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Graham-Cassidy May Be Dead, But Health Care Is Still Under Attack

In what has become a recurring motif this year, yet another piece of legislation designed to repeal and replace the Affordable Care Act has fizzled out just short of the finish line, leaving the Trump Administration and Congressional Republican leaders empty-handed once again. Thanks in large part to the tireless efforts of a broad coalition of health care advocates including many from the HIV community, the GOP’s 11th hour attempt to make good on their 7-year quest to destroy the ACA was foiled on Tuesday, as three GOP Senators (Susan Collins of Maine, John McCain of Arizona, and Rand Paul of Kentucky) declared their opposition.

The bill that failed—widely known as Graham-Cassidy in reference to its original co-sponsors, Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA)—was in many ways the perfect encapsulation of the myriad flaws in both the content and construction of Congressional Republicans’ numerous failed efforts to pass a health care bill of their own. Despite having majorities in both the houses of Congress and having control of the White House, the GOP’s slim 52-to-48 majority in the Senate and the partisan nature of their proposals has given them little room for legislative error, only allowing them two Republican defections from the party line if they want to push through health care legislation under reconciliation instructions that require 50 votes for passage.

For months, Congressional Republican leadership tried in vain to create legislation that would appease both the moderate and ultra-conservative wings of their party. Graham-Cassidy was not that legislation. In fact, Graham-Cassidy was viewed by health care policy experts as the least considered and most extreme GOP repeal attempt to date.

Like previous Republican health care attempts, Graham-Cassidy would have allowed insurers to discriminate based on pre-existing conditions and destroyed traditional Medicaid by changing it from an open-ended entitlement program to a restrictive per-capita-cap system. However, whereas earlier versions of the Senate health care bill simply reduced the amount of funding for Medicaid expansion and marketplace subsidies provided to states by the federal government, Graham-Cassidy got rid of them both outright, replacing them with a grossly insufficient block grant that actually would have punished states that tried to expand coverage under the ACA while rewarding those that did not.

The fact that Graham-Cassidy got as close as it did to a vote on the Senate floor has less to do with the substance of the actual bill than the Senate Parliamentarian’s ruling that the reconciliation instructions allowing health care legislation to pass with just a simple majority would expire at the end of the fiscal year at midnight on October 1. This sense of urgency and desperation to make good on their pledge to defeat the ACA and appease their voter base, their political donors and their increasingly frustrated President helps explain how the HIV community and health care advocates found themselves fighting against a health care bill co-sponsored by a Senator Graham, a foreign policy specialist who, by his own admission, had very little knowledge of the US health care system.

“Well, I’ve been doing it for about a month,” Graham said about his experience working on health care reform after a reporter asked why it was that the Republican Party had been having such a difficult time overhauling the health care system after having 7 years to work out a plan. “I thought everybody else knew what the hell they were talking about, but apparently not.”

Now that reconciliation instructions for FY17 have all but run out and Congressional Republican leadership has pivoted to touting their plan for massive tax cuts, the big question going forward is not so much if the GOP will try to repeal the ACA again, but when. Both Senators Graham and Ron Johnson (R-WI) have stated that they would not vote for a budget resolution that does not include reconciliation instructions for both tax cuts and health care, and it is extremely unlikely that Congressional Republicans will be content to accept this humiliating defeat around what has been one of their signature issues for the better part of a decade.

Regardless of whether Senate Republican leadership takes another stab at repealing Obamacare in FY18, The White House is already hard at work trying to sabotage the ACA in any way that they can. Last week, we covered how the Trump Administration has cut the advertising budget for the upcoming ACA enrollment season by 90% in addition to shortening the open enrollment period by half and cutting  the funding for ACA navigator groups. This week, the Administration went a step further by abruptly cancelling all of the Department of Health and Human Services’ participation in ACA marketplace enrollment coordination and education in the South this year.

The immediate threat of ACA repeal from Congress may be gone for now, but the efforts of the Trump Administration to destroy the health care marketplaces with a thousand cuts is just beginning in earnest. AIDS United will have more on what you can do to prevent this sabotage of our health care in the coming weeks.

Posted By: AIDS United, Policy Department - Friday, September 29, 2017

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