Another GOP effort to replace the Affordable Care Act

By Janice Podolski
ACE-Naperville Health, Education, and Welfare Team Member

The current administration continues to try to cause the ACA to implode. More recently, the Department of Health and Human Services has cut funds for the “Navigators” who help enrollees wade through the enrollment process in the ACA Exchanges by 92%. Enrollment begins for 2018 on November 1, yet the funding for advertising and notices of the date have been slashed. Have you seen any alerts that it is time to plan to enroll for next year other than on Facebook or Twitter? Neither has anyone else.

But the GOP is making one last effort to repeal and replace significant pieces of the ACA before the end of this government fiscal year, which is at midnight on September 30, 2017. Four Republican senators, Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI), rolled out their latest bill, which is referred to as the Graham-Cassidy Bill last Wednesday. They propose to offer it as another amendment to the H.R.1628 American Health Care Act, which passed the House earlier this year, but failed to pass in the Senate. Senate Majority Leader Mitch McConnell said he will bring the bill to the Senate floor only if they have 50 votes. They are increasingly optimistic about getting there.

Key points of the Graham-Cassidy Bill are reportedly as follows.

  • It will collapse the ACA market subsidies and Medicaid expansion.
  • It will block grants given to each state to design its own health system with few strings attached. The funding will come from former ACA subsidies and Medicaid expansion funds. A complex formula will determine the size of the grant to be given to each state, a formula that punishes blue states and those that expanded their Medicaid exchanges, while rewarding red states.
  • It will set slow-growing per-capita caps on traditional Medicaid. Please note that Illinois has the lowest per-capita cap relative to our neighboring states.
  • It will allow states to waive out of core ACA insurance regulation. Insurers still cannot deny coverage for pre-existing conditions, but states could allow them to not cover costs associated with some conditions. Insurers would again be allowed to charge older customers up to five times as much as younger enrollees. Children will still be able to stay on their parents’ plans until age 26.
  • It will repeal the individual mandate, as well as the mandate that employers with 50 or more full-time employees provide health insurance coverage for employees.
  • It will defund Planned Parenthood for one year.

As of September 18, the GOP felt they had 48-49 Republican votes and were working on another two or three senators. McConnell is pushing the Congressional Budget Office (CBO) to do a quick review of the bill, but the CBO only meets three days a week and will probably not be able to do an in-depth review in time. As of this posting (9/19), the CBO said it aims to provide a preliminary assessment of the Graham-Cassidy bill by early next week. The bill must meet the parliamentarians criteria for a Reconciliation Bill and pass in the Senate with 51 votes (Vice President Pence would be the tie breaker) before the end of September 30, or face a 60-vote count needed to break a filibuster.

If it passes in the Senate, the House can pass it at any time; they just cannot make any changes. If the House amends the Senate bill and then passes it, it would have to go back to the Senate, at which time they will have to overcome the 60-vote filibuster.

So hold on to your hats, here we go again. Republicans are increasingly optimistic, and the Democrats are worried.


ACE-Naperville Health, Education, and Welfare Team Member Janice Podolski is a retired faculty member from the Department of Pharmacology at Rush University Medical Center in Chicago. She was a registered nurse for fifty years and has a master’s degree in Nursing and Ph.D. in Physiology. She volunteers at Loaves & Fishes Community Services and with PADS in DuPage County.