The last-ditch proposal to effectively repeal the Affordable Care Act remains deeply unpopular, even while Senate Republicans try to rally the votes to make it happen. And in the midst of all that politicking, a new federal analysis shows that several of the states whose Senators’ votes leadership is trying to curry could be badly hurt by the bill.
Massive Medicaid Cuts
According to an estimate [PDF] from the Centers for Medicare and Medicaid (CMS) that compares current Medicaid funding levels with what would be available under the proposed Graham-Cassidy repeal bill, more than half of the states would see between funding cut by 5%-10% by 2020.
Looking ahead even further, by 2027, 31 states would see a drop in Medicaid funding, with nearly half the country (24 states) experiencing funding decreases of 20% or more.
Those that would suffer the deepest cuts are Connecticut and Maryland, with projected reductions of 52% and 51% respectively.
Others in this group would be Alaska, Arkansas, California, Colorado, Delaware, D.C., Hawaii, Kentucky, Louisiana, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Oregon, Pennsylvania, Vermont, Washington, and West Virginia.
On the flip side, a handful of states — all of them among those that have continued to reject the Medicaid expansion and its related federal funds under the ACA — would see huge increases in Medicaid funding.
By 2020 alone, South Dakota would see a 282% increase in funding, followed by a 109% bump in Wyoming, a 59% increase in Alaska, a 55% lift in Montana, 52% for North Dakota, and increases between 10 and 30% in Alabama, Georgia, Kansas, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and Utah.
Shift the outlook to a ten-year one, and the disparity becomes even more stark and shocking.
By 2027, CMS estimates, the biggest winners under Graham-Cassidy would be Mississippi residents, who would see a 347% increase in Medicaid funding.
Kansas, with a 234% increase, would also do well enough for itself, and Texas (210%), Tennessee (194%), Alabama (192%), and South Dakota (162%) would also see major funding improvements.
The National Association of Medicaid Directors, which represents the directors of Medicaid programs for all 50 U.S. states, D.C., and all U.S. territories, issued a statement asking the Senate not to move forward on Graham-Cassidy, and instead, to “revisit the topic of comprehensive Medicaid reform when it can be addressed with the careful consideration merited by such a complex undertaking.”
Best Case Scenario?
Axios, which was the first to report on the CMS estimates, notes that these sharp cuts are the are the least bad projection so far, calling the CMS numbers “rosier than other estimates.”
In part because of the projected cuts to Medicaid, several independent analyses are projecting that Graham-Cassidy would cause at least 32 million Americans to lose coverage altogether in the coming decade.
The Brookings Institute is the most recent think tank to issue a study on the projected outcomes of Graham-Cassidy. The Brookings report finds that in the immediate short term (2018-2019), 15 million people would lose health care coverage.
But It Might Be Doomed Anyway
That’s all the bad news. Here’s the good: It’s looking less likely today than it has all week that Graham-Cassidy will actually come to a vote or become law.
The Graham-Cassidy bill is technically a budget resolution amendment, meaning that it can squeak out of the Senate with a simple majority — 51 votes — as long as it does so by Sept. 30. There are currently 52 Republican members of the Senate, plus Vice President Mike Pence can cast a tie-breaking vote as needed, so the math says Senate Majority Leader Mitch McConnell can only afford to lose three votes.
Sen. Rand Paul (KY) has repeatedly and emphatically gone on the record as a “no” to Graham-Cassidy. It’s worth noting that he also opposed the July bill at first, before voting on it anyway, but for now at least folks who are tallying up the votes count him out.
Sens. Lisa Murkowski (AK) and Susan Collins (ME) were two of the three holdouts over the Senate’s July bill. Both opposed it in part due to its severe cuts to Medicaid funding. Although neither has officially yet gone on the record as a “no” to Graham-Cassidy, Collins is publicly leaning against it. Republicans, meanwhile, have been strongly pressuring Murkowski to vote for the bill, but she has as yet not indicated any support for it.
That means all eyes have been on Arizona Senator John McCain, whose dramatic, surprise late-night vote spelled the doom of the Senate Republicans’ last ACA repeal effort in July.
Friday afternoon, McCain issued a statement definitively indicating his opposition to the proposal.
“I cannot in good conscience vote for the Graham-Cassidy bill,” McCain said. “I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it.”
There won’t be time for the Congressional Budget Office to issue an analysis on the bill before the end-of-month deadline, McCain noted, so the Senate “won’t have reliable answers to those questions.”
Hill-watchers generally suspect that McCain’s firm no will give political cover for Collins and Murkowski, at least, to join him — killing the bill.
In the meantime, however, the Senate Finance Committee is planning a hearing on the Graham-Cassidy proposal for Monday afternoon, Sept. 25.