Just when we thought that the repeal and replace effort against Obamacare was over, the Republicans are back with the Graham-Cassidy bill. The premise of this bill is to turn over control to the states but it is a Trojan horse which does much more, cutting funding drastically.
The sponsors have noted that the Affordable Care Act sends much more money to certain populous states such as California, New York, Massachusetts (blue states). They fail to mention that these states receive more because they expanded Medicaid. Non-expansion states chose not to accept the federal money. The initial plan of the ACA was for all states to expand Medicaid. Legal challenges made in an attempt to kill the ACA resulted in Medicaid expansion being an option for states. Many red states chose not to expand Medicaid and therefore did not obtain the added funds.
Graham-Cassidy would markedly cut the funds for states that expanded Medicaid, particularly California and New York, and would give more to states that did not expand Medicaid, especially Texas.
A particularly interesting carve-out exists for Alaska. The carve-out is to give low-population-density states with health-care spending more than 20 percent above the U.S. mean an exemption from the deep cuts to Medicaid, giving them about 50 percent more funding. Only Alaska and North Dakota fit that description.
It is notable that a senator from Alaska, Sen. Lisa Murkowski, has voted against the previous repeal and replace bills. This appears to be a carve-out to get her on board with this bill. It may be unconstitutional, as it does not provide uniform treatment of the states.
This bill is being pushed through without a reasonable hearing process and on such a rapid time frame that the Congressional Budget Office will not to be able to properly score it to see how many millions of people this plan will throw off health-care insurance. It likely will be tens of millions.
Graham-Cassidy rolls together Medicaid funding and ACA cost-sharing subsidies into a block grant to each state. However, the block grants will be cut by 25 percent in five years and completely eliminated in 10 years. The cost sharing subsidies will end in 2020. While states that did not expand Medicaid will get a windfall initially, they too will see the block grants diminish over time, then disappear. Many governors oppose this bill as they will have to pick up the pieces.
The impact on New Hampshire will be catastrophic. We will lose $1 billion over the next 10 years. Before the ACA, our hospitals faced $400 million per year in unfunded liabilities due to taking care of people without insurance. These liabilities decreased significantly after Medicaid expansion. As people are thrown off insurance, we will see increased costs of uncompensated care that will be very difficult for our smaller, rural hospitals to absorb.
Graham-Cassidy removes many other positive features of the ACA. It repeals mandates to have health insurance. As I have noted in previous columns, it is important to have everybody in the insurance pool to share the risk and prevent the inevitable cost shifting that occurs when people are not covered. The medical costs of the uninsured do not go away, they just get shifted to those with insurance and the taxpayers.
It also repeals the subsidies, which lower premiums, deductibles and co-pays. This will make insurance more expensive. This bill allows states to waive the ACA protections regarding pre-existing conditions and covered benefits. It ends federal funding of retroactive Medicaid eligibility, a basic safety net feature that enables catastrophically ill people to be covered for a high-cost event occurring before they were covered. States would also be able to change the essential health benefits, impacting the ACA prohibition of annual or lifetime caps on coverage.
In an earlier column, I profiled a self-employed woman who had a premature baby and was left with $87,000 of debt because she was covered with a non-ACA-compliant insurance product grandfathered in when the ACA took effect.
The strategy we are currently working on to get her help is to use the retroactive coverage of her baby’s Medicaid. If Graham-Cassidy is passed, a family having a premature baby will once again face these same problems and the child would likely be uninsurable in the future, due to pre-existing conditions and because of reaching lifetime caps for coverage.
This bill primarily attacks Medicaid recipients and lower-income people. As I noted in a previous column, per capita expenditures for Medicaid are lower and have had a lower inflation rate than private insurance or Medicare over the past seven years. We are seeing an attempt to throw millions of poor people off their health-care coverage in order to fund tax cuts.
Graham-Cassidy is not health-care reform. It is time for real health-care reform that fixes our broken health-care system, which costs on average twice as much as the systems in other developed countries and is dead last in health-care outcomes.
Jerry Knirk is a freshman representative from Carroll County District 3: Tamworth, Madison, Freedom and Albany. He lives in Freedom.