

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

Joining a rapidly growing number of health experts from across the political spectrum, the Bipartisan Policy Center’s Future of Health Policy panel called for a return to bipartisan cooperation on health reform. The panel, which includes former Senate Majority Leaders Bill Frist and Tom Daschle; former acting administrator of the Centers for Medicare and Medicaid Services Andy Slavitt; and former administrator of the Health Care Financing Administration Gail Wilensky, condemned the partisan process around the Graham-Cassidy repeal bill. Rather than trying to ram thru the widely opposed Graham-Cassidy bill which Senator John McCain announced his opposition to today, the Senate should focus on productive bipartisan proposals such as the the Collins-Nelson market stabilization proposal and the Alexander-Murray discussions that were under way in the Senate HELP Committee.

The panel of bipartisan leaders said:

“Bipartisan, fully negotiated and analyzed reforms to our nation’s health care system are essential if we are to ensure access to quality, affordable health care coverage for all Americans. Cooperation across party lines is critical to creating legislation that will be sustainable over the long term. It is regrettable that consideration of the Graham-Cassidy amendment is taking place entirely outside of a productive bipartisan process.”

The announcement comes as non-partisan groups representing nearly every facet of the health care industry, including insurance companies, doctors, patients, hospitals and other patient-provider groups have come out in opposition to Graham-Cassidy. A sampling of these many groups include: American Cancer Society Cancer Action Network, AARP, American Medical Association, American Academy of Pediatrics, AHIP, the President and CEO of the Robert Wood Johnson Foundation, Blue Cross Blue Shield Association and the American Heart Association.

Yesterday, in an unprecedented joint statement, all the board of directors of the National Association of Medicaid Directors said: “Our members are committed to ensuring that the programs we operate improve health outcomes while also being fiscally responsible to state and federal taxpayers. In order to succeed, however, these efforts must be undertaken in a thoughtful, deliberative, and responsible way. We are concerned that this legislation would undermine these efforts in many states and fail to deliver on our collective goal of an improved health care system.”

Meanwhile, a group of governors representing both parties have come out in strong opposition to Graham-Cassidy. In a letter to Majority Leader Mitch McConnell, the governors said: “We ask you to support bipartisan efforts to bring stability and affordability to our insurance markets. Legislation should receive consideration under regular order, including hearings in health committees and input from the appropriate health-related parties. Improvements to our health insurance markets should control costs, stabilize the market, and positively impact coverage and care of millions of Americans, including many who are dealing with mental illness, chronic health problems, and drug addiction.”

Nevada Governor Brian Sandoval added last night that “Flexibility with reduced funding is a false choice. I will not pit seniors, children, families, the mentally ill, the critically ill, hospitals, care providers, or any other Nevadan against each other because of cuts to Nevada’s health-care delivery system proposed by the Graham-Cassidy amendment.”

The many calls for bipartisanship and regular order echo those by Senator John McCain (R-AZ) for the Senate to return to regular order to consider how to best reform our health care system. Senate leadership should not jam a bill of this magnitude through with nothing more than a facade of a Finance Committee “hearing” and a CBO score that does not address how many people will lose coverage.

This growing chorus of leaders and experts from across the political spectrum are calling for a return to the bipartisan legislative process, rather than rushing to push through an unpopular bill without due consideration or analysis. It is time for the Senate to heed these calls.

Protect Our Care Statement on Sen. John McCain’s Announcement in Opposition to Graham-Cassidy

“Senator McCain established a test which all Senators should follow on health care: reforms to an issue of this importance and magnitude should be addressed on a bipartisan basis and should follow regular Senate procedure including hearings and expert witnesses. Graham-Cassidy fails this test in every regard, and Senator McCain is right to oppose this latest effort at partisan repeal,” said Brad Woodhouse, Campaign Director for Protect Our Care.

