Image courtesy of Indivisible Anchorage from their #KillTheBill Rally on September 20, 2017.
The Graham-Cassidy bill is poised to pass the Senate next week. I want to be clear: we cannot take this threat seriously enough. With their backs against the wall, those who have devoted years to attacking the Affordable Care Act will do everything they can to get this through. And Republicans are very, very close to having the 50 votes they need to pass it.
Massive and Sudden Disruption to Health Care
We’ve only had the text of this bill for a few days and we know Republicans intend to hold the vote before we have a full analysis of its consequences from the Congressional Budget Office (CBO), which scores legislation for its effects and cost to taxpayers.. But here’s what we do know: it radically reshapes our country’s health system. This deserves repeating. We will have had, at most, 17 days to review a bill that fundamentally changes how we get health insurance, as well as no information on its impact on the uninsured, before it is voted on. Every Senator should oppose it for that reason alone. And that’s not to mention that many of its provisions take effect immediately and the rest in just two years.*
Graham-Cassidy affects every person who receives employer sponsored, Medicaid, or Affordable Care Act (ACA) marketplace health insurance. While the latter two are more dramatically altered, this bill lets states end the Essential Health Benefits (EHB) that ensure insurance actually covers the care you need. Because the ACA’s bans on lifetime benefit limits and charging higher premiums for people with pre-existing conditions are tied to EHB, those consumer protections are killed off as well for everyone, including the nearly fifty percent of Americans with employer-sponsored insurance.
In addition to ripping away consumer protections, Graham-Cassidy follows previous ACA repeal bills by making massive cuts to health care. The ACA Medicaid expansion and tax credits are ended and instead block granted to states, with cuts growing over time. Block grants, by their nature, give states insufficient funds to meet their population’s’ needs. Funding for pre-ACA Medicaid is capped per beneficiary. These actions cut federal health spending by $4 trillion (!!!) over 20 years. States that expanded their Medicaid programs would see the largest cuts, as funding is taken from them and given to states that did not expand as a reward for choosing not to provide health care to some of their poorest residents.
End of Certainty for Medicaid
This bill ends Medicaid as a federal health care commitment to those who need care the most. That is, the elderly, the poor, the disabled and children. Right now, this commitment happens in two ways.
- If you are eligible for Medicaid, you get Medicaid.
- Medicaid funding is permanent. Congress does not need act to fund it.
Graham-Cassidy shreds both parts of that commitment. First, with pre-ACA Medicaid capped, states could easily run out of money for health care if they face a spike in health costs due to something like a natural disaster (think Hurricane Harvey or Irma) or disease outbreak (like Zika). Second, the block grant replacing the ACA tax credits and Medicaid expansion abruptly ends in 2027. At that point, Congress must take regular action to keep people covered, or (more likely, as we’ve seen from recent Congressional deadlines), let health care funding to the states completely break down.
We Can Kill This Thing
Since starting in professional health care advocacy in 2012, it sometimes feels like I’ve worked endlessly to defend the ACA. We’ve overcome Supreme Court cases, multiple elections and now, nine months of viable repeal attempts. But, with deadlines looming and the last idea standing coming to a vote, I truly believe we’re facing our most serious threat yet. I know health care opponents don’t back down easily. Yet I’ve also seen constituent voices and stories overcome these years of assaults. I know that we still have a fighting chance to save health care if enough voices speak up. So it’s time to speak up!
This bill is very similar to previous repeal bills rejected by the American public. It doesn’t pass the Kimmel test. It is opposed by a bipartisan group of governors. The American Medical Association opposes it. And repealing the ACA would disproportionately impact communities of color. But all that means nothing unless members of Congress hear from their constituents.
So call your senators, every day. And get your friends and family, especially in states like Maine, Alaska, Ohio, Arizona, Colorado, and West Virginia to call as well. If your senators are already committed to voting against Graham-Cassidy, that’s great. The most effective thing you can do is to use Indivisible’s peer dialing tool to call progressives in key states and get them to call their senators. Because, without your calls, this bill will pass.
*For comparison, the ACA had four years of implementation and passed only after 44 Senate hearings and 13 days of committee markup that included consideration of 130 Republican and Democratic amendments.