Over the spring and summer, four different bills to repeal the Affordable Care Act were voted on by members of Congress. All were deeply unpopular with the American public and failed in close votes.
These bills would not have delivered on politicians’ promises of better and less expensive health insurance plans and expanded coverage. Instead, they would have resulted in tens of millions of people losing their insurance, sharp price hikes in the next few years for everyone else, and the elimination of popular consumer protections such as prohibiting insurance companies from excluding people with pre-existing conditions from buying policies.
Now, in a last ditch effort to repeal the ACA by September 30, the end of the federal fiscal year, Congress is back with another destructive bill. Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina have introduced legislation that, like its failed predecessors, will result in coverage losses, higher costs, and elimination of consumer protections. Over the long term, the Cassidy-Graham bill may well be the worst one of all.
Cassidy-Graham would pool the federal dollars the residents of each state receive for financial assistance to purchase health insurance and send those funds to the states in temporary block grants. Included in these fixed block grants would be money states receive for expanding their Medicaid programs to cover more people. Kansas has not expanded its Medicaid program, known as KanCare, and has not received this enhanced funding.
The block grants would come with few strings. States would not have to use the funding to provide financial assistance to insurance purchasers. National consumer protections would be eliminated and each state would be responsible for deciding whether insurance companies could charge higher premiums to those with pre-existing conditions.
In addition, the guarantee that insurance covers a minimum set of benefits, such as hospital stays and physician care, would be eliminated. Again, states would decide which, if any, services must be covered and which are optional.
If Cassidy-Graham passes, insurance rules would resemble those that were in place before the ACA, when tens of thousands of Kansans with pre-existing conditions could not afford coverage and women could not purchase a standard policy that included maternity care.
Block grants would not increase at the same rate as insurance premiums, so each year consumers would see their financial assistance decline as prices go up. Block grants also do not respond to actual conditions on the ground, so if a recession occurred and the need for assistance increased, the block grant would remain the same. In the event of a natural disaster, such as Hurricane Harvey or Irma, or a tornado that devastates a Kansas community, there would be no additional funding to assist those in need.
And then, after 2026, the block grants would end. States would fall off a funding cliff in which federal financial assistance stops. The state would then be on the hook to replace the funds or see tens of thousands of residents lose their insurance coverage because they could no longer afford the premiums without financial help.
In Kansas, this funding cliff would result in a drop of more than a billion dollars in one year, according to an analysis by the Center for Budget and Policy Priorities.
But Cassidy-Graham does not stop there. Like the previous bills, it would slash funding for the KanCare program. Most of the Kansans who receive coverage through KanCare are children. Most of the program’s spending goes to the care of seniors in nursing homes and individuals with disabilities. Cuts to KanCare mean cuts to services for these populations. Additional thousands could lose their coverage.
Cassidy-Graham was introduced just last week and has not had a single hearing or debate. There has not been sufficient time for independent analysis by experts and by the clinicians and patients who would be directly affected by the proposed changes. Consideration of the bill has diverted time and attention from an ongoing bipartisan effort to stabilize the insurance market, increase competition, and reduce prices.
It’s time for Congress to stop playing politics with the lives and health of Americans. This bill must be stopped in the Senate. We urge Sens. Roberts and Moran to protect Kansans and stand firmly against Cassidy-Graham.
Sandy Praeger is former Kansas Insurance Commissioner. She co-authored this with Sheldon Weisgrau, director of the Health Reform Resource Project in Topeka.