Major healthcare associations said they were “relieved” by Senate Republicans’ decision to table the Graham-Cassidy legislation to repeal the Affordable Care Act (ACA), bringing at least a temporary halt to the party’s efforts to replace the law with only Republican votes.
Groups representing physicians, hospitals and insurance companies had been opposed to this attempt and several others which had been introduced since President Donald Trump took office. Only one, the American Health Care Act, managed to pass when the House approved it by a narrow margin in May. Graham-Cassidy was seen as a last ditch effort at repeal-and-replace ahead of a Sept. 30 deadline to use the budget reconciliation process, which allowed Republicans to avoid a Democratic filibuster and pass the bill with a simple majority.
The legislation centered on turning the ACA’s funding for premium support and Medicaid expansion into block grants, generally redistributing funds from expansion states to nonexpansion states. The Congressional Budget Office estimated it would amount to a $1 trillion cut in Medicaid funding through 2026, while other estimates pegged the loss in insurance coverage as high as 32 million.
The bill’s namesakes, Sens. Lindsey Graham, R-South Carolina, and Bill Cassidy, MD, R-Louisiana, said on Sept. 26 they didn’t have enough support among their Republican colleagues to pass the bill. Six medical groups—the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, the American Osteopathic Association and the American Psychiatric Association—released a joint statement saying the bill “would have done so much harm to so many.”
“The policies put forward in the Graham-Cassidy bill would have dramatically increased the number of uninsured in our country,” the groups wrote. “The bill would have put vulnerable patients with pre-existing conditions at risk of being priced out of health insurance. It would have taken away patients‘ assurances that their health insurance would cover essential benefits like maternity care and mental health services. We urge the Senate and the House to move on, for good, from their efforts to roll back coverage.”
The American Hospital Association echoed the call for the parties to work together on future healthcare legislation and added a gentle warning to Democrats.
“The failure of this proposal shouldn’t be a victory for one side or a loss for the other, but rather a catalyst to spark meaningful solutions,” AHA President and CEO Rick Pollack said in a statement. “Instead of once again pursuing a partisan path while expecting a different result, it is our hope that leaders from across the aisle will start to work together for the benefit of patients across America.”
There had been bipartisan talks on a short-term stabilization effort through the Senate Health, Education, Labor and Pensions (HELP) Committee, but those discussions were halted as Graham-Cassidy gained momentum among Republicans last week. The ranking Democrat on that committee, Sen. Patty Murray of Washington, said she was ready to reopen negotiations on a bill which would likely involve full funding for cost-sharing reduction subsidies to insurers for at least a year in exchange for offering states wider latitude on the ACA’s waiver process to experiment with benefit design.
A week after he said Republicans and Democrats couldn’t reach a consensus on a short-term fix, HELP Committee Chairman Lamar Alexander, R-Tennessee, indicated he’s willing to try again.
“I will consult with Senator Murray and with other senators, both Republicans and Democrats, to see if senators can find consensus on a limited bipartisan plan that could be enacted into law to help lower premiums and make insurance available to the 18 million Americans in the individual market in 2018 and 2019,” Alexander said in a statement, noting that he would’ve voted for Graham-Cassidy.
It may be too late to have much impact on the ACA market for 2018, however. The decision to table the bill came just a day before insurers have to finalize contracts to offer coverage through the federal Healthcare.gov exchange. States have already begun announcing rate increases—in Florida, for example, premiums for individual market plans will increase by an average of 44.7 percent, according to the state’s Office of Insurance Regulation.