On October 12, President Trump issued an executive order aimed at weakening protections in the Affordable Care Act (ACA). The order instructs agencies to identify and consider ways in which plans can be offered that do not meet the ACA’s requirements. These changes, if implemented, have the potential to drive up the cost of plans that provide adequate benefits and coverage for people with disabilities and chronic health conditions. See The Arc’s statement here.
Later that day, the White House announced that it would stop cost-sharing reduction payments. The ACA requires insurance companies to substantially reduce out-of-pocket expenses for beneficiaries with incomes under 250% of the poverty level and provides for reimbursement from the federal government. According to the Congressional Budget Office, this decision is likely to increase the number of uninsured Americans, premiums, and the federal deficit. For more information, see The Arc’s blog post.
Last week, Senate Majority Leader Mitch McConnell (R-KY) cancelled plans to hold a vote on the Graham-Cassidy bill. With Fiscal Year (FY) 2017 having ended on September 30, Congress can no longer use that fiscal year’s budget reconciliation process to pass the bill with a simple majority vote. It now requires 60 votes. This victory would not have been possible without the disability community. Had this bill become law, it would have:
- Capped growth in per capita Medicaid spending at below the cost of providing services;
- Replaced premium tax credits and Medicaid Expansion funds with a block grant that grows more slowly than current law and expires after 2026;
- Redistributed funds away from states that accepted Medicaid expansion; and
- Allowed states to let insurers sell plans that cover fewer services and charge more based on health status or disability.
The Senate Finance Committee hearing on the Graham-Cassidy-Heller-Johnson Proposal on September 25 was marked by high attendance of disability advocates. Protesters from ADAPT started a chant of “No cuts to Medicaid, save our liberty” and their arrests delayed the start of the hearing by 15 minutes. Senator Robert Casey (D-PA) mentioned The Arc’s advocacy and showed the stack of letters with stories from our advocates across the country.
While the cancellation of the vote on the “Graham-Cassidy” bill closed the door on Congress’s best opportunity to pass this legislation for now, there are still major challenges ahead. The 115th Congress can write two more budgets, one each for FY 2018 and FY 2019. With each budget, there is an opportunity for one reconciliation bill which requires only a simple majority to pass in the Senate. The reconciliation bill for FY 2018 will most likely focus on tax cuts. It is possible that Congress will attempt to cut Medicaid, Medicare, Supplemental Security Income, or other programs that pay for basic livings needs of people with disabilities as a way to offset revenue reductions. Additionally, Congress could attempt to pass an Affordable Care Act Repeal with Medicaid per capita caps and major tax legislation in one package. In summary, fewer pathways now exist to cut program that cover basic living expenses, but threats still remain. See article above for Congressional efforts to develop a new budget resolution similar to the most recent efforts which allowed for consideration of major Medicaid cuts and repeal of the Affordable Care Act in 2017.
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.