“But beyond process, Senators should oppose this latest repeal effort because it would devastate our health care system. Graham-Cassidy has been called radical and the worst of all repeal bills, and rightly so. It would deny coverage to 32 million Americans, end Medicaid expansion, undermine traditional Medicaid, impose an age tax on seniors and end protections against discrimination for people with pre-existing conditions. Graham-Cassidy is bad on process as Senator McCain has rightly noted, but it would be a dumpster fire for the American health care system. It’s time for Senator Mitch McConnell to set this partisan bill aside and allow bipartisan efforts to stabilize our health care system to move forward.”

Graham-Cassidy: The Worst GOP Repeal Bill, Confirmed

Since its announcement last week, Graham-Cassidy, the Senate’s latest iteration of secret, partisan repeal bill that would raise costs, decrease options, remove protections for pre-existing conditions and end Medicaid as we know it, has run into setback after setback, from seemingly every entity with a stake in this legislation. Just take a look for yourself…

“With their deadline fast approaching, Senate Republicans’ rush to repeal and replace Obamacare remains as unpopular as ever with the public. Only 24 percent of Americans support Graham-Cassidy, the health care bill Republicans are furiously whipping to pass ahead of September 30, according to a new poll released Thursday by Public Policy Polling. The poll is the first to date of the proposed legislation, which would cripple Obamacare’s exchanges and sharply cut long-term Medicaid spending while also taking billions of funding from blue states that implemented Obamacare and giving it to red ones that did not.”

“In public, President Donald Trump is all-in on the Senate’s final chance to repeal Obamacare. But privately, there’s ambivalence in the White House about the bill’s contents and its chances of clearing the tightly divided chamber next week… The public stance is coupled with a sense of doubt inside the White House, though, about the bill and deep concerns about whether it can pass the Senate or House, according to administration officials and congressional sources. These people say the president and his team have little sway with some key members, like GOP Sens. Susan Collins of Maine, John McCain of Arizona and Murkowski, the trio that tanked Republicans’ repeal attempt in July.”

“An internal analysis by the Trump administration concludes that 31 states would lose federal money for health coverage under Senate Republicans’ latest effort to abolish much of the Affordable Care Act, with the politically critical state of Alaska facing a 38 percent cut in 2026. The report, produced by the federal Centers for Medicare and Medicaid Services, focuses on the final year of a block grant that states would receive under the Cassidy-Graham legislation. It shows that government funding for such health insurance would be 9 percent lower overall in 2026 under the plan than under current law.”

“The National Association of Medicaid Directors (NAMD) warned Republicans on Thursday that the Senate’s latest ObamaCare repeal bill would place a massive burden on states. The bill, sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), would eliminate ObamaCare’s Medicaid expansion and subsidies beginning in 2020, converting the funding to state block grants. It would also change the federal government’s funding of the traditional Medicaid program from an open-ended commitment to the states to a per capita cap on each enrollee. ‘Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history,’ the NAMD’s board of directors wrote in a statement Thursday.”

“Bipartisan, fully negotiated and analyzed reforms to our nation’s health care system are essential if we are to ensure access to quality, affordable health care coverage for all Americans. Cooperation across party lines is critical to creating legislation that will be sustainable over the long term. It is regrettable that consideration of the Graham-Cassidy amendment is taking place entirely outside of a productive bipartisan process.”

“Alaska could receive a special bonus under the GOP-led Graham-Cassidy health care bill for having premiums higher than any other state. Studies this week, however, also indicate a dark future for insurance costs in the state. According to financial projections produced by the office of Sen. Bill Cassidy, one of the bill’s authors, Alaska would be the only state to receive additional money from the legislation’s $182 billion stability fund. The money would be delivered through a provision in the bill that, in 2026, would award each state $4,400 in federal subsidies to each ‘eligible beneficiary.’ Alaska, however, would be awarded $6,500, or 48 percent more than other states.”

