As a crucial deadline nears, Louisiana's senior U.S. senator is doubling down on his latest attempt upend the federal Affordable Care Act – even as the proposal draws opposition from some of the state's leaders back home.
Gov. John Bel Edwards and Health Secretary Dr. Rebekah Gee in separate letters this week said they believe U.S. Sen. Bill Cassidy's plan to dramatically overhaul the federal health care law would harm Louisiana, likely to the benefit of other states.
"In its current form, the harm to Louisiana from this legislation far outweighs any benefit; therefore, I must register our deep concerns and hope we can find a better path forward towards fixing the broken parts of our health care system," Gee said in a letter addressed to Cassidy on Monday.
Edwards, meanwhile, joined a bipartisan group of nine other governors to appeal to U.S. Senate leadership Tuesday to outright block the ongoing efforts by Cassidy and three other Republican senators.
"Rushing a piece of legislation of this significance through the process without proper vetting, thorough hearings or robust debate will leave us with unintended consequences that can be avoided," Edwards, a Democrat, said in a statement. "Congress should take the time to get this process and policy right because it is the American people’s lives, well-being and tax dollars that hang in the balance."
The GOP-controlled U.S. Senate has spent several weeks yo-yoing over whether it can successfully repeal and replace Barack Obama's signature health care law. President Donald Trump has repeatedly urged Republicans, who also control the House, to follow through with his campaign promise. After previous attempts have fizzled, they now face a Sept. 30 deadline to move forward using a procedural move that would allow them to do so with only Republican support.
Cassidy's proposal, which is also backed by U.S. Sens. Lindsey Graham, of South Carolina, Dean Heller, of Nevada, and Ron Johnson, of Wisconsin, is largely seen as a last-ditch effort.
U.S. Senate Majority Leader Mitch McConnell, R-Kentucky, hasn't promised a vote will take place on it, but acknowledged Tuesday that the window is narrowing.
"We’re in the process of discussing all of this," McConnell said. "Everybody knows that the opportunity expires at the end of the month."
Cassidy, a physician who has been promoting various Obamacare replacement plans for more than a year, has said his goal is to put more decisions in the hands of states. A key component of his plan is providing block grant funding, which would loosen federal restrictions but also ultimately reduce funding.
"We give the dollars to the states for the states to be inventive," Cassidy told reporters Tuesday.
But Edwards said flexibility isn't enough.
"What he’s giving me the flexibility to do there is cut people off of healthcare and that’s not what I’m looking for,” Edwards said in an interview Monday. "I appreciate the flexibility — but not the funding cuts."
The proposal would ultimately threaten Medicaid expansion in Louisiana, which Edwards frequently refers to as his most significant achievement since taking office in January 2016.
Nearly 435,000 people in Louisiana – mostly the working poor – have signed up since expansion took effect in July 2016.
"We’re saving lives, money, and investing in our people to ensure they are able to receive quality healthcare," Edwards said in a statement.
Even Cassidy's fellow Louisiana senator hasn't yet taken a hard stance on the latest push. U.S. Sen. John Kennedy, R-Madisonville, had no comment on the legislation Tuesday and has floated the idea of proposing amendments, including implementing work requirements for Medicaid recipients and barring states from using the plan's flexibility to adopt more liberal systems.
Jeff Drozda, CEO of the Louisiana Association of Health Plans, which is the state trade association for the health benefits industry including managed-care companies that cover more than 1 million Medicaid recipients, said he sees Cassidy's proposal as a possible path to something better.
"I'm sure that there will be some tweaking as the bill moves forward," he said. "It will be improved – at least we hope it will be improved."
Drozda expects to meet with Cassidy next week to discuss the proposal, as well as the Louisiana health insurance industry's concerns about the current system.
"Doing nothing is not an option," he said. "For the consumer, it's extremely important that we stabilize the market."
In a letter that quickly went viral online, Gee expressed concern over the threat to Louisiana's expansion population, as well as the impact of proposed per capita caps on funding.
An analysis from the liberal-leaning Center for Budget and Policy Priorities estimates Louisiana stands to lose about $3.2 billion in federal healthcare funding over the next decade if Cassidy's proposal is successful.
"The legislation you've introduced this past week gravely threatens health care access and coverage for our state and its people," Gee wrote.
Responding to Gee's letter, Cassidy said he believes some of her concerns are unfounded, but she is correct that the legislation would cut federal dollars currently flowing to states.
"Our proposal spends less money than Obamacare. We eliminate the penalties paid by individuals and business which do not conform to Obamacare mandates," he said. "If Dr. Gee thinks that more money is needed, she should suggest that these taxes be re-imposed on state level."
Bryn Stole of The Advocate Washington bureau contributed to this report.