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September 2017

Men Lie, Women Lie, Numbers Don’t: Graham-Cassidy By the Numbers

As GOP Senators prop up their latest partisan repeal bill which raises costs, cuts coverage, guts protections for people with pre-existing conditions and ends Medicaid as we know it, its sponsors continue attempting to muddle the discussion. With Sen. Graham claiming his bill protects consumers as insurance companies publicly state it doesn’t and Sen. Cassidy being called out by Jimmy Kimmel for lying to his face, it’s hard to keep up. How best to evaluate this bill? In the words of Jay-Z, “Men lie, women lie, numbers don’t.”

32 Million: At least this many people would likely lose their health insurance in the next ten years — 15 million would lose their coverage in the next year.

$4.1 Trillion: The amount of health care funding states would lose over the next two decades; which includes funding for people who need nursing home care and children with disabilities.

20 Percent: The increase in premiums next year, at minimum

$16,174: The amount more a 60-year old making $25,000 would have to pay per year for the same coverage received today.

31 Percent: The funding cut over the next two decades for children who receive coverage through Medicaid.

$17,320: The surcharge a woman would have to pay for coverage if she were pregnant.

Nine: The number of Republican senators who couldn’t answer what the legislation they plan to support does when Vox asked.

TODAY’S 12 FACTS YOU NEED TO KNOW ABOUT THE LATEST GOP HEALTH CARE REPEAL (GRAHAM-CASSIDY)

  1. EVERY INDEPENDENT ANALYST AGREES: MASSIVE FUNDING CUTS FOR STATES. Avalere’s new analysis shows that every state will face deep cuts — more than $4 trillion over the next two decades because of Medicaid cuts and eliminating Medicaid expansion and tax credits for the ACA marketplaces to make coverage more affordable.
  2. 32 MILLION LOSE COVERAGE NATIONWIDE, WITH A STATE BREAKDOWN. Multiple analyses show that 32 million people will lose coverage under Graham-Cassidy, including an analysis by the Center for American Progress that has a state breakdown.
  3. THE BIGGEST LOSERS? CHILDREN AND THOSE WITH DISABILITIES. As the Avalere report noted, Graham-Cassidy would cut funding for people with disabilities by 15-percent and 31-percent for children by 2036.
  4. CASSIDY FAILS THE LIE DETECTOR TEST. In his monologue last night, Jimmy Kimmel called out Sen. Bill Cassidy for claiming the bill would protect pre-existing conditions and lower costs, accosting Sen. Cassidy for lying. “Not only did it fail the ‘Jimmy Kimmel test,’” Kimmel said, “It failed the ‘Bill Cassidy test.’”
  5. THE GOP SABOTAGED BIPARTISAN NEGOTIATIONS. Politico reported yesterday that under guidance from the White House and Paul Ryan, the GOP ended the bipartisan talks many members of its caucus had spent months calling for, and despite many Democratic concessions, including on copper plans and waiver authority.
  6. GOP GOVERNORS COME OUT AGAINST THE BILL IN FULL FORCE. New Jersey Gov. Chris Christie came out against the bill, joining Maryland Gov. Larry Hogan, New Hampshire Gov. Chris Sununu and the five governors who signed a bipartisan letter to Senate leadership urging them to reject the bill: Nevada Gov. Brian Sandoval, Ohio Gov. John Kasich, Massachusetts Gov. Charlie Baker, Vermont Gov. Phil Scott and independent Alaska Gov. Bill Walker.
  7. THE SENATE’S RUSH TO VOTE IS THE OPPOSITE OF REGULAR ORDER.


8. WHAT WILL HAPPEN IF THE BILL PASSES? CHAOS. Under Graham-Cassidy, all states would be left to their own devices, with significantly less money in the short term, to set up individual exchanges. In 2026, the money would completely run out — leading to chaos across the country, and leaving Americans feeling the burden.

9. GOP SENATORS ADMIT THEY DON’T KNOW OR CARE WHAT THEY’RE VOTING ON. Vox asked nine GOP senators — Pat Roberts, Jim Inhofe, Ted Cruz, John Kennedy, Richard Shelby, Johnny Isakson, John Barrasso, Luther Strange and Chuck Grassley — what Graham-Cassidy does, and none could give a good answer, all but admitting they don’t have a good grasp of what they’re voting on, nor do they care. When asked what in the bill will control costs and encourage innovation, Louisiana Senator John Kennedy said, “Well, you need to read the bill.”

10. THE BILL PUNISHES STATES THAT HELP THEIR CITIZENS AND REWARDS THOSE WHO HARMED THEM. The sponsors of the bill are quick to point out that money will be redistributed under their legislation, arguing it is “unfair” some states currently receive more money than others. They fail to point out the states they cite as receiving more money, like Texas and Florida, could receive federal money to insure their residents if they simply chose to expand Medicaid. Meanwhile, states with GOP governors who expanded Medicaid like Nevada, Ohio and Arizona, helping millions receive insurance, would be punished for no reason other than vengeance.

11. PEOPLE WON’T BE ABLE TO GET TAX CREDITS IN CALIFORNIA, NEW YORK OR OREGON. Graham-Cassidy would make it illegal starting in 2018 for health plans on the ACA marketplaces to offer plans that cover abortion. For a state like New York that requires all plans to cover medically necessary abortions, this means that no one would be able to get tax credits to lower their monthly premiums.

12. WOMEN WILL FACE HIGHER COSTS AND LOSE ACCESS TO CARE. Graham-Cassidy would gut Medicaid, which one in five women of reproductive age use for overage; end provisions that helped lower premiums and out-of-pocket costs for 9 million women; and defund Planned Parenthood.