“Arizona stands to lose a third of its federal funds that support the expanded Medicaid program as early as 2020 if Congress adopts the Graham-Cassidy bill, according to legislative budget staffers. The analysis released late Thursday by the Joint Legislative Budget Committee shows the state now gets about $3.8 billion in federal dollars for Medicaid expansion and the health insurance exchange. That is expected to grow to $4.9 billion by 2020. Under the Graham-Cassidy health-care bill, the report says, the state would get $3.2 billion in 2020. That $1.7 billion difference — a 35 percent change compared to current law — could affect the approximately 80,000 Arizonans now getting care under a federally funded expanded Medicaid program.”

“The health care bill Senate Republicans are rushing to finish would cripple West Virginia opioid treatment and end Medicaid expansion, according to an analysis that also says the bill could end coverage of pre-exisiting conditions.Sean O’Leary, senior policy analyst for the West Virginia Center on Budget and Policy, said the last-ditch attempt to get a GOP-only Obamacare repeal though the Senate would cut Medicaid funding so much that the state would have to roll back expansion. In addition, he said, while Sen. Shelley Moore Capito, R-W. Va., negotiated added funding for opioid treatment in previous Affordable Care Act repeal bills, there is none in this legislation. ‘There is no extra money for opioids. There’s nothing,’ O’Leary said. ‘So it could really, really have a really devastating impact on the state’s battle against opioid addiction.’”

“The Maine Hospital Association is urging U.S. Sens. Susan Collins and Angus King of Maine to oppose the latest attempt to repeal and replace the Affordable Care Act. The president of the association says the Graham-Cassidy bill is similar to previous efforts that have been rejected. One major component of Graham-Cassidy is that it would convert Medicaid to a block grant program and, in the process, critics say, significantly reduce funding. Maine Hospital Association President Steven Michaud says Maine would lose $1 billion in federal dollars by 2027, which would devastate rural hospitals that operate on razor-thin margins. ‘We’re talking about something that is almost impossible to overstate. We’re talking about, for sure, service closures and probably hospital closures if this would go through,’ he says.”

“Gov. Brian Sandoval said Thursday that the flexibility fellow Republican Sen. Dean Heller promised will be good for Nevada in a health-care bill he’s sponsoring is a “false choice” because the legislation will also slash funding. Sandoval, in a statement to The Nevada Independent, said he would not ‘pit seniors, children, families, the mentally ill, the critically ill, hospitals, care providers or any other Nevadan against each other’ because of the steep cuts to federal funding the state would face if the Heller-sponsored measure were to pass. A state analysis, also obtained by The Nevada Independent, agrees with independent calculations from various health-care organizations estimating Nevada will lose between $600 million and $2 billion in federal funding by 2026 if the legislation passes.”

A GOP Senator Held A Town Hall Yesterday: Health Care Dominated the Discussion

In Charles City, Iowa yesterday, GOP Sen. Joni Ernst held the first town hall by a Republican senator since four of her colleagues held a press conference announcing their iteration of the least popular bill in three decades, legislation which would raise costs, lower options, remove protections for pre-existing conditions and gut Medicaid. Sen. Ernst’s constituents had one topic most on their mind: health care. And perhaps unsurprisingly, they were not thrilled with the GOP’s latest plan. Maybe the Republican Senate caucus should start listening to the American people, just 24% of whom support the bill?

Des Moines Register: Joni Ernst is ‘leaning yes’ on Graham-Cassidy health care bill: “Kill the bill. Don’t kill us.”

“Many in the crowd of about 75 weren’t so sure the proposal could deliver. In one impassioned exchange, Tami Haught, a community organizer from Nashua, told Ernst that she has been living with HIV since 1996, and worried the changes proposed in the bill could make her ongoing treatment unaffordable. Before treatment breakthroughs, Haught said, she felt like she was living to die. Now, ‘I am living to live, but I need access to my care, treatment and lifesaving medications,’ she said. ‘I will die without them.’ Haught, who buys her insurance on Iowa’s individual market and said she was arrested outside Ernst’s Washington, D.C., office earlier this year during a health care protest, called Graham-Cassidy ‘one of worst versions of the health care repeal that has come out.’ ‘We will not let this tea-party GOP kill us now without a fight,’ she told Ernst. ‘Kill the bill. Don’t kill us.’”

