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Rotting Corpse of Obamacare Repeal Haunting Congressional Hallways. Chance of Zombie Attack Rising

Rotting Corpse Of Obamacare Repeal Haunting Congressional Hallways. Chance Of Zombie Attack Rising

An idea that looked like a potentially good Obamacare stabilization stop-gap months ago appears to be another tired GOP Affordable Care Act (ACA) repeal attempt today. Led by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), along with Sens. Dean Heller (R-Nev.) and Ron Johnson (R-Wis.), their bill would:

  • Repeal most of the ACA (except most taxes) and give lump-sum monies to the states to run uninsured coverage programs for about a decade. We viewed block grants positively in the past to help states stabilize Exchanges by limiting premiums and plan pullouts. That might have worked. As a complete substitute for the ACA, we don’t think so.
  • Remove both the employer and individual mandates. Without a defined benefit structure (however ugly we think the current one may be), it is a recipe to further increase adverse selection.
  • Give significant flexibility to states to waive pre-existing condition protections, eat away at the essential benefits mandates, and reduce or remove limits on allowable premium variability between old and young. Some of these reforms are worthy of looking at ad hoc. But together, and combined with the mandate repeals, they do little to drive consistent coverage for all Americans. We are back to the “dog eat dog” world of healthcare.
  • Eliminate the Medicaid expansion funding under the ACA, limit funding to states over time through a per-capita cap formula, and endorse equalization of payments to states. We have gone on record about the importance of the Medicaid program and expansion. Smart reform is needed, including a generous per-capita cap allocation, but the approach here is wrong-headed. And while we are sympathetic to some steps to limit the over-spending and richness of the benefits in some states for both Exchanges and Medicaid, the Graham-Cassidy bill is draconian.The 31 states that took the chance on the national experiment would have the rug pulled right out from under them.

In summary, what looked like a decent idea was co-opted by sinister elements on Capitol Hill. Thankfully, the bill’s future still looks a little bleak right now. But you never know what will happen on Capitol Hill. Deader bills have come back to life. Weighing against this bill are several procedural issues. The Congressional Budget Office (CBO) will not issue a report until next week and then only a partial one. To get this through the Senate would require days of debate, time the upper chamber may not have due to other pressing matters.

However, momentum seems to be building. The opportunity to send this bill through under budget reconciliation (where just 51 votes are needed in the Senate) expires at the end of September. If the Senate were to pass the bill, we have little doubt that the House would adopt it quickly. Which means that, based on the last votes in the Senate, one or two of three GOP senators will decide the bill’s fate. Lisa Murkowski of Alaska seems to be the most likely to switch sides. She is being actively courted, although her state’s Governor has come out against the bill. Susan Collins of Maine is likely to continue opposing repeal. Our superhero, Sen. John McCain of Arizona, has taken issue with the process but has not yet ruled out support. In fact, he seemingly endorsed the bill about 10 days back, although he later re-thought his rather vigorous endorsement. Arizona’s governor also has endorsed the bill, but others on both sides of the aisle (including policy sage John Kasich, R-OH) have lined up against it. The wild card of conservative firebrand Rand Paul of Kentucky has also voiced opposition. But many are now outflanking him, arguing a vote against the bill would be a tacit endorsement of Obamacare. So Paul may get on board after all. Signs that this could have life are the fact that Democrats are wildly worried and all other talks on reasonable bipartisan compromise largely have been shut down.

In the end, the bill is a political one, not a reasonable effort at policy reform. The reallocation provision outlined above essentially moves dollars from Democratic states (largely) to GOP states. The sport of politics is a fun one that this blogger has followed for years. But the sport should not cause havoc in America’s healthcare system. The truth is about two-thirds of all states would lose funding overall, with a total national reduction through 2026 in excess of $200 billion. We will find out what happens soon, as Senate Majority Leader Mitch McConnell, R-KY, has announced a floor vote for next week.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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