Senate Majority Leader Mitch McConnell (R-Ky.) Sept. 20 announced his intent to bring to the floor for a vote a proposal introduced by Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wis.), that would repeal and replace large portions of the Affordable Care Act (ACA). The Graham-Cassidy proposal may be brought to the floor for a vote before the fast-track reconciliation instructions expire on Sept. 30.
In a press statement, and in a letter sent to all senators on Sept. 19, AAMC President and CEO Darrell G. Kirch, MD, called for the Senate to reject the Graham-Cassidy proposal and return to its bipartisan efforts to craft legislation that will stabilize the market. Specifically, the letter states that the current proposal “will almost surely lead to dramatic increases in the number of uninsured patients nationwide and put important existing patient protections at risk. Additionally, a proposal like this—a complete overhaul of the health care system—should be fully and adequately examined by the Congressional Budget Office before it is brought to a vote.”
The Congressional Budget Office (CBO) has indicated it will not be able to issue a comprehensive analysis of the proposal before it is brought to the floor for a vote. However, as the proposal retains large portions of the Senate’s Better Care Reconciliation Act, some analysts have been using previous CBO scores to estimate the impact of the bill. The Kaiser Family Foundation has also issued an analysis of the proposal.
According to these projections, the Graham-Cassidy proposal will result in tens of millions of uninsured patients due to the repeal of the individual and employer mandates, reduced funding for traditional Medicaid through per capita caps, and instability in the market as cost sharing reductions (CSRs) will be repealed. Specifically, the Kaiser Family Foundation estimates that “…overall federal funding for coverage expansions and Medicaid would be $160 billion less than current law...over the period 2020-2026. Thirty-five states plus the District of Columbia would face a loss of funding.” After the block grants provided for by Graham-Cassidy expire in 2026, the Kaiser Family Foundation states, “If [the block grants] are not renewed, federal funding for coverage would decrease by $240 billion in 2027 alone.”
In addition to AAMC, the Graham-Cassidy proposal is opposed by numerous other health care organizations including: American Hospital Association, American Medical Association, America’s Essential Hospitals, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American Cancer Society Cancer Action Network, the American Heart Association, AARP, the Children’s Health Association, the March of Dimes, AHIP, and others.