Globe Gazette: Ernst shifts health care blame on Democrats at Charles City town hall: “Ethically, do you see it as your responsibility to ensure the state cannot offer a waiver so that they abandon me?”

“Those in attendance, however, continued to express doubts with the Graham-Cassidy bill, including Laura Wright of Decorah, who fears she will lose valuable medication under the new plan. ‘If I don’t have that, I become a cripple at 55 or 60,’ she told Ernst through tears. ‘Ethically, do you see it as your responsibility to ensure the state cannot offer a waiver so that they abandon me?’ She added that rural areas are at risk of losing a significant part of Medicaid funds through the new bill.”

KCRG: Ernst hears harsh words on health care at town hall meeting: “You have a voice, Senator. You have a voice. Show your backbone”

“Ernst invited her constituents to bring their opinions about the latest health care bill and other topics. Several of those in attendance didn’t hold back. ‘Senator Grassley said last night he couldn’t name anything good in it but he was going to vote for it because politically he had promised. That’s a piss-poor way to run a government,’ said one attendee. ‘You have a voice, Senator. You have a voice. Show your backbone,’ said another.”

TODAY’S 10 FACTS YOU NEED TO KNOW ABOUT THE LATEST GOP HEALTH CARE REPEAL (GRAHAM-CASSIDY)

It’s been another long 24 hours for the Senate’s latest secret, partisan health care repeal bill. The insurance industry announced its opposition, laying out six principles and noting the legislation fails all of them; AARP found the average older American would see a premium increase of $16,174 under this legislation, with Alaskans seeing one as high as $26,986; and after health care analysts backed his knowledge of Graham-Cassidy over Sen. Bill Cassidy’s, Jimmy Kimmel asked the bill’s author which part he was misunderstanding: the $243 billion in federal cuts, or the lack of protections for pre-existing conditions? The 10 facts you need to know are below:

