After a politically chaotic summer where their first attempt met a dramatic late-night demise, Republican members of the Senate are mounting one last effort to repeal the Affordable Care Act. Basically every major stakeholder in the country has announced its opposition to the new bill, but the Senate is racing to squeeze in a vote before a hard deadline at the end of the month just the same.
Sens. Lindsey Graham (SC), Bill Cassidy (LA), Dean Heller (NV), and Ron Johnson (WI) released the latest proposal to reverse the ACA late last week.
The Graham-Cassidy bill, as it is generally known, is actually technically a budget resolution — so for procedural reasons, it’s got a hard make-or-break Sept. 30 deadline.
There is a hearing on Graham-Cassidy scheduled for Monday, Sept. 25, and a spokesperson for Senate Majority Leader Mitch McConnell confirmed to Politico that McConnell does indeed intend to bring the proposal to the Senate floor for a vote before the cutoff.
That means, among other things, that the non-partisan Congressional Budget Office will not have time to issue a proper score on the bill before the Senate has to move on it.
However, several independent, non-partisan third-party groups have released analyses in the last day sussing out what the effects of Graham-Cassidy would likely be.
The Kaiser Family Foundation released a report looking at the effect on Medicaid funding to the states the Graham-Cassidy bill would have. Overall, KFF estimates that 35 states plus D.C. would lose Medicaid funding, with states that accepted a Medicaid expansion as part of the ACA losing an average of 11% of their funds.
The Commonwealth Fund also issued a report, estimating that at least 32 million people who currently have coverage would lose it under Graham-Cassidy. And based on an analysis from the Center for Budget and Policy Priorities, Fitch Ratings has determined that Graham-Cassidy would be “more disruptive” than even other ACA repeal proposals.
Even the Republican Senators championing the bill don’t seem particularly enamored of it, Vox notes — they’re just planning to vote for it because it’s the bill they’ve got, they all ran on “repeal and replace,” and time is running out.
In the last week, dozens of groups representing basically everyone you can think of — retirees, children, doctors, nurses, hospitals, patients, and even insurers — has come out in opposition to the bill. You name a stakeholder, and they’re probably against it.
The health insurers are the big moneybags corporations in the room, when it comes to healthcare — and they are not happy with the Graham-Cassidy proposal.
America’s Health Insurance Plans, the industry’s largest trade and lobbying group, sent a letter [PDF] to McConnell, as well as Senate Minority Leader Chuck Schumer, outlining some of the ways in which they expect Graham-Cassidy would hurt consumers, and asking the Senate to approach healthcare differently.
“The Graham-Cassidy-Heller-Johnson proposal… would have real consequences on consumers and patients by further destabilizing the individual market; cutting Medicaid; pulling back on protections for pre-existing conditions; not ending taxes on health insurance premiums and benefits; and potentially allowing government-controlled, singly payer healthcare to grow. … We cannot support this proposal.”
AHIP is joined by the Blue Cross Blue Shield Association, which said in a statement that it has “significant concerns” with the Graham-Cassidy bill, due to its Medicaid cuts and “provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions.”
Kaiser Permanente CEO Bernard J. Tyson also opposed Graham-Cassidy in a statement, saying, “At Kaiser Permanente, we believe that changes to our nation’s health care laws should increase access to high-quality, affordable care and coverage for as many people as possible. The Graham-Cassidy bill does not meet any of those tests.”
The American Medical Association, which represents physicians and medical students, wrote a letter [PDF] to the Senate opposing the bill.
“Unfortunately, the Graham-Cassidy amendment … violates the precept of ‘first do no harm,’ the organization’s CEO writes.
“Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care,” he continues. “We also urge the Senate to reject any other legislative efforts that would jeopardize health insurance coverage for tens of millions of Americans.”
The doctors are joined here by the nation’s registered nurses: The American Nurses Association is calling Graham-Cassidy “the worst healthcare bill yet,” and urging ANA members to contact their Senators in opposition.
Insurers aren’t the only giant corporate entity in healthcare; hospitals, too, are a booming (and increasingly concentrated) business.
The American Hospital Association — the national lobbying group representing, as you’d think, the interests of hospitals — issued a statement opposing Graham-Cassidy in no uncertain terms.
“We believe that coverage could be at risk for tens of millions of Americans under the Graham-Cassidy proposal,” AHA CEO Rick Pollack said. “This proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term. In addition, the block grant to provide support for the expansion population expires in 2026, thereby eliminating coverage for millions of Americans.”
“For these reasons,” Pollack concluded, “We oppose the Graham-Cassidy plan.”
Health and Medical Issue Groups
There are a large number of groups in the country dedicated to promoting the interests of patients and families impacted by certain medical conditions. Sixteen of the largest — including the American Cancer Society, the American Diabetes Association, the American Heart Association, the American Lung Association, the Arthritis Foundation, the March of Dimes, and the National Multiple Sclerosis Society — issued a statement opposing the bill.
“Affordable, adequate care is vital to the patients we represent. This legislation fails to provide Americans with what they need to maintain their health,” the groups said.
They added, “This bill would limit funding for the Medicaid program, roll back important essential health benefit protections, and potentially open the door to annual and lifetime caps on coverage, endangering access to critical care for millions of Americans. Our organizations urge senators to oppose this legislation.”
Schools, Educators and Civil Rights Groups
A massive coalition of more than 70 groups representing schools, teachers, education administrators, civil rights advocates, and disability rights’ advocates sent a letter [PDF] to the Senate expressing opposition to the bill.
The coalition is “concerned that the Graham-Cassidy bill jeopardizes healthcare for the nation’s most vulnerable children: students with disabilities and students in poverty,” the letter reads.
“The projected loss of hundreds of billions in federal Medicaid dollars will compel states to ration health care for children,” as well as cutting off “basic health screenings for vision, hearing, and mental health problems for children,” the coalition explains. “Considering these unintended consequences, we urge a ‘no’ vote on Graham-Cassidy.”
The long list of signatory groups includes the ACLU, the National Association of Elementary School Principles, the National Association of Secondary School Principals, the National Association of Social Workers, the National Association of State Boards of Education, the National Education Association, and the United Way.
“We are deeply concerned these cuts will endanger the health, safety, and care of millions of individuals who depend on the essential services provided through Medicaid,” the AARP notes. “Should this bill be brought to the Senate floor for a vote, we strongly urge all Senators to vote NO.”
A genuinely bipartisan group of states’ governors, including the top executives of Alaska, Colorado, Louisiana, Massachusetts, Montana, Nevada, Ohio, Pennsylvania, Vermont, and Virginia, also urged the Senate to reconsider. In a letter [PDF], the governors “Ask [the Senate] not to consider the Graham-Cassidy-Heller-Johnson amendment and [instead] renew support for bipartisan efforts to make health care more available and affordable for all Americans.”
And last but not least, we have comedian and late night host Jimmy Kimmel: