Kaiser Health News on the effort to replace Obamacare

A renewed effort to replace Obamacare is moving forward, but this time there is a shorter time-limit for passage. The proposed Graham-Cassidy bill in the U.S. Senate could pass by September 30th, 2017 with a simple majority of votes, but after October 1st, 2017, the beginning of the new fiscal year, the Republicans would need 60 votes to pass the bill under Senate rules. Based on the unpopularity of previous bills this year to Replace and Repeal Obamacare, this would very likely be an insurmountable obstacle for passage.

Here is an excerpt from an article in Kaiser Health News (KHN), "Last-Ditch Effort By Republicans to Replace ACA: 5 Things You Need to Know" by Julie Rovner, 9/19/17:
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Here are five things to know about the latest GOP bill: 

1. It would repeal most of the structure of the ACA.

The Graham-Cassidy proposal would eliminate the federal insurance exchange, healthcare.gov, along with the subsidies and tax credits that help people with low and moderate incomes — and small businesses — pay for health insurance and associated health costs. It would eliminate penalties for individuals who fail to obtain health insurance and employers who fail to provide it.

It would eliminate the tax on medical devices.

2. It would eliminate many of the popular insurance protections, including those for people with preexisting conditions, in the health law.

Under the proposal, states could “waive” rules in the law requiring insurers to provide a list of specific “essential health benefits” and mandating that premiums be the same for people regardless of their health status. That would once again expose people with preexisting health conditions to unaffordable or unavailable coverage. Republicans have consistently said they wanted to maintain these protections, which polls have shown to be popular among voters.

3. It would fundamentally restructure the Medicaid program.

Medicaid, the joint-federal health program for low-income people, currently covers more than 70 million Americans. The Graham-Cassidy proposal would end the program’s expansion under the ACA and cap funding overall, and it would redistribute the funds that had provided coverage for millions of new Medicaid enrollees. It seeks to equalize payments among states. States that did not expand Medicaid and were getting fewer federal dollars for the program would receive more money and states that did expand would see large cuts, according to the bill’s own sponsors. For example, Oklahoma would see an 88 percent increase from 2020 to 2026, while Massachusetts would see a 10 percent cut.

The proposal would also bar Planned Parenthood from getting any Medicaid funding for family planning and other reproductive health services for one year, the maximum allowed under budget rules governing this bill.

4. It’s getting mixed reviews from the states.

Sponsors of the proposal hoped for significant support from the nation’s governors as a way to help push the bill through. But, so far, the governors who are publicly supporting the measure, including Scott Walker (R-Wis.) and Doug Ducey (R-Ariz.), are being offset by opponents including Chris Sununu (R-N.H.), John Kasich (R-Ohio) and Bill Walker (I-Alaska).

On Tuesday 10 governors — five Democrats, four Republicans and Walker — sent a letterto Senate leaders urging them to pursue a more bipartisan approach. “Only open, bipartisan approaches can achieve true, lasting reforms,” said the letter.

Bill sponsor Cassidy was even taken to task publicly by his own state’s health secretary. Dr. Rebekah Gee, who was appointed by Louisiana’s Democratic governor, wrote that the bill “uniquely and disproportionately hurts Louisiana due to our recent [Medicaid] expansion and high burden of extreme poverty.”

5. The measure would come to the Senate floor with the most truncated process imaginable.

The Senate is working on its Republican-only plans under a process called “budget reconciliation,” which limits floor debate to 20 hours and prohibits a filibuster. In fact, all the time for floor debate was used up in July, when Republicans failed to advance any of several proposed overhaul plans. Senate Majority Leader Mitch McConnell (R-Ky.) could bring the bill back up anytime, but senators would immediately proceed to votes. Specifically, the next order of business would be a process called “vote-a-rama,” where votes on the bill and amendments can continue, in theory, as long as senators can stay awake to call for them.

Several senators, most notably John McCain, who cast the deciding vote to stop the process in July, have called for “regular order,” in which the bill would first be considered in the relevant committee before coming to the floor. The Senate Finance Committee, which Democrats used to write most of the ACA, has scheduled a hearing for next week. But there is not enough time for full committee consideration and a vote before the end of next week.

Meanwhile, the Congressional Budget Office said in a statement Tuesday that it could come up with an analysis by next week that would determine whether the proposal meets the requirements to be considered under the reconciliation process. But it said that more complicated questions like how many people would lose insurance under the proposal or what would happen to insurance premiums could not be answered “for at least several weeks.”

That has outraged Democrats, who are united in opposition to the measure.

“I don’t know how any senator could go home to their constituents and explain why they voted for a major bill with major consequences to so many of their people without having specific answers about how it would impact their state,” said Senate Minority Leader Chuck Schumer (D-N.Y.) on the Senate floor Tuesday.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

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Senate Bill to "Repeal and Replace" Obamacare targets Medicaid expenditures to reduce federal spending

According to the federal Medicaid website, “Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.” As of April 2017, it provides health care coverage to 69 million people.

