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What every major health group has said about Graham-Cassidy

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https://www.vox.com/policy-and-politics/2017/9/21/16340066/health-group-statements-graham-cassidy-bill

 

Senate Republicans are teeing up what appears to be one final vote on Obamacare repeal next week.

Notably, health care groups — from the American Medical Association to health insurance companies like Blue Cross Blue Shield — are beginning to release statements about the bill sponsored by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-SC). Avalere Health, a health care consulting firm, predicted Wednesday that the bill would reduce federal funding to states by $215 billion through 2026 and by more than $4 trillion over a 20-year period.

Put simply, the bill would redistribute money allotted for Obamacare and Medicaid expansion to states that have resisted Obamacare implementation. Thirty-four states would lose funding they previously received from the federal government for health care, according to Avalere.

Republicans are rushing to pass this bill before the September 30 expiration of its special budget reconciliation status, and the Congressional Budget Office will not have time to give a full report on how many Americans would lose coverage under the bill.

But several health groups have reviews of the bill anyway — and so far, none of them are positive.

Here’s a roundup of what leading health organizations have said about the Graham-Cassidy Bill:

American Medical Association

“…the Graham-Cassidy Amendment fails to match this vision and violates the precept of “first do no harm.” 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.”

American Academy of Pediatrics

“I [Fernando Stein, president, American Academy of Pediatrics] must speak out against this dangerous, ill-conceived policy on behalf of our 66,000 pediatrician, pediatric surgical specialist and pediatric medical sub-specialist members, and stop it from advancing.

“This bill may be disguised under a different name, but it contains the same dangerous policies as the legislation that failed to advance out of the Senate earlier this summer. In fact, Graham-Cassidy goes even further in its attacks on Medicaid.”

AARP

“Overall, the Graham/Cassidy/Heller/Johnson bill would increase health care costs for older Americans with an age tax, decrease coverage, and undermine preexisting condition protections. In addition, this bill would jeopardize the ability of older Americans and people with disabilities to stay in their own homes as they age and threaten coverage for individuals in nursing homes.”

Blue Cross Blue Shield Association

“The [Graham-Cassidy] 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.”

Planned Parenthood

“The Graham-Cassidy bill is a serious threat to the health care of millions of Americans. This bill is the worst Obamacare repeal bill yet: Millions of Planned Parenthood patients could lose their health care if the Graham-Cassidy bill were to pass — millions more would lose their coverage through Medicaid, and could lose essentials like maternity care and coverage for prescription drugs. Policy on women’s health care should not be written by a small group of male politicians behind closed doors. Enough is enough. With this latest version of Trumpcare, Americans will pay more and get less, but women will pay the biggest price of all.”

Kaiser Permanente

“At Kaiser Permanente, we believe that changes to our nation’s health care laws should increase access to high-quality, affordable care and coverage for as many people as possible. The Graham-Cassidy bill does not meet any of those tests.

“The block grant proposal in the bill would erode coverage of needed medical services and pose major issues for state budgets. Repealing the individual mandate without alternative incentives for enrollment will lead to fewer people enrolled and higher premiums.”

America’s Health Insurance Plans

“[The Graham-Cassidy-Heller-Johnson proposal] 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.”

American Heart Association and 16 other patient and provider groups

“Affordable, adequate care is vital to the patients we represent. This legislation fails to provide Americans with what they need to maintain their health. In fact, much of the proposal just repackages the problematic provisions of the Better Care Reconciliation Act (BCRA), which we opposed. Fortunately, the BCRA was voted down by Congress earlier this year.”

Association of American Medical Colleges

“During the long debate regarding health care reform, the nation’s medical schools and teaching hospitals have continually advocated for a number of key principles as fundamental cornerstones of any successful health care system. These principles include offering high-quality, affordable health insurance to all; preserving and fortifying the safety net through Medicaid and other policies; and encouraging innovation in the delivery system, among others.

“The current proposal does not meet these principles and will almost surely lead to dramatic increases in the number of uninsured patients nationwide and put important existing patient protections at risk. Additionally, a proposal like this—a complete overhaul of the health care system—should be fully and adequately examined by the Congressional Budget Office before it is brought to a vote.”