Stories of Note

Washington Post: Another execrable health-care bill proves bad ideas never die

Bloomberg: GOP Health Bill Would End Guarantee That Sick People Won’t Pay More

Huffington Post: The Sponsors Of Obamacare Repeal Are Trying To Fool America — And Fellow Republicans

Politico: Kimmel, not Cassidy, is right on health care, analysts say

AZ Central: Ducey dumps 400,000 Arizonans…maybe more

Kansas City Star: Cassidy-Graham is like previous Affordable Care Act repeal bills. It will hurt Kansans.

West Virginia Register-Herald: Cassidy-Graham health care bill could cut state’s Medicaid funding by $2 billion

Reviews Are In: Graham-Cassidy Is The Worst Of All The GOP Repeal Bills

Senate Republicans are once again trying to repeal our health care through the same secretive, partisan approach they tried before. Only this time, it’s worse.

The Graham-Cassidy-Heller health care repeal rips apart Medicaid and ends Medicaid expansion, it guts protections like those for people with pre-existing conditions and it raises health care costs for millions of Americans.

Any Republican who opposed this in the past, and even those who supported it, now knows that this one is worse. Don’t take our word for it. Take a look:

“…more disruptive for most states than prior Republican efforts.”

“Graham-Cassidy is the most radical.”

“….could reduce funding, coverage and consumer protections even more sharply than the GOP’s previous repeal bill.”

“…slashes health-care spending more deeply and would likely cover fewer people than a July bill that failed precisely because of such concerns.”

“…exacerbates rather than addresses concerns that prevented previous Senate bills from passing in July.”

THOSE WHO KNOW HEALTH CARE THE BEST SAY THE LATEST EFFORT TO REPEAL HEALTH CARE IS THE WORST

Response to Graham-Cassidy, the latest Senate partisan health care repeal bill, has been swift and harsh. Physicians, patient groups, hospitals, consumer groups and senior groups have all come out against it. The American Medical Association said, “We believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care”; AARP said the bill “would result in an age tax for older Americans who would see their health care costs increase under this bill”; and the Children’s Hospital Association said, “This bill would have devastating consequences for children and families.”

Response to Graham-Cassidy, the latest Senate health care repeal bill, has been swift and harsh. Physicians, patient groups, hospitals, consumer groups and senior groups have all come out against the Senate repeal bill. The American Medical Association said “we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care”; AARP said the “bill would result in an age tax for older Americans who would see their health care costs increase under this bill”; and the Children’s Hospital Association said “This bill would have devastating consequences for children and families.”

PHYSICIANS AND NURSES

American Medical Association: “We Believe The Graham-Cassidy Amendment Would Result In Millions Of Americans Losing Their Health Insurance Coverage, Destabilize Health Insurance Markets, And Decrease Access To Affordable Coverage And Care.” “On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing to express our opposition to the Cassidy-Graham-Heller-Johnson Amendment to H.R. 1628, the “American Health Care Act of 2017.” We also urge the Senate to reject any other legislative efforts that would jeopardize health insurance coverage for tens of millions of Americans. Instead, in the short term we urge Congress to pursue legislation that will stabilize health insurance premiums in the individual insurance market by continuing to fund cost-sharing reduction payments. Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care.” [AMA, 9/19/17]

American Medical Association: “Allowing States To Get Waivers To Vary Premiums Based On Health Status Would Allow Insurers To Charge Unaffordable Premiums Based On Those Pre-Existing Conditions.” “In addition, the amendment does not take steps toward coverage and access for all Americans, and while insurers are still required to offer coverage to patients with pre-existing conditions, allowing states to get waivers to vary premiums based on health status would allow insurers to charge unaffordable premiums based on those pre-existing conditions. Also, waivers of essential health benefits will mean patients may not have access to coverage for services pertinent to treating their conditions.” [AMA, 9/19/17]

American Medical Association: “We Also Continue To Oppose Congressionally-mandated Restrictions On Where Lower Income Women (And Men) May Receive Otherwise Covered Health Care Services.” “We also continue to oppose congressionally-mandated restrictions on where lower income women (and men) may receive otherwise covered health care services — in this case the prohibition on individuals using their Medicaid coverage at clinics operated by Planned Parenthood and other similar organizations.” [AMA, 9/19/17]

American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Osteopathic Association, American Psychiatric Association: “The Proposal Fails To Protect The Health Care Coverage And Consumer Protections Available Under Current Law.” “Our organizations, which represent over 560,000 physicians, oppose the new Graham-Cassidy bill and its approach to reforming our health care system. The proposal fails to protect the health care coverage and consumer protections available under current law. Additionally, it would create a health care system built on state-by-state variability that would exacerbate inequities in coverage and most likely place millions of vulnerable individuals at risk of losing their health care coverage.” [Letter, 9/13/17]

American College Of Physicians: “We Believe That The Substantial Cuts To Medicaid Authorized By This Legislation Would Cause A Significant Increase In The Number Of Uninsured Patients And That It Would Undermine Essential Benefits Provided For Patients Insured Under Current Law.” “We believe that the substantial cuts to Medicaid authorized by this legislation would cause a significant increase in the number of uninsured patients and that it would undermine essential benefits provided for patients insured under current law. We urge you to set aside this legislation and instead allow the Senate to consider any improvements to the ACA, through a more deliberative process of regular order, in which hearings are held to solicit the advice of health care experts and stakeholders, with any such improvements considered in a bipartisan manner in which both parties may offer amendments.” [ACP, 9/13/17]

