As the budget reconciliation period draws to a close in the Senate, a handful of Republicans are pushing a last-ditch effort to repeal and replace the Affordable Care Act (ACA), branding their proposal as a “compromise.” While media may be tempted to accept that framing, the proposal is built on the same unworkable, recycled ideas that undermined previous ACA repeal plans.
Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC) have been shopping a plan, known informally as the Graham-Cassidy health care bill, to repeal and replace the ACA for months. Just last week, Sen. John McCain (R-AZ), one of three Republican senators who voted against the last iteration of ACA repeal, said he would support the Graham-Cassidy bill (but after he reads a draft and if it goes through committee hearings). McCain’s support means the bill has a chance of reaching the 50-vote threshold it would need to pass the Senate under budget reconciliation rules, which expire September 30.
The Graham-Cassidy effort is largely a regurgitation of the same unworkable solutions Republicans have been putting forward for years. The biggest difference seems to be how the plan’s supporters are selling it. As Vox noted, the Republicans who support the bill “have spent the past two months selling it as a compromise plan” to gain support on Capitol Hill and in the media. Media cannot accept this framing. Here are a few reasons why:
Graham-Cassidy’s Medicaid block grants would increase the number of uninsured and hurt low-income people, the elderly, and the disabled
New York magazine reported last month that the Graham-Cassidy plan would “turn both Medicaid expansion and Obamacare-tax-credit money into a block grant for states” and “put a long-term per capita cap on Medicaid.” This same provision was adopted in the American Health Care Act (AHCA), the bill the Republican-led House passed this summer to repeal and replace the ACA.
Per capita caps on Medicaid funding make as little sense today as they did earlier this summer. Block-granting Medicaid “is not a new or innovative idea,” according to Families USA, but rather “just another way to cut Medicaid.” In a piece for The Washington Post, political scientist Ryan LaRochelle explained that “turning Medicaid into a block grant would result in less funding.” Edwin Park of the Center on Budget and Policy Priorities (CBPP) also pointed out that block-granting Medicaid would “threaten benefits for tens of millions of low-income families, senior citizens, and people with disabilities.”
Graham-Cassidy would repeal the individual and employer mandates, resulting in less coverage and higher premiums
Graham-Cassidy, like two previous bills -- the Better Care Reconciliation Act (BCRA) and the Health Care Freedom Act -- that failed in the Senate, would repeal the ACA’s employer mandate, which “requires larger companies to offer affordable coverage to their employees,” The Washington Post reported. The Graham-Cassidy plan also eliminates the ACA’s individual mandate, which the Post noted “requires most Americans to have health coverage or pay a fine.” This proposal was floated earlier this year by Republican members of the House Appropriations Committee.
Repealing these mandates would have devastating consequences. The Commonwealth Fund found that repealing the individual mandate “would significantly reduce health insurance enrollment and cause individual market premiums to rise.” Additionally, CBPP policy analyst Tara Straw concluded that ending the employer mandate “would erode employer-sponsored insurance and increase the ranks of the uninsured.”
Graham-Cassidy would end ACA subsidies by 2020, leaving many people without affordable coverage options
Under the Graham-Cassidy bill, “ACA subsidies would be eliminated” by 2020, according to The Washington Post. This would include ending “cost-sharing reductions” (CSR), which help insurers offset the costs of covering low-income customers, something President Donald Trump has hinted he may do in the near future.
Ending CSR payments would increase individual market insurance premiums by nearly 20 percent, according to the Kaiser Family Foundation (KFF). And, as CBPP noted, getting rid of these subsidies specifically would “shift additional costs and risks onto states”; “leave low- and moderate-income people with no guarantee of affordable or adequate coverage”; and “create significant near-term uncertainty and disruption in the individual market.”
The Graham-Cassidy legislation would reinstitute the so-called “age tax,” which, The Washington Post reported, would mean that “insurers would be able to charge older customers up to five times as much as they charge younger customers.” This provision was also included in the Senate health care bill that failed to pass the chamber last month.
This “age tax” would make coverage “unaffordable” to seniors, according to the American Association of Retired Persons (AARP). An AARP representative told CNBC in June that currently “health care is barely affordable for those people who are over age 50” and cautioned that the “‘age tax’ … would just make it unaffordable for them.” A report AARP published in March found that this “age tax” could cost some older adults over $8,000 per year in premium increases.
Like the Senate health care bill, under the Graham-Cassidy plan, “people can contribute more to their health savings accounts than under the ACA, among other changes making HSAs more attractive,” The Washington Post reported.
This reliance on health savings accounts (HSAs) would benefit the rich by letting them set aside more pretax income, but would cause harm to low-income people and those with high medical costs who already cannot afford to save money. As CBPP’s Park noted, similar HSA proposals “would mostly help wealthy, not uninsured” people. Economist Kathryn Phillips explained that HSAs “primarily benefit the wealthy, the healthy, and the educated.” Additionally, KFF found that HSAs can increase out-of-pocket costs for “people with chronic conditions, disabilities, and others with high-cost medical needs” and would do nothing to increase coverage among the uninsured.
Graham-Cassidy would allow states to change what qualifies as an essential health benefit, giving insurers “a backdoor way” to discriminate against people with pre-existing conditions
The Graham-Cassidy legislation, like the failed Senate bill, would allow states to “change what qualifies as an essential health benefit,” according to The Washington Post. Under the ACA, insurers are required to cover things designated as essential health benefits (EHBs), including hospitalization, maternity care, ambulatory care, and other important services.
According to a May 2 report from The Brookings Institution, allowing states to set their own standards for what qualifies as an EHB could “weaken ACA protections against catastrophic costs for people with employer coverage nationwide.” And as economist Gene Sperling and former White House economic advisor Michael Shapiro explained in The Atlantic, eliminating some EHBs would give insurers a “backdoor way” to price out people with pre-existing conditions. Sperling and Shapiro added, “If these benefits are not covered, a plan is all but worthless to those with serious pre-existing conditions.”
Graham-Cassidy would freeze Medicaid funds to Planned Parenthood, leaving many women without a health care provider
Under the Graham-Cassidy proposal, “Planned Parenthood would face a one-year Medicaid funding freeze,” The Washington Post wrote. A similar provision was included in the House and Senate bills brought up this summer to repeal and replace the ACA.
The Republican crusade against Planned Parenthood would leave millions of American women stranded. In a blog post for Health Affairs, public health professor Sara Rosenbaum wrote that the right-wing argument that community health care centers could “absorb the loss of Planned Parenthood clinics” is “a gross misrepresentation.” The Guttmacher Institute found that in 103 counties, Planned Parenthood is the only “safety-net health center” that provides accessible contraception services. And, as The New York Times editorial board explained, Planned Parenthood serves more patients and has “higher quality care than centers without an emphasis on reproductive health.”
While those who support the Graham-Cassidy bill may try and frame it to the media as a newfound compromise on health care reform, it’s not. The supposed compromise proposal is based on the same unpopular proposals Republicans have fought for years to enact. And just like those plans, this one would wreak havoc on the health care system as it exists. Media need to say so.