HIV Medicine Association

Senators Cassidy and Graham’s proposal, like the ACA repeal proposals before it, would put the health and lives of tens of thousands of persons living with HIV at risk. We appeal once more to our senators to stop once and for all efforts to repeal the ACA and turn to improving rather than dismantling critical health coverage reforms.

The Alzheimer’s Association and Alzheimer’s Impact Movement

“The proposed changes to Medicaid outlined in the Graham-Cassidy Amendment could have a drastic impact on this vulnerable population given that more than 1 in 4 seniors with Alzheimer’s and other dementias are currently on Medicaid. The Alzheimer’s Association and AIM are also alarmed by the potential impact of this legislation on Americans living with pre-existing conditions, including the 200,000 Americans living with younger-onset Alzheimer’s.”

American Cancer Society

“Our analysis indicates the bill could allow insurers to:

  • Charge cancer patients and survivors far higher rates to make coverage unaffordable
  • Eliminate coverage for cancer care in their health plans
  • Re-institute arbitrary caps on annual and lifetime coverage”

Analysis: Senate’s health care cuts could top $4 trillion

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https://www.axios.com/analysis-senates-health-care-cuts-could-total-more-than-4-trillion-2487504157.html

Change in federal funding under Graham-Cassidy compared to current law, 2020-2026

Image result for Analysis: Senate's health care cuts could top $4 trillion

The Senate’s health-care overhaul would quickly pull $215 billion in federal funding out of the health care system, and those cuts could later grow as high as $4 trillion, according to a new analysis from the consulting firm Avalere Health.

Why it matters: Avalere is a respected and independent voice, and because the Congressional Budget Office won’t have time to completely evaluate the bill’s effects before a vote, this will likely be one of the best estimates we have available.

What Avalere found: The bill, sponsored by Sens. Lindsey Graham and Bill Cassidy, would redistribute federal health care dollars while also shrinking the overall pot. Avalere’s analysis looks at how the cuts would grow over time:

  • 2020-2026: Total federal spending would shrink by $215 billion; 34 states and Washington, D.C. would lose money, compared with the status quo, while seven states would get more.
  • By 2027, the total national cut would climb to $489 billion.
  • 2027-2036: Federal spending would shrink by more than $4 trillion, and every state would be getting less than they’re on track to get under current law.

Key caveat: The Graham-Cassidy bill would roll federal funding for the Affordable Care Act’s premium subsidies and Medicaid expansion into a single pool, then convert it into block grants to the states. Those grants are set to expire in 2026. Avalere analyzed the bill as written — with that money disappearing completely — but the bill’s supporters say Congress would obviously step in to authorize a new round of grants.

What Graham-Cassidy means for pre-existing conditions

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https://www.axios.com/what-graham-cassidy-really-means-for-pre-existing-conditions-2487720743.html

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Jimmy Kimmel’s takedown of Sen. Bill Cassidy, and Cassidy’s response, ripped open the question of whether the GOP’s latest health reform bill protects people with pre-existing conditions. Cassidy and co-sponsor Sen. Lindsey Graham insist it does — as did President Trump in a tweet last night — but experts say that’s not really the case.

The bottom line: The bill’s funding cuts could pressure states — even blue states — to waive protections for sick people, as a way to keep premium increases in check. Older, sicker people in every state could end up paying more as states try to make up for a funding shortfall.

What the bill does: The bill wouldn’t repeal the Affordable Care Act’s rules about pre-existing conditions. But they might end up only existing on paper, the Kaiser Family Foundation’s Larry Levitt said.

Graham-Cassidy doesn’t let states waive the part of the Affordable Care Act that says insurers have to cover sick people. But it does allow states to opt out of several other ACA rules that can cause people with pre-existing conditions to pay more for their health care. Those provisions include:

  • The ban on charging sick people higher premiums than healthy people.
  • The requirement that insurers cover “essential health benefits,” including prescription drugs. People who need expensive drugs might not have access to a plan that covers those drugs, requiring them to pay out of pocket.
    • Services that aren’t “essential” benefits aren’t subject to the ACA’s ban on annual and lifetime limits.
  • The bill also would also loosen rules about how much insurers can raise their premiums because of a customer’s age. (Older people are more likely to have pre-existing conditions.)

