The growing Senate interest in the Graham-Cassidy-Heller-Johnson bill last week has derailed bipartisan efforts by the Senate Finance Committee to reauthorize the Children’s Health Insurance Program (CHIP). The bipartisan leadership of the Senate Health, Education, Labor, and Pensions Committee has also ended efforts to stabilize the health insurance market places by extending the programs that help make health insurance affordable for people and making other small changes to the Affordable Care Act. These two efforts are critical to maintaining affordable health insurance for children and people in the individual health insurance market and The Arc urges Congress to address these critical issues.
Over the weekend, the Graham-Cassidy-Heller-Johnson proposal was revised. The new version appears to make adjustments to the funding provisions designed to benefit certain states. It also allows more state flexibility to waive requirements in the law such the essential health benefits, prohibiting discrimination based on disability, age, and other factors, covering preventive services without cost-sharing, charging people with pre-existing conditions higher premiums, and other provisions. It is unlikely that the bill will be scored by the Congressional Budget Office in time for a vote this week. The new version does not appear to alter the Medicaid per capita cap provisions which cuts and caps the traditional Medicaid program. The Arc continues to oppose this proposal and is deeply concerned about the impact it will have on people with disabilities who rely on the Medicaid program for access to health care and long term supports and services.
Today, September 25, at 2:00 PM EDT, the Senate Finance Committee is holding a hearing to consider the Graham-Cassidy-Heller-Johnson Proposal. Witnesses will include: Senator Lindsey Graham (R-SC); Senator Bill Cassidy (R-LA); former Senator Rick Santorum (R-PA); Dennis G. Smith, Senior Advisory for Medicaid and Health Care Reform, Arkansas Department of Human Services; Teresa Miller, Acting Secretary, Department of Human Services, Commonwealth of Pennsylvania; Cindy Mann, Former Deputy Administrator and Director of the Center for Medicaid and CHIP Services, Centers for Medicare & Medicaid Services, United States Department of Health and Human Services; and Dick Woodruff, Senior Vice President, Federal Advocacy, American Cancer Society Cancer Action Network. The is the first hearing on the legislation. Visit the Committee web site for more information or to access the hearing live today. Read The Arc’s written testimony here.
While the Congressional Budget Office announced it will not have time to analyze the health care coverage impact of the bill before the September 30 deadline, it is expected to release a report this week on the fiscal implications of the bill. Avalere released an analysis showing that there will be a total reduction of $215 billion between 2020 and 2026 compared to current law with all but 16 states seeing funding reduced. Kaiser Family Foundation estimates there will be a reduction of $160 billion compared to current law with all but 15 states losing funding. Overtime the overall cuts to the Medicaid program would total over $4 trillion through 2036. Cuts to the traditional Medicaid program would be more than $1 trillion over two decades.
The Senate has until September 30 to pass the Graham-Cassidy-Heller-Johnson bill with a simple majority vote. After that date, the legislation will require 60 votes to pass, unless Congress passes a budget resolution for fiscal year 2018 that contains reconciliation instructions intended to address health care. Last week, Majority Leader McConnell (R-KY) said that he intended to have a Senate vote this week. The vote is expected to be very close. If successful, expectations are that the bill would go immediately to the House floor for passage and then to the President for signature. This would be a devastating blow to people with disabilities and their families who have worked so hard this year to prevent block grants and per capita caps from destroying the Medicaid program – a program which provides basic health care and long term supports which make it possible for millions of people to live as independently as possible in their communities. The Washington Post printed a letter to the editor from The Arc’s Marty Ford expressing these concerns.
Today is the national call-in day to mobilize disability advocates to stop the Graham-Cassidy health care bill. We must act again to protect Medicaid and defeat this dangerous legislation. We need you to call today to tell your Senator to oppose this bill.
On September 13, Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI) introduced their most recent version of legislation to replace the Affordable Care Act and cap Medicaid. The bill eliminates the Affordable Care Act’s premium tax credits, cost-sharing subsidies, and Medicaid expansion and replaces them with a block grant. The block grant represents a 17% cut in funding by 2026 compared to current law. This block grant will only be funded until December 31, 2026. Like previous proposals, this bill also allows states to weaken consumer protections such as the ban on pre-existing condition exclusions and the essential health benefits requirement. Finally, it includes the per capita caps on the traditional Medicaid program as seen in the Better Care Reconciliation Act. The Congressional Budget Office is developing a cost estimate on the bill in preparation for possible Senate floor action next week.
This summer – advocates helped defeat a dangerous health care bill that would have included massive cuts to Medicaid. We need your help to reinforce this message once again, as proposals such as the Graham, Cassidy, Heller, and Johnson bill include threats that are just as damaging to people with disabilities and their families.
