September 25, 2017

Editor’s note: Deborah Weinstein, Executive Director of the Coalition on Human Needs, sent the following letter Monday to the Senate Finance Committee, which is scheduled to hear testimony on the Graham-Cassidy ACA repeal proposal:

“I am writing to convey the very deep concerns of the Coalition on Human Needs about the dangers posed by the Graham-Cassidy health care repeal legislation.  We strongly urge the Senate Committee on Finance to reject this proposal.

“The Coalition on Human Needs is an alliance of over 100 national organizations, including faith, service provider, policy, labor, civil rights and other advocacy groups.  Our nationwide network includes groups and individuals in every state.  We believe strongly that every state would be harmed at least as much by Graham-Cassidy as by the other proposals previously defeated in Congress.

“Graham-Cassidy is a repeal bill with no replacement specified.  Its cuts begin with almost no transition period in 2020, both by replacing the current Medicaid expansion and individual health insurance subsidies with reduced funding in a block grant and by restrictively capping the regular Medicaid program.  While the specific losses to states from the block grant have been modified since the bill’s first versions, there is still an overall loss of $40.6 billion in federal funds from 2020-2026.  Twenty-seven states do worse than under current law, with states that have done the most to provide health coverage to their people losing the most.  Losses will rise steeply in 2027, when the block grant containing inadequate resources for Medicaid expansion and marketplace subsidies expires.  The independent health care consulting firm Avalere estimated that the loss for all states would exceed $4 trillion through 2036, utilizing the earlier draft of the bill.  We do not know how that number would shift as the bill changes, but it is clear that once repeal has taken effect, with no clear replacement, that state losses will mount. The uncertainty feared by insurance companies and state governments (not to mention people whose insurance hangs by a thread) will loom large, with destructive consequences.

“Whether or not states make temporary gains through the block grant, every state will experience losses because of the per capita cap imposed on the regular Medicaid program.  The cap is estimated at reducing federal Medicaid reimbursements to states by about $175 billion from 2020 – 2026, with a cut of $39 billion in 2026, or 8 percent below current law.  After 2025, the cap would tighten, with an inflation adjustment lower than estimated cost increases for medical care.  Year after year, the gap between what states receive and what health care costs require will widen, making it more and more likely states will restrict eligibility, benefits, and/or reimbursements to health care providers.  Medicaid is a critically important part of the nation’s health care system, and the far-reaching restrictions proposed will deny health care to millions and cost lives.  Under current law, Medicaid covers more than four in ten of U.S. children, 15 million people with disabilities, 1.8 million veterans, and nearly two-thirds of people in nursing homes.

“Funding is not all that is at stake:  Graham-Cassidy will remove existing protections for pre-existing conditions, for a minimum benefits package, and against lifetime limits.  Everyone with private insurance would be affected, whether they get insurance through their employers or through the marketplace.

“Because this legislation is being so hastily pressed upon the Senate, there is no CBO estimate of the number of people who would lose health coverage.  The lack of such important information is reason enough to oppose this legislation.  Further, there is every reason to assume that millions of people nationwide would lose coverage.  Applying estimates for previous proposals with similar provisions to Graham-Cassidy projects that 32 million would lose insurance by 2027.  The per capita cap to Medicaid would likely swell the numbers of the uninsured even more, by further shrinking every state’s health care resources, potentially affecting 70 million people now in the Medicaid and Children’s Health Insurance programs each month (among them about 35 million children).

“The American Medical Association and major insurance companies have objected to the bill. ‘Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care,’ wrote AMA CEO and Executive Vice President James L. Madara, M.D. A bipartisan group of governors wrote to the Senate urged that Graham-Cassidy not be considered, and that instead the Senate should seek bipartisan improvements to stabilize health insurance markets.  We urge the same.  A bipartisan effort was underway in the HELP Committee.  Practical gains can be achieved through this approach, while Graham-Cassidy offers constricted funding coupled with loss of protections that have been literally life-saving.

“Please stand against this hasty proposal to undermine the success in reducing the proportion of uninsured (down from 14.8 percent to 8.6 percent from 2012 to 2016, according to the U.S. Census Bureau).  This is one of the most consequential votes Senators will cast.  Rejecting this legislation will not only prevent serious financial and health losses for all states and the American people; it will make it possible to re-direct the Senate towards a constructive solution.”

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