  1. PRESIDENT TRUMP GETS IN ON THE ACTION. Last night, President Donald Trump tweeted that he “would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does!” The notion that this bill “covers” pre-existing conditions has been debunked by the Associated Press, NPR, Politico, The Hill, Vox, Bloomberg, NBC News and CNN, and was cited by Blue Cross Blue Shield in its opposition to the bill.
  2. SEN. CHUCK GRASSLEY ADMITS POLITICS, NOT CONCERN OVER PEOPLE’S HEALTH CARE, IS DRIVING FORCE BEHIND BILL. “You know, I could maybe give you ten reasons why this bill shouldn’t be considered,” Sen. Grassley told Iowa reporters on a conference call, “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”
  3. GRAHAM-CASSIDY THREATENS COVERAGE FOR OLDER AMERICANS, HARMS ALASKA. AARP released an analysis of the bill regarding its effects on older Americans, and the results were not pretty. Graham-Cassidy “threatens to make health care unaffordable and inaccessible for millions of older Americans,” the report found, with a 60-year-old earning $25,000 a year seeing an increase of $16,174 in their premiums. The single biggest loser is Alaska, where seniors could see an increase of $26,986 per year. A separate AARP analysis found Alaska could lose $11 billion in Medicaid funding under the legislation.
  4. INSURERS BLAST THE BILL. America’s Health Insurance Plans (AHIP), the country’s largest insurance group, came out against the bill, writing that the bill “would have real consequences on consumers and patients by further destabilizing the individual market.” Blue Cross Blue Shield offered criticism, too, writing that the legislation “would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.”
  5. AMERICA’S DOCTORS DO, TOO. In a joint letter to Senate leadership, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Osteopathic Association and American Psychiatric Association — representing over 560,000 physicians — described Graham-Cassidy as “worse” than previous bills and called for its rejection in favor of bipartisan negotiations.
  6. OPPOSITION FROM GOP GOVERNORS GROWS FURTHER. Yesterday, Republican Governors Susana Martinez of New Mexico and Chris Christie of New Jersey both announced their opposition to Graham-Cassidy. They join GOP Governors Brian Sandoval (Nevada), John Kasich (Ohio), Charlie Baker (Massachusetts), Phil Scott (Vermont), Larry Hogan (Maryland) and Chris Sununu (New Hampshire) and Independent Governor Bill Walker (Alaska), who previously announced they were against the bill.
  7. JIMMY KIMMEL: WHICH PART OF YOUR TERRIBLE BILL DO I NOT UNDERSTAND? Ending a day when health care experts backed his understanding of the bill ahead of that of its co-author in a piece entitled, “Kimmel, not Cassidy, is right on health care, analysts say,” Jimmy Kimmel again took Sen. Bill Cassidy to task, asking, “Oh I get it, I don’t understand it because I’m a talk show host. Then help me out. Which part don’t I understand? The part where you cut $243 billion dollars from federal healthcare assistance? Am I not understanding the part where states would let insurance companies price you out of coverage for having pre-existing conditions?”
  8. DON’T FORGET ABOUT MEDICAID. As the Kaiser Family Foundation points out, often overlooked has been what Graham-Cassidy would do do Medicaid — namely, it would devastate the program. The bill would end all federal funding in 2026, cutting off untold people from their health insurance; massively redistribute funds, penalizing states that expanded coverage for their most vulnerable citizens while rewarding those that didn’t; and eliminate funding for Planned Parenthood, preventing millions of women from getting the coverage they need.
  9. THE BILL STRIPS THE CONCESSIONS MODERATES SAID WERE NECESSARY. In a piece published this morning, Talking Points Memo reporter Alice Ollstein notes that every demand GOP moderates like Sen. Rob Portman and Sen. Shelley Moore Capito said were necessary for their support, including Medicaid funding, federal dollars for opioid relief and protections for pre-existing conditions, have been removed from Graham-Cassidy.
  10. MEDICAID CUTS AND CHANGES TO THE INDIAN HEALTH SERVICE WOULD HARM AMERICAN INDIAN AND ALASKA NATIVES. According to an analysis by the Center on Budget and Policy Priorities, the bill would harm American Indian and Alaska Natives (AI/AN) in two major ways. “First, Cassidy-Graham would end the ACA’s Medicaid expansion starting in 2020, but it would let AI/ANs who remain continuously enrolled in Medicaid remain covered after the expansion ends for everyone else. Any help that this exception provides would be short-lived, however. Low-income people frequently move on and off Medicaid, depending on their economic circumstances, so most AI/ANs would likely lose Medicaid eligibility within a year or two…Second, Medicaid currently pays 100 percent of the cost of services that Indian Health Service (IHS) and Tribally operated facilities provide for AI/ANs…Cassidy-Graham would enable Medicaid to also pay 100 percent of the cost of services that non-IHS and Tribally operated facilities provide for AI/ANs…which would jeopardize coverage for AI/ANs and the financial stability of IHS and Tribally operated facilities.”

Graham-Cassidy: The Most Dishonest Senate Bill of All-Time?

As Senators Bill Cassidy and Lindsey Graham make the rounds attempting to prop up support for their version of the least popular bill in three decades, it seems they’ve managed to achieve another important measure: the most dishonest Senate bill of all-time. They continue to lie about their bill, which all experts agree would raise costs, cut coverage, eliminate protections for pre-existing conditions and gut Medicaid. They’ve spread so much false information, in fact, we can hardly keep up. Just how many times have they been called out for lying?

