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”

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

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.

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

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/

Blue States Face Biggest Cuts Under New Republican Health Care Plan

Which states would gain or lose federal funding in 2026.

https://apnews.com/a533c012173f4d879bee565f6fe1eec2/Study:-Most-states-would-take-a-hit-from-GOP-health-bill

Most states would take a stiff budgetary hit if the latest Senate GOP health care bill becomes law, according to an analysis released Wednesday. That would likely result in more uninsured Americans.

The study by the consulting firm Avalere Health found that the Graham-Cassidy bill would lead to an overall $215 billion cut to states in federal funding for health insurance, through 2026. Reductions would grow over time.

“A reduction in federal subsidies for health insurance is likely to result in more people being uninsured,” said Caroline Pearson, a senior vice president at Avalere, which specializes in health industry research. The study itself did not make estimates of the impact on insurance coverage.

States that voted for President Donald Trump would not be immune from cuts, though deep-blue California and New York face the deepest reductions. West Virginia, a Trump bastion, would see a $1 billion cut from 2020-2026.

The Avalere analysis comes as Senate leaders are rushing a vote on the legislation by the end of the month, before the expiration of special budget rules that allow passage by a simple majority. The findings could take on added importance, because the nonpartisan Congressional Budget Office says it can’t complete a full analysis of the bill by the Sep. 30 vote deadline.

Named for Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, the bill would repeal much of the Obama-era Affordable Care Act and limit future federal funding for Medicaid. That federal-state health insurance program covers more than 70 million low-income people, ranging from newborns to elderly nursing home residents. Compared to current projected levels, Medicaid spending would be reduced by more than $1 trillion, or 12 percent, from 2020-2036, the study found.

The bill would also end Obama’s health insurance subsidies and put money into a big pot that would distributed among the states. Governors and legislatures would have broad leeway on how to spend the money, and could also seek waivers from ACA insurance requirements. Though insurers would still have to cover people with medical problems, in some states they may be able to charge them more.

The Avalere study also found that over 20 years cuts could potentially total more than $4 trillion, but that scenario appears unlikely. It’s based on a literal reading of the bill, under which legal authority for the big pot of money to subsidize coverage would expire after 2026. Typically, Congress renews expiring programs.

Still, the study found more losers than winners. Thirty-four states would see cuts by 2026, while 16 would see increases. Among the losers are several states that were key for President Donald Trump, including Florida, Pennsylvania, Michigan, and Ohio.

Arizona and Alaska would be losers, a detail that could be important. Sens. John McCain, R-Ariz., and Lisa Murkowski, R-Alaska, are seen as undecided on the legislation, and Republican leaders cannot afford many defections.

New Jersey Republican Gov. Chris Christie said Wednesday he is opposed to the Graham-Cassidy bill because of cuts to his state, estimated by Avalere at $10 billion from 2020-2026.

Texas would be the biggest winner, with a $35-billion funding increase by 2026. Georgia, Alabama, Tennessee and Virginia would also see funding gains, as would Wisconsin and Wyoming.

Within states, the analysis found that there could be winners and losers among people at different income levels. Because the GOP bill focuses on providing money to cover poor people and the near-poor, states may decide to reduce support for middle-class people who now receive subsidies under Obama’s law.

Funding for the Avalere report was provided by the Center for American Progress, a liberal think tank. Avalere said it maintained full control over the research and the think tank did not influence the findings.

GOP leaders and the White House are pushing for a vote next week.

http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta

New analysis from Avalere finds that the Graham-Cassidy-Heller-Johnson (GCHJ) bill to repeal and replace the Affordable Care Act (ACA) would lead to a reduction in federal funding to states by $215B through 2026 and more than $4T over a 20-year period.

The proposed legislation would repeal the ACA’s Medicaid expansion, premium tax credits, cost sharing reduction (CSR) payments, individual and employer mandates, and the Basic Health Program (BHP). Instead, the bill would provide states with block grants to fund health insurance coverage in their state. The bill would also change the financing structure for the traditional Medicaid population from an open-ended approach to a fixed per capita cap or block grant approach.

“The Graham-Cassidy bill would significantly reduce funding to states over the long term, particularly for states that have already expanded Medicaid,” said Caroline Pearson, senior vice president at Avalere. “States would have broad flexibility to shape their markets but would have less funding to subsidize coverage for low- and middle-income individuals.”

Avalere’s analysis projects the impact of the bill compared to current law and details the expected cumulative changes in federal funding for each state through 2026, 2027, and 2036.

Who Loses the Most? The Obamacare replacement bill now being considered in the Senate — and scheduled for a vote next week — would reduce federal funding to states for health care by $215 billion through 2026, and those cuts would shoot up to more than $4 trillion through 2036, according to a new analysis by consulting firm Avalere Health. What it means for states: The analysis found that the Graham-Cassidy bill’s approach to Medicaid financing, which would award block grants to states and implement a per capita cap, would reallocate federal money, creating near-term winners and losers. Thirty-four states and the District of Columbia would see funding reductions by 2026, with states that expanded Medicaid under Obamacare being hardest hit. Seven states would lose more than $10 billion each, with California losing $78 billion and New York funding dropping by $45 billion. The block grant funding in the bill expires in 2026, and Congress would have to re-appropriate money for the block grants to continue. “The ability of the Congress to appropriate additional funding is uncertain and could be constrained by the need to offset the cost,” the report says. Without that renewed funding, by 2036 all states would have their funding reduced compared with the current law.

Other winners and losers: “The bill creates a financial incentive for states to direct coverage to very low-income residents near or below the poverty line, potentially at the expense of lower-middle-income individuals who currently receive exchange subsidies,” Avalere’s Chris Sloan said. Separately, analysts at The Commonwealth Fund and the liberal Center for American Progress found that 32 million fewer people would have health coverage after 2026. Why it matters: The Avalere estimate may be the best available given that the non-partisan Congressional Budget Office said it would only be able to provide a partial assessment of the bill’s effects by early next week and would require at least several weeks to evaluate the legislation’s potential effects on the deficit, health insurance coverage levels and premiums. The figures are sure to ramp up criticism of the bill, which would repeal Obamacare’s subsidies for health coverage in the individual market and its expansion of Medicaid benefits for low-income Americans, among other things. Health care groups, a number of governors and even talk show host Jimmy Kimmel have come out against the bill as Senate Republicans have worked to round up the 50 votes required to pass it.