The Scourge of Graham-Cassidy

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You’d think that Republican politicians at Capitol Hill would know by now that taking people’s healthcare away for whatever reason is as morally reprehensible as it is unpopular. But as soon as Congress is back in session, a group of Republican US Senators introduce this Graham-Cassidy legislation which is seen as the last Obamacare repeal bill left standing. The US Senate has until the end of the month to vote on this bill. In many ways, Graham-Cassidy is strikingly similar to earlier Trumpcare bills. But it’s also could be the most radical plan yet, drafted in secrecy without the usual committee hearings and markups. Senators Lindsey Graham and Bill Cassidy are rushing this legislation to the floor under the special “budget reconciliation which allows the bill to advance with only 51 votes instead of the usual 60. So far, it faces long odds that some of its backers said it would be almost impossible to get a massive rewrite of the healthcare system through the Senate within that period of time. And even if it passes, it could take the Congressional Budget Office could take several weeks to estimate Graham-Cassidy’s impact. That means we may have no idea how many Americans will lose their health insurance, how much premiums would increase, how much the deficit will increase, how much it will increase costs, and other impacts on the US economy. Still, keep in mind that it took only took 3 Republican US Senators to kill Obamacare repeal in July so anything’s possible. Even worse is that US Senator John McCain is open to supporting it. And remember, he was the deciding vote to sink Trumpcare back in July. Nonetheless, Graham-Cassidy’s impact can be potentially devastating to 1/6 of the US economy as well as millions of Americans.

Regardless of you think, it is morally unconscionable to introduce legislation designed to take away people’s healthcare for any reason, especially politics. Every Republican plan to repeal and replace the Affordable Care Act has meant higher costs, millions of hard-working Americans losing their insurance, and key protections gutted with devastating consequences for anyone with pre-existing conditions. Should Graham-Cassidy be made law, millions will lose their insurance, thousands will face bankruptcy and loss in quality of life, hundreds of jobs will be lost, hospitals and medical facilities will close, costs will rise, and many will die from not getting the treatment they needed to save their lives. There will be more abortions, more maternal and infant deaths, more deaths and disabilities from gun violence, more ravaged communities, and more opioid overdose deaths. Most of all, it will threaten the health security for every American. This isn’t the kind of healthcare future most Americans want to live in and I will absolutely not stand for it.

The fact my access to Medicaid in the next decade may depend a few GOP Senators’ votes just scares the living shit out of me. It’s appalling enough that I have to live under a for-profit healthcare system I strongly believe has no moral right to exist. If I lose my Medicaid coverage, it’s very likely I may never be able to get health coverage that’s just as good or at all. Why the hell should I have my healthcare taken away from me just so some rich guy can enjoy some massive tax cut he doesn’t even need? I can’t live with that. I shouldn’t have to live with that. I shouldn’t have to lose my healthcare just so the Republican Party can satisfy their donors and voters. My healthcare shouldn’t be sacrificed to fulfill some market-based conservative vision that won’t benefit me. My autism shouldn’t reduce my own humanity to a financial risk. I’d rather pay taxes for someone else’s healthcare treatment I may not even need than be dropped from my coverage due politicians’ selfish interests.

As I’ve said before, the Republicans’ war on Obamacare must end. Graham-Cassidy is just mere malicious cruelty that robs Americans of their dignity and possibly their life, liberty, and the pursuit of happiness. Healthcare is a fundamental right the federal government should protect for all Americans. Corporations, politicians, and employers shouldn’t decide who has access to healthcare, especially Republicans on Capitol Hill. Nobody should be denied treatment if they’re sick or injured regardless of whether they can afford it or who has to pay for it. If a medical treatment can save someone’s life, then nothing else should matter. If you believe otherwise, then you can just go to hell for all I care.

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What Graham-Cassidy does:

1. Shift Medicaid funding and insurance subsidies to a block grant system: Instead of determining the federal government’s share of funding for Obamacare’s Medicaid expansion and individual insurance subsidies, states would receive large chunks of money up front and determine what to do with it. For instance, they could spend it on providing insurance, fund high risk pools, or pay bills for patients with high medical needs. But there is no accountability for how this money is spent, won’t adjust based on need or higher costs, nor requires offering low and moderate income individuals coverage or financial assistance. Nevertheless, this system literally takes money from states that expanded Medicaid and gives it to states that didn’t. For those that did, their block grant funding could be anywhere from 35-60% below what they’d receive in the Medicaid expansion and/or marketplace subsidy funding under the current law. It would also would make it much more expensive for states to continue Obamacare if they like it. In fact, most states if not all would have to use the bill’s so-called “flexibility” to eliminate or cut coverage and financial assistance to low or moderate income people. Many states would likely do one or more of the following: cap enrollment; offer very limited benefits; charge unaffordable premiums, deductibles, and co-payments; redirect federal funding from providing coverage to other purposes, like reimbursing hospitals for uncompensated care; and limit assistance to fixed dollar amounts that put coverage out of reach for most low- to moderate- income people. Millions would lose coverage. Rural hospitals that receive more of their income from the ACA and Medicaid will be disproportionately hurt. In addition, to get this money, states would have to kick in some of their funds, too. And that block grant funding will end in 2026.

2. Convert Medicaid’s current federal-state partnership to a per-capita cap: This could cut Medicaid per-beneficiary funding for seniors, people with disabilities, and families with children. This could result in states having to raise taxes, cut other budget priorities like education, or make severe cuts to eligibility, benefits, and provider payments. Home- and community- based services allowing people needing long term services and supports to remain in their homes rather than move to an assisted living facilities could be cut in many states. These and other “optional” benefits to states under federal law could be at greatest risk. Moreover, the gap between federal funding under the per-capita cap and states’ actual funding needs would grow even larger if Medicaid costs grow more quickly than expected in ways the cap doesn’t account for. Over time, this will not only leave Medicaid underfunded and way less responsive to low-income people’s health needs.