American Academy Of Pediatrics: “By Turning Medicaid Into A Block Grant, Capping Its Funding And Ending Its Expansion, This Proposal Would Have Devastating Effects On The Nearly 37 Million Children Across The Country Who Rely On The Program.” “As a pediatrician, I am fearful for my patients and the uncertain future they would face under Senators Lindsey Graham (R-S.C.) and Bill Cassidy’s (R-La.) health care proposal, currently set for a vote next week in the U.S. Senate. As president of the American Academy of Pediatrics, I must speak out against this dangerous, ill-conceived policy on behalf of our 66,000 pediatrician, pediatric surgical specialist and pediatric medical subspecialist members, and stop it from advancing…By turning Medicaid into a block grant, capping its funding and ending its expansion, this proposal would have devastating effects on the nearly 37 million children across the country who rely on the program.” [AAP, 9/20/17]

American College Of Emergency Physicians: “We urge you not to bring this amendment to the Senate floor for consideration, as its passage would have devastating impacts on millions of Americans.” “We urge you not to bring this amendment to the Senate floor for consideration, as its passage would have devastating impacts on millions of Americans. ACEP cannot support any legislation that does not include emergency medical care as a covered benefit in health insurance. The Affordable Care Act included emergency services as an essential health benefit, and any replacement legislation must do the same. Yet the Cassidy-Graham-Heller-Johnson Amendment to H.R. 1628, the American Health Care Act, allows states to easily forego requiring insurers to adhere to important consumer protections, including the requirement to cover the ten essential health benefits, and protections for those with pre-existing conditions.” [ACEP, 9/19/17]

American Nurses Association: “As With All Other Repeal And Replace Proposals To Date, The Current Proposal Fulfills None ANA’s 4 Principles For Health System Transformation.” “The Graham-Cassidy bill — also supported by Sens. Dean Heller (R-NV) and Ron Johnson (R-WI) — is not substantially different from any of the other repeal and replace bills we have seen from House and Senate Republicans. It repeals Medicaid expansion in 2020; it eliminates the $1 billion Prevention and Public Health Fund; it creates high-risk pools for individuals with pre-existing conditions; it defunds Planned Parenthood for a year; it puts a per-capita cap on Medicaid funding and gives states the option to convert their Medicaid programs into block grants; and it ends premium tax credit assistance and cost-sharing subsidies and puts greater control of healthcare spending in state hands. As with all other repeal and replace proposals to date, the current proposal fulfills none ANA’s 4 principles for health system transformation.” [ANA, 9/19/17]

CONSUMER GROUPS

AARP: “The Graham/Cassidy/Heller/Johnson Bill Would Result In An Age Tax For Older Americans Who Would See Their Health Care Costs Increase Under This Bill.” “Should this bill be brought to the Senate floor for a vote, we strongly urge all Senators to vote NO. As our members expect from AARP, we will monitor each Senator’s vote should this bill come to the Senate floor and notify older Americans by reporting the vote in our publications, online, through the media, and in direct alerts to our members…The Graham/Cassidy/Heller/Johnson bill would result in an age tax for older Americans who would see their health care costs increase under this bill…We have serious concerns that Graham/Cassidy/Heller/Johnson would allow states to once again permit insurance companies to charge people with pre-existing conditions more just because they have cancer, asthma or diabetes.” [AARP, 9/19/17]

AARP: “#GrahamCassidy Would Price Gouge Older Americans With An Age Tax, Decrease Coverage, And Undermine Pre-existing Condition Protections.” “AARP stands ready to work with Congress on commonsense, bipartisan solutions to improve health care. #GrahamCassidy is not that bill. #GrahamCassidy has the same flaws as the proposals rejected by AARP, consumer groups, doctors, hospitals, & the public earlier this year. #GrahamCassidy would price gouge older Americans with an age tax, decrease coverage, and undermine pre-existing condition protections. #GrahamCassidy’s Medicaid caps would also jeopardize the ability of older Americans to stay in their own homes as they age. #GrahamCassidy is just another bad bill that would 🔺 costs & 🔻 coverage. We urge Congress to reject it & the flawed approach it represents.” [AARP Advocates, 9/15/17]

Consumers Union: “This Is Just Another Version Of The Previous Failed Proposals That Were Not Only Rejected By The Majority Of Americans, They Were Rejected By The Senate Itself.” “The Graham-Cassidy bill is the third strike in this losing game of repealing the Affordable Care Act. Just like its predecessors, this plan would leave tens of millions uninsured, threaten key consumer protections and coverage requirements, and fundamentally alter Medicaid by drastically cutting funding and shifting billions of dollars of healthcare costs onto states and consumers. This is just another version of the previous failed proposals that were not only rejected by the majority of Americans, they were rejected by the Senate itself.” [Consumers Union, 9/13/17]

National Farmers Union: “The Graham-Cassidy Bill Does Not Address The Barriers That Farmers And Ranchers Face In Accessing Health Coverage, And It Would Only Make Matters Worse.” “I write on behalf of nearly 200,000 members of National Farmers Union (NFU) who are engaged in all forms of family farming and ranching. NFU’s member-driven policy ‘affirms the right of all Americans to have access to affordable, quality health care.’ The Graham-Cassidy bill does not address the barriers that farmers and ranchers face in accessing health coverage, and it would only make matters worse. We urge you to vote no on the legislation. NFU will be monitoring each Senator’s vote and will include it in our Congressional scorecard.” [NFU, 9/21/17]

