The Senate Finance Committee (SFC) held a hearing on September 25 examining the Graham-Cassidy proposal, the latest Senate Republican health care bill to repeal and replace the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). Offered as an amendment to the House-approved American Health Care Act (AHCA) (HR 1628) (TAXDAY, 2017/05/05, C.1), the proposal is being called Republicans’ “last effort” to repeal the ACA, as the budget resolution vehicle needed to pass a repeal with a simple majority will expire on September 30.
Expected to Fail
A spokesperson for Senate Majority Leader Mitch McConnell, R-Ky., told Wolters Kluwer during the week of September 18 that, at the time, McConnell intended to bring the bill to the House during the week of September 25 for a vote (TAXDAY, 2017/09/21, C.1). At press time, however, the measure is expected to fail, as three Republican senators have now voiced opposition to the bill. Sens. John McCain, R-Ariz., Rand Paul, R-Ky., and Susan Collins, R-Me., have all stated they will not vote in favor of the measure.
Thus, the proposal is not expected to garner the required 50 votes under Senate Republicans’ narrow 52 majority, as President Trump noted earlier in the day. “We’re going to lose two or three votes, and that’s the end of that,” Trump said on September 25.
The Graham-Cassidy proposal would repeal the structure of the ACA and certain related taxes. It would replace the ACA with an annual block grant to states to assist individuals with health care payments. The proposal is authored by Sens. Lindsey Graham, R-S.C., Bill Cassidy, R-La., Dean Heller, R-Nev., and Ron Johnson, R-Wis. Notably, the measure would eliminate the individual and employer mandates retroactively, to calendar year 2016, as well as repeal the medical device tax.
Democrats have criticized Senate Republicans for trying to rush the ACA repeal to the floor for a vote. A Congressional Budget Office (CBO) score has not yet been released. “Senate Republicans haven’t gotten answers to the most basic questions about the real-world effects of their bill. How many people will lose coverage? By how much will premiums increase?” SFC ranking member Ron Wyden, D-Ore., said during the hearing. The CBO preliminary analysis was released after the hearing, with the CBO noting that it, along with the Joint Committee on Taxation, “would need at least several weeks to provide point estimates of the effects on the deficit, health insurance coverage, and premiums.”
According to Cassidy, the proposal would repeal the individual mandate, which the ACA architect, Jonathon Gruber, found does not increase enrollment.” Regarding this, the IRS reports that 58 percent of those penalized have [adjusted gross income] of less than $50,000,” Cassidy testified. The proposal also repeals the employer mandate, “which data shows decreases full time employment opportunity for the lowest quintile of wage earners, those who can least afford,” he added.
Would Create Chaos
Teresa Miller, Pennsylvania acting secretary, Department of Human Services, told lawmakers at the hearing that the Graham-Cassidy proposal would “create chaos” if enacted. “We would have two years to completely revamp our health care system, work with stakeholders to figure out what this new system could look like, develop whatever infrastructure would be needed, make system changes required, pass legislation, get any necessary federal waivers, and a host of other activities,” she testified. “All of this would need to happen apparently without federal funding to support these essential planning activities,” she added.
By Jessica Jeane, Wolters Kluwer News Staff
Text of the Revised Graham-Cassidy Amendment to HR 1628
CBO Preliminary Analysis of Legislation That Would Replace Subsidies for Health Care With Block Grants
SFC Press Release: Hatch Opening Statement
SFC Press Release: Wyden Statement at Finance Committee Hearing on
Statement of Sen. Graham
Opening Statement of Sen. Cassidy
Statement of Sen. Hirono
Testimony on Graham Cassidy Healthcare Amendment by Former Sen. Rick Santorum
Graham-Cassidy-Heller-Johnson Amendment Testimony by Dennis G. Smith, Senior Advisor for Medicaid and Health Care Reform, Arkansas Department of Human Services
Testimony of Teresa Miller, Pennsylvania Acting Secretary of the Department of Human Services and Former Pennsylvania Insurance Commissioner