The measure would give states annual block grants to help individuals pay for healthcare.
This article first appeared September 13, 2017 on MedPage Today.
WASHINGTON -- A group of Republican senators introduced a bill Wednesday to repeal and replace the Affordable Care Act (ACA) as the timeline for getting such a bill passed this year continues to wind down.
The yet-to-be-named measure, introduced by senators Bill Cassidy, MD (R-La.), Lindsey Graham (R-S.C.), Dean Heller (R-Nev.), and Ron Johnson (R-Wis.) would give money annually to states in the form of a block grant, which could be used "to help individuals pay for healthcare," Cassidy's office said in a press release posted on the senator's website.
"This proposal removes the decisions from Washington and gives states significant latitude over how the dollars are used to best take care of the unique health care needs of the patients in each state," the press release stated. "The grant dollars would replace the federal money currently being spent on Medicaid expansion, Obamacare tax credits, cost-sharing reduction (CSR) subsidies and the basic health plan dollars."
The amount of money each state would receive is based on a complicated formula which starts with the amount of money each state receives from Medicaid expansion, ACA tax credits, CSR subsidies, and basic health plan funds. "By 2026, at base rate, every state will be receiving the same amount of money for each beneficiary in the 50-138% federal poverty level range," according to an FAQ on Cassidy's website. "This ensures that high-spending states and low-spending states come to parity at the end of the time frame."
The measure would also repeal the ACA's individual and employer mandates as well as its medical device tax, and would "strengthen the ability for states to waive Obamacare regulations," the release continued. It also would "protect patients with pre-existing medical conditions."
The American College of Physicians (ACP) opposed the bill. "We believe that the substantial cuts to Medicaid authorized by this legislation would cause a significant increase in the number of uninsured patients and that it would undermine essential benefits provided for patients insured under current law," Jack Ende, MD, president of the ACP, wrote in a letter to Graham and Cassidy.
"We urge you to set aside this legislation and instead allow the Senate to consider any improvements to the ACA, through a more deliberative process of regular order, in which hearings are held to solicit the advice of health care experts and stakeholders, with any such improvements considered in a bipartisan manner in which both parties may offer amendments."
In addition, Ende said, the ACP is concerned that the funding formula outlined in the legislation "provides less funding than currently in place for individuals to purchase health insurance in the individual market and that states could use these funds for a broad range of health care purposes, not just coverage, with essentially no guardrails or standards to ensure affordable, meaningful coverage."
Planned Parenthood, whose funding would be zeroed out under the bill, also announced its opposition. "The Graham-Cassidy-Heller proposal is the worst ACA repeal bill yet, and it is especially terrible for women," Dawn Laguens, executive vice president at Planned Parenthood Federation of America, said in a statement.
"It blocks women from getting preventive care at Planned Parenthood. It slashes Medicaid, which 1 in 5 women of reproductive age rely on for care, including birth control and cancer screenings. It guts essential health benefit protections, including maternity coverage and prescription drugs. Thirteen million women could lose coverage to maternity care under this bill. And it raises premiums on millions more by eliminating tax credits."
The bill does have one important supporter: President Trump. "I applaud the Senate for continuing to work toward a solution to relieve the disastrous Obamacare burden on the American people," Trump said in a statement. "Obamacare has been a complete nightmare for the many Americans who have been devastated by its skyrocketing healthcare premiums and deductibles and canceled or shrinking plans. As I have continued to say, inaction is not an option, and I sincerely hope that Senators Graham and Cassidy have found a way to address the Obamacare crisis."
The senators face a very narrow window of time to get the bill passed, since the authority to use the budget reconciliation process -- which would allow the bill to pass with only 50 votes -- expires on Sept. 30th; after that, 60 votes would likely be needed for passage. To meet that Sept. 30 deadline, they would have to get the bill passed by all the relevant committees, scored by the Congressional Budget Office, and put on the Senate floor for a vote, all within about 2.5 weeks.
In the meantime, there was also other healthcare action Wednesday as Sen. Bernie Sanders (I-Vt.) introduced his single-payer bill, which would transition all Americans to a government-run "Medicare for all"-type system.
"I know taking on the insurance companies and the drug companies and Wall Street ... and all those people who profit off our dysfunctional healthcare system will not be an easy fight," Sanders said in a video posted on his website. "The only way we win this is when the American people stand up -- as they are -- and demand real change ... Let us go forward and finally do what this country should have done a long time ago and that is to guarantee healthcare for all people."
Sanders' bill, which has virtually no chance of passage with a Republican-controlled Congress and White House, nonetheless has 15 Democratic senators who have signed on as co-sponsors.
And in another ACA-related move, representatives Michael Burgess, MD (R-Texas), and Pat Tiberi (R-Ohio) introduced a bill Tuesday to repeal the ACA's individual mandate. "The individual mandate is forcing Americans to purchase plans they don't want, don't need, and can't afford to use," Tiberi said in a statement. "This legislation would provide relief to Americans who are trapped in overpriced and unreliable Obamacare plans and eliminate the threat of an unfair fine from the IRS."