3. Allow states to adjust the essential health benefits: Currently the federal government mandates that all plans sold on the Obamacare exchanges cover 10 basic types of care, including maternity care, emergency room visits, prescription drugs, mental health coverage, rehabilitative services, and substance abuse treatment. Under this proposal, states could significantly pare back their insurance coverage to cover less expensive benefits. We should not that before the ACA, 75% of all individual market plans excluded maternity coverage, 45% excluded substance abuse treatment, and 38% excluded mental health care. This could lead many people without access to the healthcare they need, especially if they have a pre-existing condition. According to the CBO, states accounting for half of the nation’s population would choose to let insurers exclude essential health benefits. People needing these services could face increased out of pocket costs that could amount to thousands of dollars per year.

4. Eliminate or weaken protections for people with pre-existing conditions by allowing states to waive the ACA’s underwriting prohibition: Underwriting allows insurance plans to charge premiums to expected health costs of a specific patient. Thus, resulting in low premiums for the young and healthy and high premiums for those sicker or older. Obamacare bans varying premiums by health status and required all individuals to be charged the same. Because before the ACA, insurers could charge unaffordable premiums to those with pre-existing conditions which effectively resulted in coverage denial. In the US, 52% of adults under 65 have a pre-existing condition. According to the CBO, states accounting for 1/6 of the nation’s population would let insurers charge higher premiums based on health status. In those states, less healthy individuals and people with pre-existing conditions would be unable to purchase comprehensive coverage with premiums close to those under the current law and might not be able to purchase coverage at all.

5. Eliminate the individual and employer mandate: People who don’t sign up for insurance won’t face a tax under the plan and companies can’t be compelled to offer coverage. This can result in hundreds of Americans losing their employee health benefits at work. Not to mention, destabilize and risk collapse of the individual market.

6. Creates a state reinsurance fund: Allocates a certain amount of money to insurers to offset greater losses from insuring a sicker pool of people. This is known as a high-risk pool which will most likely be underfunded, charge expensive coverage, and provide terrible coverage for low-income people with pre-existing conditions.

7. Bars states from reimbursing Planned Parenthood for Medicaid enrollees for a year: Thus, preventing Medicaid recipients from accessing preventative health and family planning services. This will leave millions of Americans without access to critical services, particularly low-income women. Of course, you probably saw this coming since many Republicans are staunchly anti-abortion. Still, one’s abortion stance shouldn’t prevent women from getting a pap smear, breast cancer screening, or contraceptives, especially if Planned Parenthood is the only provider in town.

8. Lifts prohibition against annual and lifetime limits on benefits: This can be particularly devastating to premature babies, those with disabilities, the rare disease community, and cancer patients.

9. Allows states to institute work requirements for Medicaid: Studies have shown instituting work requirements for benefits doesn’t alleviate poverty. In fact, work requirements exacerbated it. Stable employment among recipients subject to work requirements proved the exception, not the norm. In addition, most recipients with significant barriers to employment never found work even after participating in work programs otherwise deemed successful. This is especially the case when such programs don’t support efforts to boost beneficiaries’ efforts and skills. Nevertheless, voluntary employment programs could significantly increase employment without the negative impacts ending basic assistance for individuals unable to meet mandatory work requirements.

10. Nearly doubles maximum contributions to Health Savings Accounts: Called HSAs, these are tax advantaged accounts for those enrolled in a high deductible healthcare plan. Proponents think HSAs encourage consumers to make more cost-effective and responsible healthcare decisions. However, they may actually worsen healthcare in the US since people may hold back spending that would be covered, or spend it unnecessarily just because it has accumulated to avoid the penalty taxes for withdrawing it. Not to mention, it’s widely believed they only benefit young, healthy people with money and make healthcare more expensive for everyone else. They’re particularly bad for those with chronic health problems with predictable costs. Besides, low-income people often don’t enough to from the tax breaks HSAs offer. To make matters worse, the FDIC doesn’t insure them since HSAs are subject to market risk. And a lot of surveys found that HSAs recipients are significantly less satisfied with most of its aspects than those with more comprehensive health plans.

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3 responses to “The Scourge of Graham-Cassidy

  1. Pingback: Disgusting! | cornfedcontessa

  2. This effort is not dead and we need to continue to be vigilant. I do think that there are several factors at play with the Republican Party and it would be worthwhile to note each one because they will all matter when the next repeal bill comes.

    1). Libertarian ideology has usurped the Republican Party establishment (elected officials). There are many in Congress that simply believe that the government has no role in guaranteeing the health of its citizens. End stop. The bigger issue though is the donor class. It is a small but powerful cohort. Congressmen and Senators are primarily concerned about the money that could come after them in a primary.

    2) Fiscal conservatives like Paul Ryan that want to “reform” entitlements which really means capping their growth rate. Entitlement reform – yes; but the block grants are coming from this ideology.

    3) Hatred for Obama. If he did it, get rid of it.

    I was really heartened to see the pushback on behalf of Medicaid. Those cuts would have hurt so many individuals for sure, but MC’s impact goes much further. Hospitals, pharmacies, and doctors in rural areas depend on MC patients and in many cases, entire small towns are employed or somehow connected to those health facilities. Reducing funding has such a long term negative effect.

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