Beware the Graham-Cassidy Affordable Care Act repeal currently floating in the Senate. Seen as the last possible ACA repeal this year, Graham-Cassidy has the same old opt-outs from community rating and pre-existing condition protections that we saw in the earlier GOP proposals that would price older and ailing patients out of the market. Graham-Cassidy would end the tax credits and subsidies that make individual coverage affordable for thousands of South Dakotans and are particularly valuable to rural folks, who have a higher proportion of self-employed (read, farmers and ranchers!) people who don’t have access to employer-based coverage.
But watch out: Graham-Cassidy includes a trick that might look good to ACA-recalcitrant states like ours. The Republican bill keeps some of the Affordable Care Act’s taxes but robs from smart states that expanded Medicaid and redistributes cash to us laggards in less effective block grants:
The plan centers around block-granting billions of dollars in Obamacare taxes that currently fund states’ Medicaid expansions and individual health insurance subsidies. The money would be funneled through the popular Children’s Health Insurance Program, a long-standing block grant to provide care for low- and moderate-income children.
The block-grant formula would generally redistribute money away from states that expanded Medicaid under Obamacare and spread them across the country, boosting the amount of federal money headed to states — largely controlled by Republicans — that refused to expand Medicaid.
Cassidy, in rejecting criticism of the proposal as “partisan,” said Democratic senators from purple states where Republican governors or legislatures blocked Medicaid expansion — a list that includes Virginia, Wisconsin and Indiana — should back the plan because of the increased money [Bryn Stole, “Cassidy, Graham Unveil Last-Ditch Obamacare Repeal Bill,” Tribune News Service via Governing, 2017.09.15].
CBO says it won’t be able to fully score Graham-Cassidy before the September 30 deadline for passing measures with 51 votes. But given that the bill removes requirements that states spend those block grants on getting people health insurance, Graham-Cassidy likely produces the same result as the Republicans’ last three swings: millions of Americans go uninsured.
Senator John Thune said last week that passage of Graham-Cassidy is unlikely. Senator Mike Rounds shares that pessimism but says he likes the original concept. Don’t let them get fooled by any promises of more money and freedom for South Dakota. Get back on the phone and fax and tell your Senators that they still haven’t come up with a health care plan that improves on the status quo.