  1. Politico: Kimmel, not Cassidy, is right on health care, analysts say
  2. Huffington Post: Bill Cassidy Says Jimmy Kimmel ‘Doesn’t Understand’ Health Care. Experts Say He Does.
  3. Washington Post: Three Pinnochios for Sen. Cassidy’s rebuttal to Jimmy Kimmel: ‘More people will have coverage’
  4. PolitiFact: Bill Cassidy offers misleading defense in face-off with Jimmy Kimmel
  5. ABC News: Fact check: Sen. Bill Cassidy on his health care bill assertions
  6. Washington Post: Cassidy-Graham and fuzzy math
  7. Bloomberg: Republicans Peddle Nonsense to Sell Health-Care Plan
  8. Vox: Cassidy is selling his health plan with misleading numbers
  9. Huffington Post: The Sponsors Of Obamacare Repeal Are Trying To Fool America — And Fellow Republicans
  10. Bloomberg: GOP Health Bill Would End Guarantee That Sick People Won’t Pay More
  11. Vox: Graham-Cassidy’s cuts are confusing. Let’s make them simple.
  12. Washington Post’s Health 202: Moderates would have to swallow deep Medicaid cuts for GOP health-care push to succeed
  13. Forbes: 6 Big Lies About Graham-Cassidy And Healthcare Reform And 1 Truth


Don’t Forget Medicaid…

In all the discussion about Graham-Cassidy imposing an age tax and destroying protection from discrimination based on pre-existing conditions, don’t forget Graham-Cassidy destroys Medicaid expansion and undermines the core Medicaid program. Below is a Kaiser analysis on how Graham-Cassidy repeal puts Medicaid at risk and linked here is a Washington Post piece on how screwed Medicaid expansion states are under Graham-Cassidy.

And last night on All in with Chris Hayes, U.S. Senator Tim Kaine (D-VA) explained why Republicans are going after the core Medicaid program in their zeal to repeal even though it was well established before passage of the Affordable Care Act.

5 Ways the Graham-Cassidy Proposal Puts Medicaid Coverage At Risk

Sep 19, 2017

The Graham-Cassidy proposal to repeal and replace the Affordable Care Act (ACA) is reviving the federal health reform debate and could come up for a vote in the Senate in the next two weeks before the budget reconciliation authority expires on September 30. The Graham-Cassidy proposal goes beyond the American Health Care Act (AHCA) passed by the House in May and the Better Care Reconciliation Act (BCRA) that failed in the Senate in July. The Graham-Cassidy proposal revamps and cuts Medicaid, redistributes federal funds across states, and eliminates coverage for millions of poor Americans as described below:

  1. Ends federal funding for current ACA coverage and partially replaces that funding with a block grant that expires after 2026. The proposal ends both the authority to cover childless adults and funding for the ACA Medicaid expansion that covers 15 million adults. Under Graham-Cassidy, a new block grant, the “Market-Based Health Care Grant Program,” combines federal funds for the ACA Medicaid expansion, premium and cost sharing subsidies in the Marketplace, and states’ Basic Health Plans for 2020–2026. Capped nationally, the block grant would be lower than ACA spending under current law and would end after 2026. States would need to replace federal dollars or roll back coverage. Neither the AHCA nor the BCRA included expiration dates for ACA-related federal funds or eliminated the ability for states to cover childless adults through Medicaid.
  2. Massively redistributes federal funding from Medicaid expansion states to non-expansion states through the block grant program penalizing states that broadened coverage. In 2020, block grant funds would be distributed based on federal spending in states for ACA Medicaid and Marketplace coverage. By 2026, funding would go to states according to the states’ portion of the population with incomes between 50% and 138% of poverty; the new allocation is phased in over the 2021–2025 period. The Secretary has the authority to make other adjustments to the allocation. This allocation would result in a large redistribution of ACA funding by 2026, away from states that adopted the Medicaid expansion and redirecting funding to states that did not. No funding is provided beyond 2026.
  3. Prohibits Medicaid coverage for childless adults and allows states to use limited block grant funds to purchase private coverage for traditional Medicaid populations. States can use funds under the block grant to provide tax credits and/or cost-sharing reductions for individual market coverage, make direct payments to providers, or provide coverage for traditional Medicaid populations through private insurance. The proposal limits the amount of block grant funds that a state could use for traditional Medicaid populations to 15% of its allotment (or 20% under a special waiver). These limits would shift coverage and funds for many low-income adults from Medicaid to individual market coverage. Under current law, 60% of federal ACA coverage funding is currently for the Medicaid expansion (covering parents and childless adults). Medicaid coverage is typically more comprehensive, less expensive and has more financial protections compared to private insurance. The proposal also allows states to roll back individual market protections related to premium pricing, including allowing premium rating based on health status, and benefits currently in the ACA.
  4. Caps and redistributes federal funds to states for the traditional Medicaid program for more than 60 million low-income children, parents, people with disabilities and the elderly. Similar to the BCRA and AHCA, the proposal establishes a Medicaid per enrollee cap as the default for federal financing based on a complicated formula tied to different inflation rates. As a result, federal Medicaid financing would grow more slowly than estimates under current law. In addition to overall spending limits, similar to the BCRA, the proposal would give the HHS Secretary discretion to further redistribute capped federal funds across states by making adjustments to states with high or low per enrollee spending.
  5. Eliminates federal funding for states to cover Medicaid family planning at Planned Parenthood clinics for one year. Additional funding restrictions include limits on states’ ability to use provider tax revenue to finance Medicaid as well as the termination of the enhanced match for the Community First Choice attendant care program for seniors and people with disabilities. Enrollment barriers include the option for states to condition Medicaid eligibility on a work requirement and to conduct more frequent redeterminations.