PATIENT GROUPS

ALS Association, American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Lung Association, Arthritis Foundation, Cystic Fibrosis Foundation, Family Voices, JDRF, Lutheran Services in America, March of Dimes, National Health Council, National Multiple Sclerosis Society, National Organization for Rare Diseases, Volunteers of America, WomenHeart: “This Bill Would Limit Funding For The Medicaid Program, Roll Back Important Essential Health Benefit Protections, And Potentially Open The Door To Annual And Lifetime Caps On Coverage, Endangering Access To Critical Care For Millions Of Americans.” “This bill would limit funding for the Medicaid program, roll back important essential health benefit protections, and potentially open the door to annual and lifetime caps on coverage, endangering access to critical care for millions of Americans. Our organizations urge senators to oppose this legislation…Our organizations, instead, strongly support the bipartisan hearings spearheaded by Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) in the Senate Health, Education, Labor and Pensions (HELP) Committee, and by Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-Ore.) in the Senate Finance Committee.” [Letter, 9/18/17]

American Cancer Society Cancer Action Network: “With Repeal Of The Health Care Law As Its Starting Point, The Graham-Cassidy Bill Is Distracting And, If Enacted, Would Be Disruptive To The Health Care Markets — Creating Uncertainty For Millions Of Americans.” “ACS CAN commends HELP Committee Chairman Lamar Alexander (R-Tenn.) and Senator Patty Murray (D-Wash.) for initiating this bipartisan examination of health care solutions and for restoring long-needed regular legislative order to the debate. With repeal of the health care law as its starting point, the Graham-Cassidy bill is distracting and, if enacted, would be disruptive to the health care markets — creating uncertainty for millions of Americans…On behalf of cancer patients, survivors and their families, we urge lawmakers to continue to focus on practical, bipartisan efforts to strengthen health care coverage and urge Senators Cassidy and Graham to work within, and not around, the HELP Committee process.” [ACS CAN, 9/14/17]

National Coalition For Cancer Survivorship Of More Than 35 Cancer Organizations: “35+ Cancer Orgs, Representing 16 Million #Cancer Pts & Survivors, Ask Sen To Vote No On Harmful #ACA Repeal.” “35+ cancer orgs, representing 16 MILLION #cancer pts & survivors, ask Sen to vote NO on harmful #ACA repeal.” [National Coalition for Cancer Survivorship, 9/19/17]

Coalition To Stop Opioid Overdose Of 469 Mental Health And Substance Use Disorder Groups: “We Are Very Concerned That The GCHJ’s Proposed Changes To Our Health Care System Will Result In Reductions In Health Care Coverage, Particularly For Individuals With Substance Use Disorders And Mental Illness, And We Cannot Support The Bill.” “The undersigned organizations are writing to share our serious concerns with several of the health system reforms included in the Graham-Cassidy-Heller-Johnson (GCHJ) proposal. We are very concerned that the GCHJ’s proposed changes to our health care system will result in reductions in health care coverage, particularly for individuals with substance use disorders and mental illness, and we cannot support the bill.” [Letter, 9/19/17]

DISABILITY RIGHTS

Consortium For Citizens With Disabilities: “We Cannot Overstate The Danger Facing The Millions Of Adults And Children With Disabilities If The Proposal’s Medicaid Provisions Are Adopted.” “As we have commented on multiple proposals considered by the Senate, we cannot overstate the danger facing the millions of adults and children with disabilities if the proposal’s Medicaid provisions are adopted. The proposal’s imposition of a per capita cap and the elimination of the adult Medicaid expansion would decimate a program that has provided essential healthcare and long term services and supports to millions of adults and children with disabilities for decades. We are also extremely concerned about the changes proposed to the private individual health insurance market and the tax credits that currently assist low-income individuals, including individuals with disabilities, to purchase insurance.”

The Arc: “Architects Of This Bill Are Still Ignoring The Pleas Of Their Constituents With Disabilities.” “While this piece of legislation has a new title and makes new promises, it is more of the same threats to Medicaid and those who rely on it for a life in the community. The Graham-Cassidy-Heller-Johnson proposal cuts and caps the Medicaid program. The loss of federal funding is a serious threat to people with disabilities and their families who rely on Medicaid for community based supports.” [The Arc, 9/14/17]

HOSPITALS

American Hospital Association: “This Proposal Would Erode Key Protections For Patients And Consumers And Does Nothing To Stabilize The Insurance Market Now Or In The Long Term” And “The Block Grant To Provide Support For The Expansion Population Expires In 2026, Thereby Eliminating Coverage For Millions Of Americans.” “We believe that coverage could be at risk for tens of millions of Americans under the Graham-Cassidy proposal. We continue to urge senators to work in a bipartisan manner to address the challenges facing our health care system. This proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term. In addition, the block grant to provide support for the expansion population expires in 2026, thereby eliminating coverage for millions of Americans. For these reasons, we oppose the Graham-Cassidy plan.” [AHA Statement, 9/19/17]

Arizona Hospital And Healthcare Association: “A Central Goal Of The Arizona Hospital And Healthcare Association Is To Ensure More Arizona Families Have Access To Quality Care They Can Afford” And “Graham-Cassidy…Falls Short On Both Counts.” “A central goal of the Arizona Hospital and Healthcare Association is to ensure more Arizona families have access to quality care they can afford. The Graham-Cassidy legislation being considered by Congress falls short on both counts. This proposal erodes critical protections for patients and consumers, and would lead to costlier premiums for many individuals — especially those with pre-existing conditions. Millions would lose coverage altogether.” [AzHHA, 9/21/17]

Kansas Hospital Association: “We Will Continue To Urge Our Senators To…Protect Health Coverage And Oppose The (Graham-Cassidy) Bill.” “‘We will continue to urge our senators to address the challenges facing our health care 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 Kansas Sen. Moran, who previously criticized his party’s efforts to roll back Medicaid, to vote against the latest bill.” [Modern Healthcare, 9/18/17]

