Healthcare stakeholders scramble to stop last-minute ACA repeal drive
Caught off guard, healthcare industry and consumer groups are racing to lobby and mobilize grass-roots efforts against a sweeping new Senate Republican bill to repeal and replace the Affordable Care Act and turn its funding into temporary state block grants.
Groups opposed to the new bill—co-sponsored by four senators led by Lindsey Graham of South Carolina and Bill Cassidy of Louisiana and unveiled just last week—are planning protests at the Capitol and at senators' offices around the country.
They're also launching digital ads, social media campaigns and phone bank efforts targeting pivotal Republican senators including Arizona's John McCain and Alaska's Lisa Murkowski, who joined Maine's Susan Collins in killing the last Senate GOP repeal attempt.
Most political observers thought the GOP drive to repeal and replace the ACA was dead following the razor-thin defeat of Senate repeal legislation in late July. Senate GOP leaders seemed to turn to tax reform, and there were bipartisan moves to stabilize the ACA-regulated individual insurance market.
But now Senate Republicans seem determined to make a last-ditch effort to gut the law before Sept. 30, when authorization to pass a budget reconciliation bill with just 51 votes runs out. GOP leaders are counting heads in preparation for a floor vote next week, even though no hearings have been held and the Congressional Budget Office hasn't had time to estimate the bill's cost and coverage impact.
"We're told that the CBO was told by our leadership to make this a priority above all other priorities," Cassidy told the Hill newspaper, predicting he can get enough votes to pass the bill.
It's likely that the fresh GOP repeal effort will delay Senate consideration of bipartisan bills to stabilize the individual insurance and renew funding for the Children's Health Insurance Program, which runs out Sept. 30. Insurers say they need to know whether Congress will fund payments to them for the ACA's cost-sharing reductions to low-income enrollees before Sept. 27, their deadline for filing 2018 plans and rates.
"We're disappointed, we thought Congress was finally making progress toward bipartisan solutions on stabilizing the market and reauthorizing CHIP," said Margaret Murray, CEO of the Association for Community Affiliated Plans, which represents safety-net insurers.
Many provider, insurer and consumer groups say the Graham-Cassidy bill could cause even bigger coverage losses and erosions of consumer protections than the previous GOP repeal-and-replace bills. In addition, it contains no provision for funding the block grants after 2026, though Cassidy says Congress would act to reauthorize them.
"What happens in 2027 is a big question mark," Murray said. "We are much more concerned about this bill than the other bills because of that cliff."
A number of hospital groups have come out against the bill, including America's Essential Hospitals, the California Hospital Association, the Colorado Hospital Association and the Kansas Hospital Association.
Provider and insurer groups want to see Congress focus on quickly passing a bill to stabilize the individual insurance market by funding payments to insurers for the ACA's cost-sharing reductions to low-income consumers.
They're also urging Congress to rapidly approve renewal of CHIP funding. That expiration at the end of the month could force a number of states, which will run out of federal CHIP dollars soon, to end their coverage programs for low- and moderate-income children.
"We will continue to urge our senators to address the challenges facing our healthcare system, protect health coverage and oppose the (Graham-Cassidy) bill," said Cindy Samuelson, vice president for public relations at the Kansas Hospital Association. Her group is pushing GOP Kansas Sen. Jerry Moran, who previously criticized his party's efforts to roll back Medicaid, to vote against the latest bill.
The Association for Community Affiliated Plans is restarting its anti-repeal social media campaign targeting Arizona, where it has member plans, and possibly other states as well. "We're working to encourage Sen. McCain to keep with his no vote," she said.
McCain has said he's considering voting for the bill, which is sponsored by his close friend Graham and supported by Arizona Gov. Doug Ducey, a Republican. An analysis by the liberal Center on Budget and Policy Priorities found that Arizona would lose $1.6 billion in federal funding by 2026 under the bill. On Monday, however, McCain, who decried the rushed and secretive process used for the previous Senate repeal bills, said he thinks the process for the Graham-Cassidy bill is "very disturbing."
In a tweet, the CBO said it would have preliminary estimates of the bill's fiscal impact next week. But it said it would be unable to provide projections of the measure's effect on coverage, premiums and overall federal deficits "for at least several weeks."
In Alaska, a coalition of consumer and provider groups are scheduled to hold "Stand with Lisa" events Tuesday at Murkowski's three offices statewide to encourage her to maintain her opposition to rolling back the ACA's Medicaid and coverage expansions.
Pro-ACA groups also are planning rallies and visits at the offices of Graham and other GOP senators including Moran of Kansas and Rob Portman of Ohio, another senator who had previously voiced sharp doubts about cutting Medicaid and ending the expansion.
In Washington, groups including Planned Parenthood, MoveOn, the Center for American Progress and the Arc are scheduled to hold a rally at the Capitol Tuesday against the Graham-Cassidy bill. "We are working with our state partners across the country to make sure members of Congress don't vote for a proposal to slash funding for consumer protections and funding for Medicaid and marketplace subsidies," said Claire McAndrew, director of campaign strategy for Families USA.
In addition, town hall-style events featuring nurses, other caregivers and patients are planned for West Virginia and Nevada, two other Medicaid expansion states whose Republican senators have wavered on rolling back expansion—though Nevada Sen. Dean Heller has joined as a co-sponsor of the Graham-Cassidy bill.
ACA supporters are firing off red alerts. "Drop what you are doing to start calling, start showing up, start descending on D.C.," tweeted Democratic Sen. Patrick Murphy of Connecticut.
Sen. Ron Johnson (R-Wis.), chairman of the Senate Homeland Security Committee and one of the Graham-Cassidy bill's sponsors, had scheduled a hearing on the bill next Tuesday, even though his committee lacks jurisdiction over the bill's subject matter. That meeting was canceled on Tuesday. Senate Finance Committee Chairman Orrin Hatch (R-Utah) is convening a hearing on the bill on Monday.
While there are widespread fears the bill would drive up the number of uninsured Americans, as previous GOP repeal bills were projected to do, the CBO said Monday it would not be able to evaluate the bill's coverage impact for at least several weeks—too late for a vote taking place by Sept. 30.
The Graham-Cassidy bill would give the states $1.2 trillion in block grant funding through 2026 and let them design their own coverage systems with few strings attached. The federal funding they would receive would be significantly less than what they are slated to receive under the ACA.
In addition, states could let insurers offer plans with fewer benefits than the ACA requires, such as not covering maternity or behavioral care, and allow plans to consider individual customer's health status in setting premiums.
Special federal funding to states to expand Medicaid to low-income adults would end in 2020. And federal payments to the states for traditional Medicaid would be cut and capped, with the annual growth rate set lower than under previous GOP repeal bills. The bill's per capita caps would reduce Medicaid funding by $175 billion over 10 years, according to the Center on Budget and Policy Priorities.
The bill also would redistribute funding from Medicaid expansion states to non-expansion states, with states such as California and New York losing billions of dollars.
"The bill's repeal of certain provisions of the Affordable Care Act are more disruptive for most states than prior Republican efforts," Fitch Ratings said.
President Donald Trump last week applauded Graham and Cassidy for "continuing to work toward a solution" to repeal the ACA, adding that "inaction is not an option."
The Associated Press contributed to this report.
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