Stakeholders Urge Congress to Oppose Graham-Cassidy, Senator McCain Announces He Will Vote No

Ahead of next week’s proposed vote on Graham-Cassidy-Heller-Johnson, a Senate reconciliation bill that proposes to replace the Affordable Care Act with a system of state block grants given annually to help individuals pay for healthcare, insurers and providers groups are calling on Congress to reject the bill.

In its statement, The Board of Directors of the National Association of Medicaid Directors (NAMD) asked Congress to take a thoughtful, deliberative, and responsible approach to healthcare reform. The letter pointed out that the ways in which block grants would be used, what programs they could be applied to, and the overall impact that they would have on states remained uncertain, but that “Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history.” The burden on states to develop new programs to administer the block grants “cannot be overstated,” the letter said, and noted the apparent lack of funding provided to states to create these complex systems prior to 2020. The letter called for a full Congressional Budget Office (CBO) score, saying that such a process “should be a bare minimum required for beginning consideration” of the bill.

America’s Health Insurance Plans, a national association of insurers, issued a statement of its own, saying that reforms to healthcare must start with stabilizing the individual insurance market, namely by continuing to fund cost-sharing reduction payments. The group also called on Congress to provide sufficient funding for Medicaid, protections for patients with pre-existing conditions, sufficient time to plan for and implement reforms, elimination of the health-insurance tax, and protection of the private market from attempts to implement a single-payer system.

Provider groups also weighed in with criticisms of the bill. The American Medical Association (AMA) said in a letter to US Senate Majority Leader Mitch McConnell (R-Kentucky) and Democratic Leader Charles Schumer (New York) that Graham-Cassidy “violates the precept of ‘first do no harm,’” and it urged the Senate to reject both the currently proposed legislation and “any other legislative efforts that would jeopardize health insurance coverage for tens of millions of Americans.” Proposals to reform health care should protect those with pre-existing conditions and coverage for young adults, and should stabilize the individual market while ensuring that those with lower incomes have affordable and “meaningful” coverage. The organization highlighted its concern that the Medicaid program would be converted into a system that “limits federal support to care for needy patients to an insufficient predetermined formula based on per-capita caps,” and said that it opposed provisions in the legislation that reached beyond the insurance marketplace to implement restrictions on lower-income patients receiving care at Planned Parenthood or similar organizations.

The American Academy of Family Physicians (AAFP) voiced its concerns as well. The group cited US Census Bureau statistics demonstrating that the uninsured rate had dropped to a low of 8.8% in 2016, and saying that “We should be celebrating this accomplishment and seeking ways to extend health care coverage to those who still lack it—not pursuing legislation that would drive up the number of uninsured.” Like NAMD, the AAFP called for a CBO score, and also requested hearings, debates, and committee markups for the bill.

Some state governors have a different view of Graham-Cassidy; the governors of Wisconsin, Arkansas, Indiana, Iowa, Kansas, Kentucky, Maine, Mississippi, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, Tennessee, and Utah signed a letter to McConnell endorsing the bill. According to the letter, “Adequately funded block grants to the states, along with maximum flexibility and control, is the best option on the table.”

On Friday afternoon, Senator John McCain (R-Arizona) released a statement saying that he would vote “no” on the bill, and that “health care reform legislation ought to be the product of regular order in the Senate.” He did not oppose the bill as such, saying, “I would consider supporting legislation similar to that offered by my friends Senators Graham and Cassidy were it the product of extensive hearings, debate and amendment. But that has not been the case.”

Cassidy, for his part, has attempted to frame the bill as one that, if not the product of a bipartisan process, should appeal to Americans across the political spectrum. In a September 19 address given at the National Association of Specialty Pharmacy Annual Meeting and Educational Conference, Cassidy said of his bill, “It shouldn’t matter if you’re Democrat or Republican, it should only matter if you’re American and if you have a need. And so we wrote this, if you will, agnostic as to whether a state was blue or red. So we’re trying to fashion this together, that’s the process. The politics of it, that’s a firestorm.” He added, “Unfortunately, bipartisanship right now does not exist on health insurance. It may on drug cost, but it does not exist on health insurance. And so we are kind of forced, if you will, to go through a process called reconciliation.”

According to the Press Herald, Senator Susan Collins (R-Maine) indicated at an event in Portland that she was “leaning against the bill.” Senator Rand Paul (R-Kentucky) has also voiced his intention to vote against the bill.