Greater New York Hospital Association And 35 New York Provider, Labor, Consumer, And Insurers: The Bill’s “Implementation Would Catastrophically Cut Federal Funding To New York’s Health Care System And Severely Compromise Your Constituents’ Access To Health Care Coverage And Services.” “Our coalition of New York State consumers, health care and human service workers, and providers and insurers urge you to strongly oppose the new Graham-Cassidy bill to repeal the Affordable Care Act (ACA), which could be voted on in the Senate in the coming days. If the bill clears the Seante, it would be sent to the House for your consideration. Your opposition to the bill is critical, as its implementation would catastrophically cut Federal funding to New York’s health care system and severely compromise your constituents’ access to health care coverage and services.” [GNYHA, 9/19/17]

Federation Of American Hospitals: “The Graham-Cassidy Proposal Could Disrupt Access To Health Care For Millions Of The More Than 70 Million Americans Who Depend On Medicaid And The Marketplaces For Their Health Coverage.” “The Graham-Cassidy proposal could disrupt access to health care for millions of the more than 70 million Americans who depend on Medicaid and the marketplaces for their health coverage. It is time to move on to secure the health coverage for those who have it, and find solutions for those who don’t. We urge the Senate to reject legislation that fails to move us forward in assuring Americans access to affordable health care and coverage.” [FAH, 9/20/17]

Children’s Hospital Association: “This Bill Would Have Devastating Consequences For Children And Families.” “The nation’s children’s hospitals stand in strong opposition to the most recent legislative proposal introduced by Sens. Lindsay Graham, R-S.C., Bill Cassidy, R-La., Dean Heller, R-Nev., and Ron Johnson, R-Wis. Their legislation would slash funding for Medicaid, the nation’s largest health care program for children, by one-third, reducing access and coverage for more than 30 million children in the program. Furthermore, the legislation weakens important consumer safeguards, and as a result, millions of children in working families would no longer be assured that their private insurance covers the most basic of services without annual and lifetime limits and regardless of any underlying medical condition. This bill would have devastating consequences for children and families.” [CHA, 9/18/17]

America’s Essential Hospitals: “It Appears To Significantly Restrict Federal Health Care Funding Through Per-Capita Caps And Block Grants, Which Would Shift Costs To States, Patients, Providers, And Taxpayers.” “It appears to significantly restrict federal health care funding through per-capita caps and block grants, which would shift costs to states, patients, providers, and taxpayers. Further, by taking an approach so close to that of the earlier House and Senate plans, it’s reasonable to conclude it would have a similar result: millions of Americans losing coverage…Further, it would impose strict new limits on how states raise support for the safety net. Rather than providing flexibility, this would limit states’ coverage and financing choices. Rather than consider a proposal with no CBO score or committee review, the Senate should stay focused on bipartisan efforts to shore up the insurance market, extend Children’s Health Insurance Program funding, and delay Medicaid DSH cuts.” [AEH, 9/15/17]

Catholic Health Association: “I Strongly Urge You To Reject The Graham-Cassidy-Heller-Johnson Legislation And Instead Support Bipartisan Efforts To Improve Our Health Care System Focusing On Insurance Market Stabilization, Affordability, And Coverage Access And Expansion.” “On behalf of the Catholic Health Association of the United States (CHA), the national leadership organization of more than 2,000 Catholic health care systems, hospitals, long-term care facilities, sponsors, and related organizations, I strongly urge you to reject the Graham-Cassidy-HellerJohnson legislation and instead support bipartisan efforts to improve our health care system focusing on insurance market stabilization, affordability, and coverage access and expansion.” [CHA, 9/19/17]

MEDICAID PROGRAMS

National Association Of Medicaid Directors: “We Are Concerned That This Legislation Would…Fail To Deliver On Our Collective Goal Of An Improved Health Care System.” “The Board of Directors of the National Association of Medicaid Directors (NAMD) urges Congress to carefully consider the significant challenges posed by the Graham-Cassidy legislation. State Medicaid Directors are strong proponents of state innovation in the drive towards health care system transformation. Our members are committed to ensuring that the programs we operate improve health outcomes while also being fiscally responsible to state and federal taxpayers. In order to succeed, however, these efforts must be undertaken in a thoughtful, deliberative, and responsible way. We are concerned that this legislation would undermine these efforts in many states and fail to deliver on our collective goal of an improved health care system.” [NAMD, 9/21/17]

SCHOOLS

The School Superintendents Association And The Save Medicaid In Schools Coalition: “Graham-Cassidy Reneges On Medicaid’s 50+ Year Commitment To Provide America’s Children With Access To Vital Healthcare Services That Ensure They Have Adequate Educational Opportunities And Can Contribute To Society.” “The 70 undersigned organizations of the Save Medicaid in the Schools Coalition are concerned that the Graham-Cassidy bill jeopardizes healthcare for the nation’s most vulnerable children: students with disabilities and students in poverty. Specifically, Graham-Cassidy reneges on Medicaid’s 50+ year commitment to provide America’s children with access to vital healthcare services that ensure they have adequate educational opportunities and can contribute to society by imposing a per-capita cap and shifting current and future costs to taxpayers in every state and Congressional district. While children currently comprise almost half of all Medicaid beneficiaries, less than one in five dollars is spent by Medicaid on children. Accordingly, a per-capita cap, even one that is based on different groups of beneficiaries, will disproportionately harm children’s access to care, including services received at school. Considering these unintended consequences, we urge a ‘no” vote on Graham-Cassidy.” [Letter, 9/19/17]

INSURERS

America’s Health Insurance Plans: “The Graham-Cassidy-Heller-Johnson Proposal Fails To Meet [Our] Guiding Principles, And Would Have Real Consequences On Consumers And Patients.” “The Graham-Cassidy-Heller-Johnson proposal fails to meet these guiding principles, and would have real consequences on consumers and patients by further destabilizing the individual market; cutting Medicaid; pulling back on protections for pre-existing conditions; not ending taxes on health insurance premiums and benefits; and potentially allowing government-controlled, single payer health care to grow.” [AHIP, 9/20/17]

