ACA Repeal Effort – Opposed by Many – May Be Stalled

The latest effort to repeal the Affordable Care Act (ACA) – through the so called Graham-Cassidy bill – would be, according to analyses from across the political spectrum, devastating to Massachusetts.  Enhanced federal funding  for the ACA’s Medicaid expansions would be eliminated along with insurance tax credits and subsidies for low- and middle-income people that purchase insurance in exchanges.  In their place, states would receive block grant funding at an amount estimated to be lower than current federal spending.

On Friday, Sen. John McCain (R-Ariz.) said he could not vote for the bill, dealing a potentially fatal blow to the slim Republican majority needed to pass the measure. McCain said he could not vote in favor of Graham-Cassidy "without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it."  Shortly after his statement, another key GOP vote -- Susan Collins (R-Maine) -- said she was leaning "No" because “the premiums would be so high they would be unaffordable.”  Sen. Rand Paul (R-Ken.) indicated he would vote no because Graham-Cassidy did not go far enough in completely overturning the ACA.

Like previous repeal bills, the federal reimbursement for Medicaid would become a per capita amount instead of the current federal-state match. The Graham-Cassidy bill would go further, however, and penalize states like Massachusetts with higher Medicaid spending due to the state’s higher cost of living and more comprehensive benefits. Insurers would have the flexibility to charge more for pre-existing conditions if state law permitted it and states could do away with the requirement that every insurance plan offer a minimum set of health benefits – such as benefits for mental healthcare.  The federal individual and employer mandate penalties would be reduced to zero.

The bill is named after two of its four main sponsors – Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), who were joined by Dean Heller (R-Nev.) and Ron Johnson (R-Wis.). Republicans had been pushing for a vote on the bill before the end of September, at which time a new set of floor rules goes into effect requiring 60-plus votes for passage. That high threshold would be impossible for the GOP to meet since all Democrats are against the ACA-repeal bill. It is unclear how McCain's Friday decision will affect the plan to move forward with a vote.
MHA President & CEO Lynn Nicholas, FACHE, said of Graham-Cassidy, “The latest effort to repeal the Affordable Care Act offers no improvement to previous attempts and in many ways it is worse.  Like its predecessors, this proposal is deeply flawed and would disproportionately harm Massachusetts and other states that have expanded Medicaid/MassHealth under the ACA."

Upon learning of McCain's decision late on Friday, Nicholas said, "From this day on, when I think about 'Profiles in Courage' I will recall Sen. John McCain's wise and reasoned position on how to consider possible changes to the Affordable Care Act. Healthcare reform in Massachusetts is on a successful path because we have had a collaborative and inclusive approach where stakeholders parked their personal peeves at the door and strove to do what was best for the citizens of the commonwealth. I hope the U.S. Congress will follow the same path laid out by Senator McCain." 

Earlier in the week, Governor Charlie Baker signed a letter with 10 other Democratic and Republican governors, calling on Senate leaders to not consider the repeal bill. Instead, the governors said, “Only open, bipartisan approaches can achieve true, lasting reforms.” They said the bipartisan hearings that have occurred before the Senate’s Health, Education, Labor and Pensions (HELP) Committee hold promise for ACA reform.

Nearly every major physicians’ group, led by the American Medical Association, have spoken out against the bill, as have the national Blue Cross Blue Shield Association and America’s Health Insurance Plans, and the American Hospital Association, as well as numerous disease-fighting advocacy groups, like the American Cancer Society.