ADEA Washington Update

Republicans Reassess Options After Failure to Repeal ACA

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Republican Senators made another last-ditch effort to pass an Affordable Care Act (ACA) repeal and replacement bill in the form of an amendment to H.R. 1628, the American Health Care Act, which was passed earlier this year in the House of Representatives. The amendment, known as Graham-Cassidy after its primary sponsors, Sens. Lindsey Graham (R-SC) and Bill Cassidy, M.D. (R-LA), followed a failed effort to pass another repeal and replacement measure two months earlier. 

Graham-Cassidy would have essentially dismantled most ACA provisions and converted ACA funding into block grants to the states, which could then determine how to spend that money. It would also have gutted the ACA’s insurance subsidies, mandatory coverage requirements for all Americans and large businesses and the minimum requirements for health care plans sold in the various state health exchanges.

Powerful interest groups like the AARP and the American Hospital Association expressed their opposition for different reasons, as did a bipartisan group of 10 governors t against the bill. 

Senator John McCain (R-AZ), who was the deciding “no” vote in the last GOP attempt to dismantle the ACA, announced Friday, Sept. 22, that he could not “in good conscience” vote for Graham-Cassidy, despite his close relationship with Senator Lindsey Graham (R-SC). The Senate Finance Committee held one hearing on the Graham-Cassidy amendment, with testimony by the primary sponsors. During the hearing, protesters filled the nearby halls chanting in opposition to the bill. 

On Sept. 25, the Congressional Budget Office (CBO) released its preliminary analysis of the Graham-Cassidy amendment. CBO states that Graham-Cassidy would reduce the budget deficit by at least $133 billion, but millions of people would lose comprehensive coverage, backing up outside analysis of the bill by the Brookings Institute and others that said at least 30 million Americans would lose coverage. An S&P analysis found that Graham-Cassidy would result in 580,000 lost jobs and $240 billion in lost economic activity by 2027, guaranteeing that the GDP growth would remain stuck at around 2% at best in the next decade.

The same day that CBO gave its analysis, Sen. Collins released a lengthy statement on why she would vote no on the Graham-Cassidy amendment if it came to the Senate floor. Having lost Senator Collins, the amendment stalled and was pulled from consideration by Senate leadership lacking the votes to move forward.

ACA supporters are staying engaged, as many Republicans have pledged to continue their efforts to repeal the law regardless of the now needing a super-majority to dismantle the ACA. Beyond legislation, Republicans are said to be examining how to weaken the ACA through regulations. 

The Centers for Medicare and Medicaid Services (CMS) announced it would spend $10 million on promotional activities for new or returning ACA enrollees, a drop of 90% from the $100 million spent during last year’s open enrollment period. Most of this year’s funds will be spent on advertising and outreach aimed at letting people know the dates of the 2018 enrollment period, which begins Nov. 1 and ends Dec. 15. The six-week period is half as long as last year’s enrollment period and ends six weeks earlier. CMS also stated,it plans to make performance-based adjustments in Navigator funding this year to “ensure accountability.”

The resignation of Health and Humans Services Secretary Tom Price, M.D., creates more uncertainity as to the Administration’s future plans for health care reform. Speculation about who will permanently succeed Dr. Price continues, as his temporary replacement Don Wright, M.D., M.P.H.,  gets to work on managing the over 53,000 agency personnel at HHS.

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