New Senate Bill to Replace ACA Gives More Power to States


September 13, 2017

A group of Senate Republicans today introduced yet another bill that would largely repeal and replace the Affordable Care Act (ACA), this time around by giving block grants to states to enact their own healthcare reforms.

The money for the block grants would come from what the federal government now spends on the ACA.

The legislation goes by the names of its four sponsors ― Sen. Bill Cassidy, MD, (R-LA); Sen. Lindsey Graham (R-SC); Sen. Dean Heller (R-NV), and Sen. Ron Johnson (R-WI).

"If you believe repealing and replacing Obamacare is a good idea, this is your best and only hope," said Graham at a press conference today. "Everything else has failed except this approach."

Graham warned that if Republicans fail to pass his bill, a single-payer system like the kind proposed by Sen. Bernie Sanders (I-VT) and Democratic allies was inevitable.

The block grants under the Graham-Cassidy-Heller-Johnson bill would replace current ACA expenditures on Medicaid expansion, premium subsidies for health plans bought on insurance exchanges, cost-sharing subsidies, and the so-called Basic Health Program for low-income individuals that some states have adopted. States could use the block grants to contract with insurers to encourage their participation in the exchanges, subsidize premiums and out-of-pocket costs for individuals, pay physicians and hospitals, support their Medicaid programs, and create high-risk and reinsurance pools.

The Graham-Cassidy-Heller-Johnson bill would repeal the ACA's individual mandate to obtain insurance coverage, the mandate for large employers to provide coverage to employees, and the law's tax on medical device makers. Individuals with preexisting conditions would still have access to affordable coverage, according to a section-by-section description of the law released by lawmakers.

Three other Senate Republican bills to undo the ACA crashed and burned earlier this summer despite the GOP enjoying a 52-seat majority in that chamber of Congress. All three bills, each of which would have increased the number of uninsured, failed to win over a handful of Republican senators who wanted to preserve coverage gains under the ACA.

Like the earlier legislation, the Graham-Cassidy-Heller-Johnson bill needs only 51 votes to pass in the Senate, or 50 if Vice President Mike Pence casts a tiebreaker. Senate Republicans don't have the 60 votes needed to break a Democrat filibuster, but they've engineered their repeal-and-replace legislation to be filibuster-proof under a parliamentary procedure called budget reconciliation. This legerdemain lowers the bar for passage to a simple majority, but not forever. A resolution that the Republican-controlled Congress passed to apply budget reconciliation to anti-ACA legislation will expire on September 30, the end of the current fiscal year.

Meanwhile, Republicans and Democrats on the Senate Committee on Health, Education, Labor, and Pensions (HELP) are trying to fast-track a bill that would strengthen the insurance exchanges established by the ACA for buying individual and family coverage in time for 2018. Open enrollment for coverage for next year begins on November 1 and ends December 15.

Follow Robert Lowes on Twitter @LowesRobert


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