Much is at stake for low-income Americans and states in the Graham-Cassidy proposal. The recent debate over the AHCA and the BCRA has shown the difficulty of making major changes that affect coverage for over 70 million Americans and reduce federal funding for Medicaid. Medicaid has broad support and majorities across political parties say Medicaid is working well. More than half of the states have a strong stake in continuing the ACA Medicaid expansion as it has provided coverage to millions of low-income residents, reduced the uninsured and produced net fiscal benefits to states. Graham-Cassidy prohibits states from using Medicaid to provide coverage to childless adults. With regard to Medicaid financing changes, caps on federal funding could shift costs to states and result in less fiscal flexibility for states. States with challenging demographics (like an aging population), high health care needs (like those hardest hit by the opioid epidemic), high cost markets or states that operate efficient programs may have the hardest time responding to federal caps on Medicaid spending. Faced with substantially reduced federal funding, states would face difficult choices: raise revenue, reduce spending in other areas, or cut Medicaid provider payments, optional benefits, and/or optional coverage groups.

WHO DO YOU TRUST ON GRAHAM-CASSIDY?

We know in the heat of a political debate, especially on an issue as important as health care, the details can seem complicated or confusing. The best way to cut through the noise is to look who is for the Cassidy-Graham repeal and who is against it. Take a look for yourself. Who do you trust?

FOR

Sen. Bill Cassidy

OPPOSE

AARP

ALS Association

American Cancer Society Cancer Action Network

American College Of Physicians

American Diabetes Association

American Medical Association

American Academy of Family Physicians

American Academy of Pediatrics

American College of Physicians

American Congress of Obstetricians and Gynecologists

America’s Essential Hospitals

America’s Health Insurance Plans

American Heart Association

American Hospital Association

American Lung Association

American Nurses Association

American Osteopathic Association

American Psychiatric Association

The Arc

Arthritis Foundation

Association Of Community Affiliated Plans

Blue Cross Blue Shield Association

Catholic Health Association

Children’s Hospital Association

Coalition to Stop Opioid Overdose

Consortium for Citizens with Disabilities

Consumers Union

Cystic Fibrosis Foundation

Family Voices

Federation of American Hospitals

Greater New York Hospital Association

Jimmy Kimmel

JDRF

Lutheran Services in America

Kaiser Permanente

Kansas Hospital Association

March of Dimes

National Coalition for Cancer Survivorship

National Health Council

National Multiple Sclerosis Society

National Organization for Rare Diseases

The School Superintendents Association and 70+ Groups

Volunteers of America

WomenHeart