The newest version of the Graham-Cassidy-Heller-Johnson Health Care bill (see article below) may be on a fast track for a Senate vote before the authority for passage by a simple majority under the budget reconciliation instructions expires on September 30. Reports from the Senate indicate that Senators Graham (R-SC) and Cassidy (R-LA) have nearly the 50 votes needed for the bill to trigger a tie-breaking vote by Vice-President Mike Pence for passage. If successful, expectations are that the bill would go immediately to the House floor for passage and then to the President for signature. This would be a devastating blow to people with disabilities and their families who have worked so hard this year to prevent block grants and per capita caps from destroying the Medicaid program – a program which provides basic health care and long term supports which make it possible for millions of people to live as independently as possible in their home communities.
The Administration continues to urge the Senate to return to efforts to repeal and replace the Affordable Care Act (ACA). Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) are promoting a bill they cosponsored which includes a Medicaid per capita cap and block grant of the Medicaid expansion funding and the market place subsidies. While their proposal may be revised, The Arc is especially concerned about the proposed cut and caps to Medicaid. Based on a recent opinion by the Senate Parliamentarian, the Senate can return to debate on health care any time before the special budget reconciliation rules for fiscal year 2017 expire on September 30; maintaining the protection of needing only a simple majority to pass the legislation until that date.
The Senate is involved in a number of efforts to address health care issues in a bipartisan manner. The Senate Health Education Labor and Pensions (HELP) Committee, under the leadership of Chairman Lamar Alexander (R-TN) began holding four hearings last week and will continue this week on ideas to stabilize the individual insurance marketplaces. His intent is to reach bi-partisan agreement on a narrow time limited proposal that could be passed by the end of the month. While legislation has not been drafted, the Committee is considering ensuring that funding is appropriated for cost sharing reduction payments that help low income people afford insurance and changes to the existing waiver program that allows states to create marketplaces that do not meet the requirements of the ACA.
The Senate Finance Committee held a hearing on the Children’s Health Insurance Program (CHIP) for which federal funding will expire this year. CHIP was created in 1997 and has strong bi-partisan support. States can create a separate program for children, expand Medicaid, or some combination of both. CHIP has been very successful at expanding insurance coverage for children. The Arc urges Congress to renew funding for CHIP as soon as possible so that states can continue their programs without interruption.
This issue of Capitol Insider is devoted to a review of the Senate’s consideration of the effort to repeal/replace the Affordable Care Act.
Health Care; Medicaid; Long Term Supports and Services –
Repeal of The Affordable Care Act Fails in The Senate: A Week In Review
Last week was a critically important week for people with intellectual and developmental disabilities (I/DD) and their families, indeed, for all people with disabilities. The result was what The Arc and its members had worked hard for over the last nine months. However, the week of Senate legislative action played out like an intense roller-coaster ride and the results were not predictable until the final vote in the early hours of Friday, July 28.
As the week began, Senate Majority Leader Mitch McConnell (R-KY) planned a series of Senate floor votes on the efforts to repeal or replace the Affordable Care Act (ACA) and make fundamental structural changes to the Medicaid program. It was expected that the votes could be close, with 52 Republicans in the Senate and 48 Members of the Democratic caucus (including the two Independents who vote with the Democrats). Republicans would need at least 50 votes in support of any action or legislation to proceed – Vice President Mike Pence would be called upon to break any tie votes. Several Republicans had already expressed serious reservations about various provisions of the bills under consideration.
Monday, July 24:
Senator John McCain (R-AZ) made the surprise announcement that he would be returning to Washington DC, despite his recent brain surgery and cancer diagnosis.
Tuesday, July 25:
The Senate voted on the “Motion to Proceed” on debate of the repeal of the ACA. This is a procedural voted needed to begin debate on the bill. With Vice President Pence casting the vote to break the tie, the motion passed the Senate 51-50. Senator Susan Collins (R-ME), Senator Lisa Murkowski (R-AK) and all Democratic Caucus Senators voted no.
Following the successful motion to proceed, the Senate voted to replace the House-passed text with it’s own text, a version of the Better Care Reconciliation Act
- This bill included an amendment by Senator Ted Cruz (R-TX) that would allow insurance companies to sell plans that do not comply with current insurance regulations as long as some of their plans do comply. Insurers could drop maternity care, mental-health treatment, and other benefits if they sell at least one health plan that includes them.
- This bill also included an amendment by Senator Rob Portman (R-OH) which would provide $100 billion to help people cover their deductibles and other expenses when they lost Medicaid coverage, and it would let states set up such arrangements without needing special federal approval.
Due to an opinion by the Senate parliamentarian, this bill would have required 60 votes to pass. With 57 “no” votes and 43 “yes” votes, the BCRA did not pass. The no votes were cast by Senators Murkowski (R-AK), Collins (R-ME), Heller (R-NV), Corker (R-TN), Cotton (R-AR), Graham (R-SC), Lee (R-UT), Moran (R-KS), Paul (R-KY), and the whole Democratic caucus.