What supporters will argue: The bill requires states to say how their waivers would provide affordable and accessible coverage for people with pre-existing conditions. But there’s no definition of what that means, and there’s also no enforcement mechanism.

  • “The bottom line is these protections are much more at risk under this bill than they are now,” said Cori Uccello, a senior health fellow with the American Academy of Actuaries.

Another level: At least theoretically, because the bill gives states so much control, a more liberal state like California might choose to preserve more of the ACA’s regulations than, say, Alabama. But this bill would radically redistribute federal health care funding — generally away from blue and purple states and toward red states. Those cuts could back blue states into seeking more expansive waivers.

  • Caroline Pearson of Avalere told me: “if you have less money, you either cover fewer people, or you cover the same amount of people with less generous coverage. People with pre existing conditions are very reliant on having access to affordable insurance and need insurance that is comprehensive. So if a bill reduces the availability of comprehensive insurance, people with chronic conditions are going to be disproportionately harmed.”

 

Kaiser Permanente CEO Bernard J. Tyson ‘disappointed’ by Graham-Cassidy bill

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http://www.beckershospitalreview.com/hospital-management-administration/kaiser-permanente-ceo-bernard-j-tyson-disappointed-by-graham-cassidy-bill.html

Image result for Kaiser Permanente CEO Bernard J. Tyson 'disappointed' by Graham-Cassidy bill

Oakland, Calif.-based Kaiser Permanente Chairman and CEO Bernard J. Tyson voiced his concerns about recent efforts to repeal and replace the ACA Sept. 20, arguing the proposed legislation does not increase access to high-quality care and affordable coverage.

In a recent blog post, Mr. Tyson relayed his opposition to a recent bill proposed by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., which the Senate reportedly aims to vote on next week.

He specifically cited his disappointment for the bill’s block grant proposal and the proposed repeal of the individual mandate, which he wrote “would erode coverage of needed medical services and pose major issues for state budgets. Repealing the individual mandate without alternative incentives for enrollment will lead to fewer people enrolled and higher premiums.”

“Only a few changes are needed to stabilize the ACA for the millions who are dependent upon the law for their care and coverage,” Mr. Tyson wrote. “Moving forward, we strongly encourage policymakers to focus on the 30 million Americans currently without coverage as the priority for any additional proposals around health reform, and to ensure that any proposals maintain or expand coverage, provide incentives for high quality, and tackle affordability.”

https://share.kaiserpermanente.org/article/chairman-ceo-bernard-j-tyson-graham-cassidy-health-reform-bill/

 

Insurers Come Out Swinging Against New Republican Health Care Bill

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Blue States Face Biggest Cuts Under New Republican Health Care Plan

Which states would gain or lose federal funding in 2026.

The health insurance industry, after cautiously watching Republican health care efforts for months, came out forcefully on Wednesday against the Senate’s latest bill to repeal the Affordable Care Act, suggesting that its state-by-state block grants could create health care chaos in the short term and a Balkanized, uncertain insurance market.

In the face of the industry opposition, Senate Republican leaders nevertheless said they would push for a showdown vote next week on the legislation, drafted by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana.

That puts Republican senators in a squeeze, especially those whose states would lose money under a complicated formula in the bill. Generally, it would shift federal funds away from states that have been successful in expanding coverage to states where Republican leaders refused to expand Medicaid or encourage enrollment.

Republican senators from Alaska, Arizona, Arkansas, Colorado, Ohio and West Virginia will all have to decide whether to heed the pleas of consumers who like the current health law — or yield to the will of Republican leaders, donors and voters who demand an end to the Affordable Care Act.

That has put the spotlight not only on the three Republicans who killed the repeal drive in July — Lisa Murkowski of Alaska, John McCain of Arizona and Susan Collins of Maine — but also on those who have been reluctantly supportive, such as Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Rob Portman of Ohio.

Senate Republicans are already under pressure from 11 governors — including five fellow Republicans and a pivotal Alaskan independent — who this week urged the Senate to reject the last-ditch repeal effort.