Blue Cross Blue Shield Association: “We Share The Significant Concerns Of Many Health Care Organizations About The Proposed Graham-Cassidy Bill.” “Although we support providing states with greater flexibility in shaping health care options for their residents, we share the significant concerns of many health care organizations about the proposed Graham-Cassidy bill. The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions. The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans. Legislation must also ensure adequate funding for Medicaid to protect the most vulnerable.” [BCBSA, 9/20/17]

Blue Shield Of California: “We Believe This Proposal Will Cause Millions Of Californians To Lose Their Health Insurance Coverage While Requiring Major State Tax Increases Over The Long-Term To Fund Basic Levels Of Access.” “We are therefore writing to express our strong opposition to the Cassidy-Graham proposal that the Senate may soon consider. We believe this proposal will cause millions of Californians to lose their health insurance coverage while requiring major state tax increases over the long-term to fund basic levels of access. This would undo much of the substantial progress California has made expanding coverage in recent years.” [Blue Shield of California, 9/21/17]

Association Of Community Affiliated Plans: “We Are Disappointed To See That The Senate Is Repeating — And In Some Ways, Doubling Down On — Many Of The Same Mistakes As It Made With The Better Care Reconciliation Act.” “We are disappointed to see that the Senate is repeating — and in some ways, doubling down on — many of the same mistakes as it made with the Better Care Reconciliation Act. As with previous efforts to overhaul the health care system, ACAP has compared the language of the Cassidy-Graham proposal against a set of stated principles surrounding health reform, which we have shared with Congress before…We’ve seen what’s possible with health reform; there have been promising talks in the Senate HELP Committee around stabilizing Marketplaces and bipartisan progress around the must-pass funding extension for the Children’s Health Insurance Program (CHIP), for which no new allotments exist after the end of the month. We urge the Senate in the strongest possible terms to turn away from partisan politics and instead build on the promising work around CHIP and the HELP committee.” [ACAP, 9/18/17]

12 Facts You Need To Know About The Latest GOP Health Care Repeal (Graham-Cassidy)

  1. MASSIVE STATE BY STATE FUNDING CUTS. The Center on Budget and Policy Priorities released a report showing in 2027, every state in the nation would see federal funding cuts under Graham-Cassidy, totaling nearly $300 billion.
  2. NO FULL CBO SCORE. The Congressional Budget Office announced it would not be able to produce a complete analysis on Graham-Cassidy that includes the impact on deficits, how many will lose coverage or the increase in premiums by September 30. Senator Bill Cassidy admitted, “I just don’t care about the coverage numbers.”
  3. PRE-EXISTING CONDITION PREMIUM HIKES. The Center for American Progress released a report showing how much more people with pre-existing conditions would pay each year under Graham-Cassidy. For example, an individual with asthma would face a premium surcharge of $4,340. The surcharge for pregnancy would be $17,320 and $142,650 more for patients with metastatic cancer.
  4. WORSE THAN BEFORE. Fitch Rating Agency found that this bill was “more disruptive for most states than prior Republican efforts.” The Washington Post found this bill is worse than previous health care repeal bills, writing “”The latest Obamacare overhaul bill gaining steam on Capitol Hill slashes health-care spending more deeply and would likely cover fewer people than a July bill that failed precisely because of such concerns.”
  5. MORE UNINSURED VETS. Rand Corp study showing Republican repeal efforts would increase the number of uninsured veterans. The report showed that the ACA’s Medicaid expansion had increased coverage for low-income veterans who lived further from VA facilities. The report found that the ACA was responsible for reducing the uninsured rate of veterans by about one-third, from 9.1% to 5.8%, in 2015.
  6. MORE UNINSURED CHILDREN. The Center for American Progress released an analysis showing that children are at immediate risk of losing coverage in Arizona, California, Connecticut, Hawaii, Idaho, Mississippi, Nevada, Oregon, Pennsylvania and Utah with CHIP funding running out quickly.
  7. KEY STAKEHOLDERS OPPOSE. The AARP, AMA, six leading physician groups, American Cancer Society Cancer Action Network and 15 more high-profile patient groups and Children’s Hospital Association — who are all unified in opposing the Republican repeal bill.
  8. GOP GOVERNORS OPPOSE. Republican Governors from Alaska, Ohio, Massachusetts and New Hampshire have come out against the plan.
  9. FAILS THE MCCAIN TEST. The NYT’s David Leonhardt’s column, “John McCain Faces a New Test of His Principles.”
  10. RAND PAUL IS A ‘NO.’ GOP Senator Rand Paul opposes Graham-Cassidy, writing in an op-ed, “In all ways, this bill is also ObamaCare Lite. In no way is it repeal the way we promised. I will oppose this bill as I did the other fake repeal bills, and I urge those who want repeal to do so, as well.”
  11. INCLUDES THE AGE TAX. This repeal bill still lets insurance companies charge up to 5 times more for people over 50, what AARP has dubbed an “Age Tax.”
  12. NO GUARANTEE IN THE HOUSE. Because this repeal bill is worse than previous ones, the Washington Post reports, “Would the House pass Graham-Cassidy? It’s not a slam dunk.”