Wednesday, July 26:
Following the defeat of the BCRA, the Senate held a vote on the Obamacare Repeal Reconciliation Act, a “repeal and delay” bill. This bill failed with 55 no votes and 45 yes votes. The no votes were cast by Senators Murkowski (R-AK), Collins (R-ME), Heller (R-NV), Alexander (R-TN), Capito (R-WV), Protman (R-OH), and the whole Democratic caucus.
Thursday, July 27 into Friday, July 28:
At around 10:30 pm Thursday, Majority Leader McConnell introduced the language of what had been called the “skinny repeal.” Officially titled the Healthcare Freedom Act, this bill would have struck down a few provisions of the ACA, including the individual mandate, the employer mandate, and the medical device tax. The Congressional Budget Office (CBO) reported that the Health Care Freedom Act would cause 16 million people to lose insurance and individual market premiums to go up by 20 percent. The insurance coverage provisions would have also resulted in a loss of $235 billion in the Medicaid program over 10 years.
At about 1:30 am Friday morning, the final vote on the Senate series of repeal efforts was completed with a defeat of the Health Care Freedom Act by a vote of 51-49, with Senators Collins (R-ME), Murkowski (R-AK), McCain (R-AZ), and the whole Democratic caucus voting against the bill.
What We Narrowly Avoided:
If the Health Care Freedom Act had passed the Senate, a joint House-Senate conference committee would have considered the Health Care Freedom Act and the House-passed American Health Care Act (AHCA) to develop a bill to be considered by both the House and Senate. Through the AHCA, per capita caps and over $830 billion in cuts to Medicaid over a decade would have been part of the consideration by the conference committee. The House also could have simply passed the “skinny repeal” without going to conference. Both of these scenarios were of major concern to many Senators and were a factor in decisions to oppose the bill.
The Arc of the United States released statement on the failure of the effort to repeal the Affordable Care Act (ACA) and make fundamental structural changes to the Medicaid program which can be seen here.
Several Senators have already announced efforts to work together to produce legislation to address issues left in limbo by the failure of the House and Senate efforts. Some are looking to work in a bipartisan manner to ensure that the affordability provisions in the ACA remain funded and to address health insurance market place issues. House Minority Leader Nancy Pelosi (D-CA) wrote to House Speaker Paul Ryan (R-WI) and Senate Majority Leader McConnell indicating that “we have a responsibility to pivot from the current debate on health care and to work in a bipartisan fashion to lower costs, improve quality, and expand coverage, while strengthening the stability of the marketplaces.” Senate Minority Leader Chuck Schumer (D-NY) has similarly expressed a desire to work in a bipartisan manner to resolve the identified problems of the ACA.
As Congress continues to debate health care policy, The Arc and other disability advocates expect to remain fully engaged. In the meantime, sincere thanks and acknowledgement are due to the extraordinary efforts of people with disabilities and their families, friends, supporters, and providers throughout the country who shared their life experiences and made their voices heard on the issues of affordable, accessible health care and the critical importance of home and community based services and health care through Medicaid. This work over the last nine months clearly affected elected officials. It was a powerful combined effort and it helped force the defeat of misguided attempts to repeal the ACA and cut and cap the Medicaid program.
Last week, the House and Senate advanced the most important spending bills for disability programs – Labor, Health and Human Services, Education, and Related Agencies (L-HHS-ED). Both would maintain overall sequestration funding levels and include a number of substantial cuts to programs, earning the promise of a veto by President Obama.
L-HHS-ED – Senate – The Senate bill passed the Appropriations Committee along party lines on June 25. The bill’s discretionary funding level is $3.6 billion below the Fiscal Year (FY) 2015 enacted level and includes numerous policy riders that would limit the activities of federal agencies. Several federal agencies would receive significant cuts and a small number would receive increases. Notable examples include:
- LABOR: Includes a 4% cut for Workforce Innovation and Opportunity Act (WIOA) programs.
- HHS: Includes a 28% cut for the Centers for Medicare and Medicaid Services (CMS) program management that would restrict the agency’s ability to operate the Affordable Care Act programs, Medicare, and Medicaid.
- EDUCATION: Includes a $1.1 billion cut for the Department. However, the IDEA state grant program would receive a nearly 1% increase.
L-HHS – House – The House bill passed the full Appropriations Committee along party lines on June 24 and would provide discretionary funding at $3.7 billion below the FY 2015 level. The bill also includes numerous policy riders. The House bill included spending cuts and select increases similar to those in the Senate bill:
- LABOR: Includes a 2% cut for the Employment and Training Administration that helps to implement Workforce Innovation and Opportunity Act (WIOA) programs.
- HHS: Includes a $344 million cut for CMS.
- EDUCATION: Includes a cut of $2.8 billion to the Department of Education. However, this includes an increase of $12 billion (4.3%) for IDEA grants to states.
See the funding levels for specific disability related programs.