A White House official said they “really aren’t sure” what the impact of the latest Republican effort to repeal and replace the Affordable Care Act would be, as Politico reported Friday—but a number of analyses have found the bill would hurt every state and leave 32 million people without insurance by 2026.
The bill, spearheaded by Sens. Lindsay Graham (R-SC) and Bill Cassidy (R-LA), would block grant health care funding to the states. The plan would also repeal a number of taxes mandates that are in place under Obamacare, a move that advocates of the law say gives states more flexibility to create a health care system that works for them.
Many members of the Senate, much like the White House, don’t actually know what the effects of the bill would be, and some have publicly said the politics of the bill are more important than the policy.
“You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” Sen. Chuck Grassley (R-IA) told reporters earlier this week. “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.”
But it’s not hard to find more information about the estimated impact of the substance of the legislation. The bill has come under fire from a diverse array of critics, including top medical associations, insurance lobbyists, governors across the country, the bipartisan Medicaid directors from all 50 states, and Jimmy Kimmel. And a number of outside analyses have outlined the likely effects should Graham-Cassidy be signed into law.
BREAKING: The bipartisan Medicaid Directors from all 50 states just issued this negative statement about Graham-Cassidy.
Big. Very unusual. pic.twitter.com/ZtqaAI8hg1
— Andy Slavitt (@ASlavitt) September 22, 2017
Senate Majority Leader Mitch McConnell has said he intends to bring the bill to the floor for a vote next week before reconciliation ends.
Health and Human Services
The short of it: Even the Trump administration thinks this is a bad idea.
A report from Health and Human Services, first obtained by Axios Thursday night, shows that Republicans in the White House and in Congress are overlooking estimates from the administration itself about the potentially detrimental effects of the bill.
The HHS report, as ThinkProgress’s Amanda Michelle Gomez reports, “projects federal health care spending would be $18 billion lower in 2026 under the latest Republican health care bill than under current law. In all, 31 states would receive less federal money for providing their residents with health insurance.”
And that’s the rosiest of any analysis.
HHS also found that Alaska would see a 38 percent decrease in federal funding, and Arizona would see a nine percent decrease in federal funding. Sens. Lisa Murkowski (R-AK) and John McCain (R-AZ) are considered key swing votes for the bill.
The short of it: Nobody wins.
Supporters of the repeal bill have often said that the system would benefit smaller, more rural states, but a report by nonpartisan health consulting firm Avalere found that, within two decades, every state would suffer the cuts in federal health care funding of up to $4 trillion.
— Avalere Health (@avalerehealth) September 20, 2017
Avalere’s analysis also noted that the bill would gut Medicaid, repealing the expansion offered under the Affordable Care Act and capping the program.
“The Graham-Cassidy bill would significantly reduce funding to states over the long term, particularly for states that have already expanded Medicaid,” Caroline Pearson, senior vice president at Avalere, said in the report. “States would have broad flexibility to shape their markets but would have less funding to subsidize coverage for low- and middle-income individuals.”
Center for American Progress
The short of it: Say goodbye to protections for people with pre-existing conditions.
A paper from the Center for American Progress focused on a provision in the bill that would allow insurers to jack up premiums for patients as soon as they get sick. (Disclosure: ThinkProgress is an editorially independent site housed at the Center for American Progress.)
Their analysis found that a 40-year-old diagnosed with metastatic cancer could suddenly be forced to pay an additional $140,510 on their annual health premium, while patients with more common conditions, such as diabetes or asthma, could see their premiums double.
This is essentially the undoing of one of the Affordable Care Act’s most popular provisions, which makes it illegal for insurers to charge someone more because of a pre-existing health condition.
The short of it: Low- and middle-income seniors will suffer.
A report from the American Association of Retired Persons found that a 60-year-old earning $25,000 a year could see their premiums and out-of-pocket costs rise by $16,174 if they wanted to keep their current coverage.
In some states, those increases could be even higher. A 60-year-old in Alaska making $25,000 could pay up to $31,790 more to keep their current coverage, and the same person in Arizona could pay up to $22,074 more.
The Graham-Cassidy bill would also allow states to charge older adults more by waiving federal protections that limit age rating, a move that the AARP concluded would be “simply unaffordable.”
The Commonwealth Fund
The short of it: 32 million more people will be without insurance over the next decade.
A report from the Commonwealth Fund relied on past estimates of effects of repeal bills to determine the possible effects should Graham-Cassidy be signed into law and found that 32 million people more people could be without insurance by 2026.
That estimate also found that 15-18 million would lose their insurance in the first full year after the law was enacted and that 50 percent of the U.S. population lives in states that are likely to enact waivers eliminating consumer protections or reduce required benefits.
The Center on Budget and Policy Priorities
The short of it: A nearly $300 billion funding cut in 2027 alone.
The Graham-Cassidy bill only allocates funding for the next ten years, and then the law calls for funding to be reappropriated—but there is no guarantee that will happen.
The CBPP report found that in the year 2027 alone, states will face a federal funding cut just shy of $300 billion. The CBO has estimated in the past that repealing the Affordable Care Act could leave 32 million people uninsured. The Commonwealth Fund came to a similar figure in their analysis of Graham-Cassidy, but CBPP argues that number could be even higher.
“Cassidy-Graham would likely be even more damaging than a straight repeal-without-replace bill because it would add large cuts to the rest of Medicaid — on top of eliminating the Medicaid expansion — by imposing a per capita cap on the entire program,” the report says. “Cassidy-Graham would presumably result in even deeper coverage losses… in the second decade as the cuts due to the Medicaid per capita cap continue to deepen.”
Kaiser Family Foundation
The short of it: Billions will be cut from Medicaid.
Graham-Cassidy caps Medicaid and slowly makes those caps stricter over the years. According to the KFF analysis of the bill, the cap would result in $53 billion less in federal spending for the traditional Medicaid program from 2020 to 2026, a one third reduction in federal funds over that time.
By 2027, federal spending would be $15 billion lower than under current law, according to KFF.
KFF’s analysis also finds that, similar to CBPP’s analysis, should funding not be reappropriated after the 10 year period, federal funding for health care would decrease by $240 billion in 2027 alone.
The short of it: Mass insurance losses.
An analysis from The Brookings Institution released Friday estimates that if Graham-Cassidy is signed into law, it would reduce the number of people with insurance coverage per year by 21 million every year between 2020 and 2026.
Brookings notes that these estimates are uncertain, in part because it’s hard to predict how states will respond to the legislation, but offers this grave warning: “This estimate likely understates the reductions in insurance coverage that would actually occur under the Graham-Cassidy legislation, particularly toward the beginning and end of the seven-year period, because it does not account for the challenges states will face in setting up new programs on the bill’s proposed timeline, the possibility that uncertainty about the program’s future will cause market turmoil toward the end of the seven-year period, or the bill’s Medicaid per capita cap and other non-expansion-related Medicaid provisions.”
***If the White House wanted to be even more sure of the effects of Graham-Cassidy, they could push for the vote to be held off until there is a full score from the Congressional Budget Office.
Because of the push to pass the bill next week through reconciliation — a budget measure that ensures the legislation only needs a simple majority and can avoid a Democratic filibuster — senators are planning vote on the repeal bill without data from the CBO about how the bill will affect the deficit, coverage, or premiums.