The purpose of the GOP plan to repeal and replace Obamacare appears be to be to reduce federal expenditures so that Congress can afford to give tax cuts to mostly wealthy citizens. Whether you agree with this assessment or not, the plan will have that effect.

People with disabilities rely on Medicaid for their health care coverage as well as for services they need to live safely in settings appropriate to their needs. Here are excerpts from two articles, that explain proposals to place caps on federal Medicaid spending.

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From Disability Scoop, “Caps Would Pinch Medicaid For Decades To Come” by Michelle Diament, 6/30/17:

“The Republican proposal under consideration in the Senate would convert Medicaid to a per-capita cap system, much like a version of the legislation passed by the House of Representatives in May.

“Currently, Medicaid operates as an entitlement program meaning that services are provided to anyone who meets eligibility requirements. The federal government provides matching grants to states to help cover the cost.

“Under a per-capita cap system, however, the federal government would chip in a fixed amount for each beneficiary regardless of the true cost of their care and leave states to make up any difference.

"The budget office previously projected that the Senate plan would mean $772 billion less in federal Medicaid spending over the next decade, a drop of 26 percent.” 

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“Individuals with disabilities represent just 15 percent of Medicaid beneficiaries, but account for 42 percent of the program’s costs, according to the Kaiser Family Foundation.” [emphasis added]

Read the full article here

From Together by Choice, “The Impact of the Proposed Medicaid Cap on Individuals with Intellectual and Developmental Disabilities” by Scott Mendel, 6/22/17:

“…The details of the bill were released today. It seeks to cap the federal portion of Medicaid at each state’s current per capita Medicaid expenditure. In addition, the federal portion of Medicaid would increase by the rate of inflation as measured by the consumer price index. Historically, the per capita cost of Medicaid has increased at a faster rate than the consumer price index.

"The Effect of a Medicaid Cap on Individuals with Intellectual and Developmental Disabilities

“Capping the federal portion of Medicaid will have a serious detrimental effect on individuals with intellectual and developmental disabilities. Individuals with intellectual disabilities suffer from a wide range of disabilities, from autism to down syndrome to cerebral palsy. The common feature is that individuals with intellectual disabilities do not function at an adult level. Many function at the level of a three or five year old and are in need of 24 hour care. For these individuals, Medicaid is the only option available to them to cover the cost of the intensive 24 hour care they need. Most individuals with intellectual disabilities will never have full-time employment, will never receive health insurance coverage through a job, and do not have income sufficient to purchase private health insurance. They are totally reliant on Medicaid.

“Capping the federal portion of Medicaid means that the portion of the cost of meeting the needs of individuals with intellectual disabilities that will be picked up by the federal government will shrink…[costs] will be shifted to the states or to the individuals. Neither can afford to pick up the portion that the federal government will no longer cover. In many states, services for individuals with intellectual disabilities are already under funded…These most vulnerable members of our society have nowhere else to turn to receive the services they need."


Read more  to see the “Call to Action” from Together for Choice with specific recommendations on how to contact Senators to voice your opinion on how these proposals will affect your disabled family member.

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More resources from the Kaiser Family Foundation, Medicaid's Future

The GOP race to advance repeal-and-replace of Obamacare by July 4th, 2017

If you thought the Republican plan to repeal-and-replace Obamacare was dead on arrival in the U.S. Senate, think again. The House of Representatives passed an extremely harsh and unpopular bill last May that has been heavily criticized. Nevertheless, Senate plans to usher through healthcare reform are underway.

According to Politico, “McConnell whips Senate GOP back in line in Obamacare repeal” by Burgess Everett, Jennifer Haberkorn, and Adam Cancryn, 6/6/2017, Republicans have emerged from meetings this week with increasing optimism that they can pass a bill by the end of June, before the July 4th recess. If and when it is voted on, you may not know what is in it and there will be no public hearings on the bill. There is no legislation written yet for you to look at, but McConnell (R-KY) says that “failure is not an option”. 

Or as Senator Pat Roberts (R-Kan.) puts it,

“We’re in the back seat with Thelma and Louise and we need to get out of the car. So details matter, but we need to get out of the car. That was the pre-eminent message…The upshot is: This has to happen.”

What will happen? No one can say exactly, but here is what might happen:

“Senate Republicans expect their bill to be more generous than the House-passed measure in almost every way: A longer runway for ending the Medicaid expansion, more money for insurance market stabilization to lower premiums and beefed up tax credits for Americans of lower income, senators said. But no decisions have been made on some key policy questions, including on handling Medicaid. Still, it’s almost impossible for the public to assess what precisely Republicans are working on — the GOP is writing the bill behind closed doors and with no committee hearings.” [emphasis added]

If a bill is passed, it will have to be done through Reconciliation. According to the Tax Policy Center, “Congressional budget committees use the reconciliation process to ensure tax laws and mandatory spending programs are revised according to the budget resolution’s revenue and spending targets. The reconciliation process is a way to fast-track revenue and spending legislation into becoming law.” For a fuller explanation, see this from the Tax Policy Center.

The bill will have to go through a number of steps described in the article, though none of them include hearings or sober consideration of a huge change to our health care system with multiple effects on our economy and health.