Until yesterday, the Senate GOP was speeding toward a vote on special budget rules before the expiration on September 30th that would allow lawmakers to pass the bill with a simple Republican majority and no Democratic votes. This controversial GOP bill would have repealed the Affordable Care Act (ACA), and completely altered the structure and operations of the healthcare market.
Under Graham-Cassidy, the ACA's marketplace subsidies and enhanced matching rate for Medicaid expansion would be discontinued, replacing them with an inadequate block grant. Furthermore, the block grant allocations will not be adjusted to satisfy high demand and the funds can be used entirely at each state's discretion. This means, unfortunately, that there would be no requirement for each respective state to offer low- and middle-income citizens coverage or financial assistance. Secondly, Medicaid's current financial partnership between state governments and the federal government would be transformed into a per capita cap, resulting in both a cap and a cut in federal Medicaid per-beneficiary funding for the disabled, families with children, and senior citizens. Thirdly, the bill would severely weaken or remove protections for citizens with pre-existing conditions due to the flexibility it provides states to waive not only the ACA's prohibition against higher premiums in response to health status, but also the requirement that insurers cover health benefits such as maternity care, mental health, and substance abuse treatment. Avalere, a health-policy consulting firm based in Washington, conducted an analysis which forecasts that the amount of federal money devoted to Medicaid and private insurance subsidies would shrink by $215 billion between 2020 and 2026.
In Maryland, the state would essentially be punished due to its distinction as a Medicaid expansion state under the current healthcare law. Republican Governor Larry Hogan has expressed his displeasure with the bill citing the negative consequences associated with its implementation, including its $2 billion price tag. Both Senators Graham and Cassidy have expressed that Maryland has received more than its fair share of funding under current law.
As of last Tuesday, September 19, eleven governors have expressed their opposition to this bill. Additionally, several prominent medical organizations have also expressed their disapproval. Dr. James L. Madara, chief executive of the American Medical Association stated that the Graham-Cassidy bill would cause millions to lose health coverage, while also noting decreasing access to affordable, quality care. The Children’s Hospital Association also issued a statement stating that this bill would cut Medicaid funding, the largest provider of health care for children, and weakens important consumer safeguards. The Nurses Association, American College of Physicians, American Academy of Pediatrics, American Academy of Family Physicians, AARP and so many more have added their input into the debate, urging the United States Senate not to pass this legislation.
While the legislation has been defeated, for the time being, this is only the latest in a line of over seventy attempts to repeal the ACA. Portions of Graham-Cassidy are likely to reappear in future iterations of repeal efforts while lawmakers play to partisan agendas instead of safeguarding Americans' best interests. Both the Trump administration as well as legislators in Congress have made it clear that scrapping the ACA remains a priority; so while today is a victory that should be celebrated, Marylanders should remain wary of coming legislative proposals concerning healthcare.