Senate leaders are preparing to hold a vote on an alternative to the 2010 health care law this week.
Pending Senate Healthcare Bill — September 25, 2017
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Senate Health Care Bill:  Senate leaders are preparing to hold a vote on an alternative to the 2010 health care law, although 50 Republicans have not confirmed they would vote for the proposal. The rush to vote on the plan crafted by Sens. Graham and Cassidy comes ahead of a crucial Sept. 30 deadline when Republicans would lose their chance to repeal parts of the law under the fiscal 2017 budget reconciliation rules – which would allow the legislation to pass with only 50 votes. McConnell had told lawmakers he would not bring the measure to the floor without 50 votes. The legislation would dramatically restructure the individual health insurance market by giving states block grants to fund health insurance coverage, replacing current federal funding that covers tax credits to help people purchase insurance, and cost-sharing reduction payments. Funding for Medicaid expansion in 31 states and the District of Columbia through 2026 also would come from those allotments. The bill would also transition traditional Medicaid, which is an entitlement, to a system that gives states a capped amount of funding based on their Medicaid population. It would repeal the health law’s individual and employer mandates and a tax on medical devices. The repeal would allow states to waive certain regulations, including one that bars insurers from charging higher premiums to individuals with pre-existing conditions. Cassidy has defended that aspect of the measure, saying that states applying for waivers must ensure that individuals with pre-existing conditions have access to "affordable and adequate coverage." "I think the price will actually be lower," he said.  "What is being circulated is by those who wish to preserve Obamacare and they are doing everything they can to discredit the alternative." Sen. Rand Paul, R-Ky., has announced his opposition to the plan. Three Republican senators who voted against the repeal effort in July — Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona — have not declared which way they would vote on the new proposal. The Senate Finance Committee is set to hold a hearing this afternoon on the proposal, and a preliminary analysis by the Congressional Budget Office is expected early next week. “The Hill” newspaper (September 21, 2017) outlined below those or are for an against the legislation:
 
Health care group against -- The American Hospital Association and the American Medical Association have come out against the Graham-Cassidy proposal in strong terms, warning that it could lead to coverage losses for millions of Americans. Republicans, for the most part, have been unable to win over the support of these industry groups, which largely opposed every variation of the Senate’s repeal bills and the bill the House passed in May. Democrats have been able to point to this opposition as proof from experts that the repeal bills have been flawed and are bad for patients. While that gives Democrats a talking point, it is clear Republicans aren’t swayed by this opposition. The groups largely have been shut out of the process, and their opposition didn’t stop the Senate from voting on a repeal bill in July or the House passing its repeal bill in May.  The AHA, which represents nearly 5,000 hospitals and other care providers, said the Graham-Cassidy proposal could put coverage at risk for tens of millions of Americans. The AMA, which represents one-third of the nation’s doctors, has similar concerns and stated that the legislation would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care. Other health-care groups that oppose the bill include: AARP, Association of American Medical Colleges, America’s Essential Hospitals, the Children’s Health Association and the March of Dimes.
 
Governors have mixed reactions: The support of governors is crucial to the passage of the bill because not only do they have influence over the senators representing their states, but the Graham-Cassidy proposal would shift enormous responsibilities to their governments.

A group of 10 governors — five Democrats, four Republicans and one Independent — signed on to a letter opposing the bill Tuesday. The group includes Govs. Brian Sandoval (R-Nev.), Bill Walker (I-Alaska) and John Kasich (R-Ohio). Walker’s opposition could weigh on Sen. Lisa Murkowski (R-Alaska), one of three Republicans to vote against the earlier Senate bill. She has said she’s waiting to see how the proposal will impact her state. Republicans are unlikely to be able to survive her defection. Fifteen Republican governors, including Wisconsin Gov. Scott Walker and Arkansas Gov. Asa Hutchinson, announced their support on Tuesday. “Adequately funded, flexible block grants to the states are the last, best hope to finally repeal and replace Obamacare — a program which is collapsing before our very eyes,” the governors wrote.

Arizona Gov. Doug Ducey also endorsed the bill last week, saying it’s time for Congress to “get the job done” on repealing and replacing ObamaCare. Sen. John McCain (R-Ariz.), another swing vote on the bill, has been consulting with Ducey on the bill and could be influenced by his support. The Trump administration along with Graham and Cassidy have been hitting the phones, trying to win over governors to their proposal.
 
Insurers: America’s Health Insurance Plans, the main insurer trade group, came out last Wednesday against the bill, arguing it would destabilize the market. The proposal would have real consequences on consumers and patients by further destabilizing the individual market; cutting Medicaid; pulling back on protections for preexisting conditions; not ending taxes on health insurance premiums and benefits; and potentially allowing government-controlled, single payer health care to grow.  The Blue Cross Blue Shield Association said it shares “the significant concerns of many health care organizations” about the bill. “The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions,” the insurer said in a statement. “The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans. Legislation must also ensure adequate funding for Medicaid to protect the most vulnerable.” However, there are provisions in the Cassidy-Graham proposal that insurers could like. For example, insurers would be able to charge older customers up to five times as much as they charge younger customers, though states could overrule this. Current law only allows insurers to charge older people three times as much as younger customers. 
 
Conservative groups: Conservative groups like FreedomWorks and Freedom Partners have approached the Graham-Cassidy bill with caution. Both groups have pushed for a full repeal of ObamaCare and have grown frustrated with Congress over the past few months for failing to do so. But as time is running out to use the 2017 repeal vehicle, FreedomWorks says senators should seriously consider the bill. Meanwhile, Freedom Partners says while it appreciates the new effort, it’s seeking “more clarity” on whether the bill provides relief from Obamacare’s regulations and mandates.
 
CBO Score of the Health Care Bill:  In order for legislation to be considered in the Senate under the reconciliation rules, the Cassidy-Graham bill must be analyzed by CBO to ensure that it reduces the deficit in both its first decade and afterwards. The bill includes large cuts to health coverage in the near term and deeper cuts in the long term which would guarantee that the legislation would meet this requirement. In addition, the parliamentarian would have to rule that the bill complies with other aspects of the so-called Byrd rule, which governs what kinds of legislation the Senate may consider through reconciliation. CBO has made clear that it will not have an opportunity to provide estimates of the bill's full impact on coverage and costs before the vote by September 30 -- and no such report is necessary for the bill to move considered by the Senate.