Stories of Note

  • Washington Post: “The new GOP health-care measure goes further than the failed one”
  • New York Times: “John McCain Faces a New Test of His Principles”
  • Washington Post: “Moderates would have to swallow deep Medicaid cuts for GOP health-care push to succeed”
  • VOX: “How Cassidy-Graham brings back preexisting conditions”
  • POLITICO: “Obamacare repeal plan won’t get full CBO analysis by key deadline”
  • Axios: “What’s missing from Graham-Cassidy”

Senate GOPers Demanded CBO Score, Until Now

Time and again, Senate Republicans demanded an analysis from the nonpartisan Congressional Budget Office before they would vote on repealing the Affordable Care Act. This analysis let the Senators know about how much people’s premiums and costs would increase and how many people would lose coverage.

Now, as they rush a partisan, secretly drafted health care repeal bill to a vote, Senate Republicans don’t seem to care. They don’t want to know the truth about how much their constituents’ health care costs will go up or how many will lose coverage. Senator Lindsey Graham put it best himself when he said that a bill without a CBO score “needs to be viewed with suspicion.”

See the history for yourself.

Sen. Lindsey Graham (R-SC): “Any Bill…Not Scored? Needs To Be Viewed With Suspicion.” “‘Like y’all, I’m still waiting to see if it’s a boy or a girl,’ said Sen. Lindsey Graham (R-S.C.). ‘Any bill that has been posted less than 24 hours, going to be debated three or four hours, not scored? Needs to be viewed with suspicion.’” [Politico, 5/5/17]

Sen. Lindsey Graham (R-SC): “We Like The CBO When They Agree With Us…When They Don’t, They’re A Bunch Of Losers.” “Graham, however, argued that his GOP colleagues should spending time reviewing and trying to address the the budget office’s findings. ‘We like the CBO when they agree with us,’ the South Carolina senator told reporters. ‘When they don’t, they’re a bunch of losers.’” [The Hill, 3/13/17]

Sen. Bill Cassidy (R-LA) Called For A CBO Score, Wants To See How Many People Lose Coverage, How Much Is Added To The Debt. [Steven Dennis Tweet, 3/6/17]


Sen. Ron Johnson (R-WI): Calls For CBO Score As The Starting Point For Debate, “We Need Better Information At The Start Of The Process.” “Johnson said he’s not asking for the discussions to go on for months, but ‘let’s take a couple of weeks and be thoughtful. Give me a chance to make the case to improve it.’ He did say he’ll vote no this week on a measure to move the bill forward, as he believes it’s too early to make that decision. ‘This is such an alternative universe,’ said Johnson. ‘We’ve gotten through the process until we get the CBO score, at the end of the process. We need better information at the start of the process.’” [Newsmax, 6/27/17]

Sen. Susan Collins (R-ME): “I Think We Need To Do The Job Right, And We Certainly Need A CBO Analysis.” “‘I think we need to do the job right, and we certainly need a CBO analysis,’ she said on Thursday afternoon. ‘Part of the problem is we don’t have a CBO analysis of the impact of the bill, so I don’t know what it is for coverage and cost sharing and the individual insurance markets. There are so many unanswered questions.’” [Vox, 5/4/17]

Sen. Susan Collins (R-ME): On CBO Not Having A Score In Time For GCHJ, “That’s Problematic.” “Sen. Susan Collins said she is upset that the nonpartisan Congressional Budget Office won’t have enough time to fully review a last-minute bill to overhaul Obamacare. The Maine Republican has not taken a position on the bill co-sponsored by Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C. However, she said she was concerned that CBO said that it won’t be able to determine how the bill would affect insurer coverage and premiums by early next week. ‘That’s problematic because that is part of the problem of short-circuiting the process,’ she told reporters Monday.” [Washington Examiner, 9/18/17]

Sen. Marco Rubio (R-FL): If Senator Mitch McConnell Does Not Honor Normal Senate Processes And Traditions, “They Won’t Have The Votes In The Senate.” “There was also a creeping concern about how quickly the bill was moving. Senator Mitch McConnell of Kentucky, the Republican leader, essentially promised to move the bill to the Senate floor without the hearings and other processes that are normal for such a far-reaching piece of legislation. He had promised when Republicans took the majority that they would honor normal Senate processes and traditions. ‘I think if that’s the approach they take,’ Mr. Rubio said, ‘they won’t have the votes in the Senate.’” [New York Times, 3/8/17]

Sen. John Hoeven (R-ND): “I…Want To See The CBO Score And Additional Analysis Of The Legislation.” “As I’ve said all along, our overall goal for health care reform legislation is to provide Americans with access to patient-centered health care and health insurance at an affordable rate. I did not support the Senate’s first draft. Now, I will review the new draft legislation and want to see the CBO score and additional analysis of the legislation. I will reserve judgment until we do so.” [Sen. Hoeven, Statement, 7/13/17]

Sen. Pat Toomey (R-PA): CBO Score “Becomes An Important Part Of The Consideration For The Final Product.” “‘I don’t think it slows it down, but it’s very important,’ Sen. Pat Toomey (R-Pa.), a member of the 13-member working group focused on health care, said about the CBO score. ‘It becomes an important part of the consideration for the final product.’” [Morning Consult, 5/10/17]

Sen. John Cornyn (R-TX): “The CBO Score On The Senate Bill Is Going To Be What Counts.” “Cornyn: ‘The CBO score on the Senate bill is going to be what counts.’” [Twitter, 5/24/17]

Sen. Roy Blunt (R-MO): “The Senate’s Going To Have To Have The Kind Of Score They Need To Move This Forward.” “‘The Senate’s going to have to have the kind of score they need to move this forward and the Senate’s going to be looking at this to see what we can do to take the House work, look at what the House did, look at what we can do to improve that in our view,’ Blunt told NBC’s “Meet the Press.” [The Hill, 5/7/17]

