It's been almost a month since a dramatic, wee-hours vote July 28 felled so-called "skinny repeal," the Senate's most recent bill intended to roll back the Affordable Care Act (ACA) . The Senate officially returns from summer recess Sept. 5; though Senate Majority Leader Mitch McConnell has suggested tax reform will be his top priority for fall, Sen. Bill Cassidy met with Health & Human Services Secretary Tom Price July 31 to continue advocating for his health care ideas.
The Center on Budget and Policy Priorities (CBPP), a Washington, D.C.-based think tank, released a new analysis this morning evaluating the effects of the Cassidy-Graham amendment attached to the Senate's most recent health care plan. Should Cassidy-Graham form the basis of a new ACA repeal effort, as some have speculated it might, the report warns it may share many problems with earlier Senate plans. According to the analysis, under a Cassidy-Graham plan, Louisiana could lose $2.3 billion in health care funding by 2026.
[jump] "In general, the plan would effectively punish states that have been especially successful at enrolling low- and moderate-income people in the Medicaid expansion," the report said. (More than 400,000 people in Louisiana are estimated to be covered under the state's Medicaid expansion.) "It would cause many millions of people to lose coverage, radically restructure and deeply cut Medicaid [and] increase out-of-pocket costs for individual market consumers."
Report authors Matt Broaddus and Edwin Park found that a Cassidy-Graham-styled plan "shifts costs and risks to states" through its use of block grants, which present a particular threat to states (like Louisiana) that struggle with chronic budgetary issues. They also criticized elements of Cassidy-Graham which they say put consumers at risk, such as allowing states to waive rules that currently prevent insurers from placing annual or lifetime limits on policies.
In a phone call with Gambit, Cassidy senior health policy advisor Matt Gallivan disputed the accuracy of the report. He described the CBPP as a "liberal-leaning organization" and said it's unclear what numbers the organization drew on for its analysis, but that the report is fundamentally incorrect.
"I'm not sure where they got their data from. ... The formula has been changing and a work in progress," Gallivan said. "Under our numbers, with the [Cassidy-Graham] block grant, Louisiana actually gained money compared to what they're getting now."
In a Washington Post op-ed earlier this summer, Cassidy framed the issue as one of state (and patient) autonomy. "We need to let states take care of themselves and give power back to patients. Let a blue state do a blue thing and a red state such as mine take a different, conservative approach," he said.
But problems potentially arise when states try to operate large, expensive programs without a federal safety net. According to the CBPP report, a Cassidy-Graham plan could mean a "funding cliff" for states beginning in 2027, the year in which proposed block grants would end. (Gallivan says this misrepresents reconciliation rules, which require re-authorization of funding at that time for any program.)
It's not certain how much this will come up during the coming months. Legislative attempts to repeal the ACA earlier this year were politically unpopular, and there are many issues on the congressional agenda, including the pressing need to reach an agreement on raising the national debt ceiling. But Cassidy communications director John Cummins says the senator has continued to work on health care plans over recess.
"[Cassidy] continues to see that Obamacare is collapsing and that we need to repeal and replace Obamacare with something that's going to work," Cummins said.
In this, Cassidy may be aligned with President Donald Trump. In a tweet shortly after ACA repeal failed, Trump indicated that health care reform remains a priority for him, and that he would take drastic measures to attempt to force Congress' hand.
"If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!," he said, possibly alluding to the cost-sharing reductions for insurers that incentivize their participation in ACA exchanges.
In another tweet Aug. 10, Trump criticized McConnell and seemed to challenge him to return to health care legislation.
"Can you believe that Mitch McConnell, who has screamed Repeal & Replace for 7 years, couldn't get it done. Must Repeal & Replace ObamaCare!," the president wrote.