The Graham-Cassidy bill, proposed last week by Republican senators Lindsey Graham and Bill Cassidy, goes to vote next Wednesday as part of the federal budget reconciliation process. It needs 50 votes to move forward.
The bill has a lot in common with the repeal-and-replace measures that failed earlier this summer. It eliminates the individual mandates, cuts subsidies for public health exchanges, and defunds Planned Parenthood, for example. It also gives states the choice to bow out of essential health benefits like mental health care and emergency visits, and to take pre-existing conditions into account for insurance eligibility.
Perhaps most importantly, the measure would change the way federal funding is allocated for Medi-Cal. Rather than an adjusted rate based on the number of people enrolled, the new plan would give states capped block grants.
One report from analysis group Avalere suggests California could lose $78 million in federal health care funding. That’s bad news for the 13 million people on Medi-Cal statewide. Nationally, about 30 million are expected to lose coverage if the current plan becomes law.
“If these proposals were to go forward, both primary and specialty care would fall further, emergency rooms would be more crowded, we would have undone exactly what ACA was trying to accomplish,” said Dr. Ted Mazer, president-elect of the California Medical Association.
Obamacare has faced a lot of criticism over the years due to high premium rates in the subsidized exchange and low reimbursement rates for providers.
Sally Pipes, of the Pacific Research Institute, says she’s in favor of repealing and replacing that system. But she isn’t sure block grants are the way to go.
“I’m pleased that the Medicaid expansion and the income-based subsidies would end,” she says. “But if the funds are block-granted to the state of California, my concern is that the funds will be used to build up a single payer plan and not to remove the insurance regulations under Obamacare.”
At a Sacramento convening Thursday, patient advocates, doctors and health plan representatives discussed single payer, Medicaid buy-in options, and other alternatives they might turn to should the Affordable Care Act fall.
But the general consensus was that the damage to the state’s health infrastructure, and all-around economy, would be deep.
“There’s just no way, given our current tax structure, that we can ever make up for that loss,” said Gary Cohen of Blue Shield of California.
This the fourth federal effort to repeal the Affordable Care Act.
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