Sen. Jeff Flake (R-AZ): “We’ll See When CBO Comes Back How That Scores…” “On the other side, Flake views the bill’s refundable tax credits as more taxpayer subsidies. ‘We’ll see when CBO comes back how that scores, but it’s still pretty expensive,’ Flake said, referring to the pending cost and coverage estimates by the Congressional Budget Office.” [AZ Central, 3/12/17]

Sen. Shelley Moore Capito (R-WV): “I Look Forward To Reviewing The Revised Senate Health Care Legislation And Forthcoming CBO Report To Determine The Impact On West Virginians.” “Any health care bill to replace Obamacare must provide access to affordable health care coverage for West Virginians, including our large Medicaid population and those struggling with drug addiction. I opposed the previous draft because it did not ensure access to affordable health care in West Virginia, did not do enough to combat the opioid epidemic that is devastating my state, cut traditional Medicaid too deeply, and harmed rural health care providers. I look forward to reviewing the revised Senate health care legislation and forthcoming CBO report to determine the impact on West Virginians but continue to have serious concerns about the Medicaid provisions.” [Sen. Capito Statement, 7/13/17]

On Health Care Repeal, The Facts Keep Getting Worse

As Republicans continue their partisan push to repeal health care, the damage their repeal would cause turns out to be even worse than the repeal bills they’ve tried in the past.

That probably explains why they refuse to wait for the nonpartisan Congressional Budget Office estimate of how their plan would impact people’s coverage and costs.

  • The Washington Post now reports, “The latest Obamacare overhaul bill gaining steam on Capitol Hill slashes health-care spending more deeply and would likely cover fewer people than a July bill that failed precisely because of such concerns.”
  • Fitch Rating Agency found that this bill was “more disruptive for most states than prior Republican efforts.”
  • New York Republican Representatives Peter King and Tom Reed are doubtful they’ll support the bill, despite voting for earlier health care repeal bills.
  • Republican Governors from Ohio, Massachusetts and New Hampshire have come out against the plan.
  • GOP Senator Rand Paul opposes it, writing in an op-ed, “In all ways, this bill is also ObamaCare Lite. In no way is it repeal the way we promised. I will oppose this bill as I did the other fake repeal bills, and I urge those who want repeal to do so, as well.“

Maybe the GOP should live up to their promise to work across-party-lines and hear from experts to make reforms that improve our health care system instead of this hyper-partisan health care repeal that is overwhelmingly opposed by most Americans.


Partisan Graham-Cassidy Repeal Fails the McCain Test

Washington — Senate Republicans are again pursuing a strategy of secretive, partisan repeal of the health care law despite failing to do so just weeks ago and despite the momentum behind a bipartisan approach to stabilizing insurance markets which has permeated the health care debate in the Senate over the last few weeks.

The current repeal effort being sponsored by U.S. Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA), among others, also clearly violates the McCain Test laid out in his floor speech on July 25th where he declared his opposition to partisan repeal based on it failing to meet the traditions and protocols of the United States Senate and for which he received broad acclaim. McCain gave the speech upon returning to the Senate after being diagnosed with brain cancer. Among other things, McCain called for a return to regular order, compromise and bipartisanship and noted that the Republican effort to ram through partisan repeal written in secret and without hearings violated those standards.

“Graham-Cassidy is a return to the very partisan approach and tactics McCain deplored in his speech and fails the McCain Test in every way,” said Protect Our Care Campaign Director Brad Woodhouse. “This repeal bill was written in secret with Republican input only, there have been no hearings on it, there has been no CBO score and there’s not a hint of compromise in the approach which repeals but fails to replace the Affordable Care Act. Graham-Cassidy is a disaster substantively and as it relates to the McCain Test for how the Senate should operate it’s a miserable failure.”

The McCain Test from his July 25th Floor Speech:

· Cooperation

· Compromise

· Common Ground

· Trust

· Working Together

· Regular Order

· Committee Process

· Bipartisanship

· Deliberative

The McCain Test reiterated yesterday on Face the Nation:

MCCAIN: “Are we going to ram through our proposal with, with Democrats and the president? That’s not the way to do it. We got to go back. If I could just say again, the way to do this is have a bill, put it through the committee. We have Patty Murray and Lamar Alexander are doing fine — bring it to the floor. Have debate. Have amendments.”

Graham-Cassidy Fails the McCain Test:

· Partisan

· Secret

· No Hearings

· Rushed


McCain and Kasich Rebuke Partisan Health Care Repeal with No Committee Hearings

On CBS’s Face the Nation this weekend, Senator John McCain reiterated his belief that any health care repeal needs bipartisan input and public hearings, as opposed to the secret, closed, partisan process currently driving the Graham-Cassidy health care repeal.

In response to McCain’s statement, Ohio Governor John Kasich agreed.


Here’s McCain’s full quote from Face the Nation:

MCCAIN: “Are we going to ram through our proposal with, with Democrats and the president? That’s not the way to do it. We got to go back. If I could just say again, the way to do this is have a bill, put it through the committee. We have Patty Murray and Lamar Alexander are doing fine — bring it to the floor. Have debate. Have amendments.”


112 Days Ago, Bill Cassidy Cared About The Damage of Health Care Repeal, Now He Doesn’t

Senator Bill Cassidy doesn’t care about how damaging the nonpartisan Congressional Budget Office says his health care repeal bill will be to people.

It’s far different from 112 days ago when he actually cared about the impact of health care repeal. The latest repeal scheme bears Cassidy’s name but was written in secret without hearings or expert input.

See here.

5/26/17 — Senator Bill Cassidy on CBO: “I think we need to be instructed by [the score],”

9/15/17 — Senator Bill Cassidy on CBO: ““I just don’t care about the coverage numbers”