The two major trade groups for insurers, the Blue Cross Blue Shield Association and America’s Health Insurance Plans, announced their opposition on Wednesday to the Graham-Cassidy bill. They joined other groups fighting the bill, such as the American Medical Association, the American Hospital Association, AARP and the lobbying arm of the American Cancer Society.

“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,’’ said Scott P. Serota, the president and chief executive of the Blue Cross Blue Shield Association. “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.”

America’s Health Insurance Plans was even more pointed. The legislation could hurt patients by “further destabilizing the individual market” and could potentially allow “government-controlled single payer health care to grow,” said Marilyn B. Tavenner, the president and chief executive of the association. Without controls, some states could simply eliminate private insurance, she warned.

Insurers had been reluctant to speak out against the Republicans’ previous proposals in hopes that the White House and Congress would agree to stabilize insurance markets by providing critical funding for subsidies aimed at low-income Americans. But with hopes of securing that money before they finalize their rates virtually extinguished, insurers have less to lose by coming out against the proposal.

And many within the industry are worried that the next two years will be chaotic, with little support for the current market while states scramble to come up with a new way for individuals to buy policies.

“It’s just basically injecting chaos in 50 state capitals for the next two years,” said Sabrina Corlette, a research professor at Georgetown University.

At this point, Republicans have not secured the 50 votes they would need to pass the bill, with help from Vice President Mike Pence to break a tie. But President Trump, in New York for meetings with world leaders at the United Nations, said he thought the health care bill had “a very good chance’’ of passing.

It has “tremendous support from Republicans — certainly we’re at 47 or 48 already,’’ he said, and “a lot of others are looking at it very positively.’’

“A great Bill,” Mr. Trump concluded on Twitter later Wednesday.

The latest Republican drive to repeal the Affordable Care Act has created painful choices for Republican senators from states that stand to lose money under the legislation.

The bill would eliminate penalties for people who go without insurance, and it would funnel federal funds to states in the form of block grants for health care or coverage. States could decide how to spend the money, which is now being used for the expansion of Medicaid and for subsidies to help low- and middle-income people buy private insurance.

State officials were racing to try to figure out the impact, looking to experts to help them do the calculations.

“States such as Alaska, Connecticut, Delaware, New Hampshire, New Mexico, New York, Oregon, Vermont and Washington would see reductions of 25 percent or more over the 2020 to 2026 period,” compared with what they would receive under current law, said a monograph issued on Wednesday by Manatt Health, a unit of Manatt, Phelps & Phillips, a national law firm that advises many states on health care issues.

Among the Republicans agonizing over how to vote is Ms. Murkowski, who has said the bill’s effect on her state will be her paramount consideration.

The authors of the new repeal bill, Mr. Graham and Mr. Cassidy, say decisions about health care are best made at the local level.

Mr. McCain is a close friend of Mr. Graham, but is still studying the bill and has not said how he would vote.

The other Republican senator from Arizona, Jeff Flake, had no such hesitation. “Given the choice between Arizona or Washington deciding how federal health care dollars are spent in the state,’’ he said, “I’ll take Arizona every day of the week.’’

The Manatt study said Arizona would lose money under the bill, and a study by Avalere, a health policy consulting company, reached a similar conclusion. Both studies indicated that Tennessee would gain money.

Senator Bob Corker, Republican of Tennessee, said he liked the latest repeal bill. “I’d be ecstatic if we could finally make something happen on health care’’ by passing it, he said, adding: “I’m a states’ rights kind of guy. Our state has been well run for a long time. To know that our state would have the flexibility to carry out the program with more money than it now has could be a real win for us.’’

The studies by Manatt and Avalere suggest that West Virginia would lose money under the bill. Ms. Capito “is still evaluating the proposal,” said her spokeswoman, Ashley Berrang.

But the state’s senior senator, Joe Manchin III, a Democrat, said, “The numbers do not work at all for West Virginia, with an older, sicker population and an opioid addiction problem.”

“As a former governor, I like the concept of block grants because they give you flexibility,” Mr. Manchin said. “But the cuts are deeper than the needs we have, and our needs are greater than the money we would have under the bill.”