GOP's Latest ACA Health Insurance Repeal Plan Still Faces Major Hurdles
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A last-ditch effort to repeal the Affordable Care Act (ACA) looks unlikely to succeed despite Republican efforts to win more support for its legislation and the release of a Congressional Budget Office analysis required for a Senate vote on the measure.
The Graham-Cassidy bill, which would eventually eliminate federal funding of the ACA and turn over a set amount of money to the states to help with health insurance costs, was subject to a flurry of changes over the past few days as Republicans tried to win over Senate GOP holdouts.
The legislation, however, still lacks enough support in the Senate to win approval before a Saturday deadline that would allow Republicans to pass the measure with just 50 votes.
Late Monday Sen. Susan Collins (R-Maine) joined GOP Senators John McCain (R-Ariz.) and Rand Paul (R-Ky.) in saying she would oppose the legislation.
How the GOP Is Trying to Win Votes
Although much of the bill is the same as a draft released last week, there have been some significant changes made over the last few days aimed at winning over GOP holdouts, says Tim Jost, a health policy expert and emeritus professor at Washington and Lee University School of Law, who analyzed the latest proposal. That includes:
More funding for certain states. There is substantially more money and a revision of Medicaid funding formulas to benefit specific states, including Alaska, Arizona, Kentucky, and Maine, where GOP Senators have either said no or expressed concerns about the bill, Jost says. Those changes don’t appear to go far enough. Although the additional money would partly offset federal funding cuts to those states, there would still be less money overall because it doesn’t take into account the bill’s proposal to cap Medicaid spending, according to an analysis by the Kaiser Family Foundation, a nonprofit organization focused on health-policy issues.
More leeway for states to design healthcare plans. Unlike the previous version of the legislation, states would no longer have to submit waivers to get approval for key changes but could just submit a description of how the plans would work. For example, it would allow states to change the federal cap on out-of-pocket spending for people. It would also allow states to define what benefits insurers would have to offer and to charge people higher rates based on their health status.
Giving states more control would enable them to allow insurers to offer a variety of policies with lower premiums and different benefit options but would also enable them to roll back consumer protections mandated by the ACA, such as not being able to charge people with pre-existing health conditions more for health insurance.
“If there was any question about Graham-Cassidy’s removal of federal protections for pre-existing conditions, this new draft is quite clear,” says Larry Levitt, a senior vice president at the Kaiser Family Foundation.
The Graham-Cassidy legislation is facing vocal opposition outside the Senate as well. Monday afternoon the Senate’s finance committee held a hearing on its bill that was repeatedly interrupted by protestors. A number of consumer groups, healthcare providers, insurers, and a bipartisan group of governors have come out against the proposal as well.
Even if the Senate approves the measure, the legislation must go to the House of Representatives for a vote. The House, where some members have proposed a bipartisan plan to stabilize the ACA markets in the short term, can’t make any changes to the legislation or it would have to go back to the Senate.
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