Just when bipartisan Senate negotiations on stabilizing the Affordable Care Act’s (ACA) marketplaces and extending the Children’s Health Insurance Program were picking up steam, Senate leaders have abruptly decided to make a last-ditch effort to repeal the ACA, also known as Obamacare, and impose massive cuts to Medicaid.
Why the sudden rush to try again on repeal? Basically, they’re facing a deadline. The Senate parliamentarian recently ruled that the procedural shortcut that allows Senate Republicans to pass repeal with only 51 votes will expire on Sept. 30. Although Senate Republicans had finally seemed ready to move on after July’s failed vote, key senators have seized on the impending deadline to push for one final attempt at repeal.
Senators Lindsey Graham and Bill Cassidy, the sponsors of the Graham-Cassidy repeal bill, claim that their bill is different—that it simply shifts health care decisions to the states. This is false. Just like the failed repeal bills that came before it, Graham-Cassidy would result in millions of Americans losing health coverage. And in crucial respects, it’s the most harmful version of repeal yet.
Like the previous bills, Graham-Cassidy would cap funding for the traditional Medicaid program, shrinking it over time and leaving millions fewer low-income people covered.
Furthermore, it would eliminate funding for the ACA’s premium tax credits and Medicaid expansion and replace these with a block grant that states could spend on a range of health care activities. The Center on Budget and Policy Priorities estimates that this block grant would represent a $239 billion funding cut compared to current law from 2020 to 2026, which would lead to millions of people losing coverage.
Although Graham and Cassidy claim that this will increase flexibility for states, in reality it will do the opposite. Slashing federal funding will force states to cut eligibility or benefits based on budgetary limits.
And worse, the state flexibility that Graham-Cassidy does provide is designed to get rid of important consumer protections. Under Graham-Cassidy, states could allow insurance companies to once again charge people with pre-existing conditions higher premiums based on their health status or medical history. For example, someone with asthma could be charged an estimated $4,320 more in premiums, while a pregnant woman could be charged $17,320 extra.
Perhaps most shockingly of all, Graham-Cassidy’s block grant funding simply disappears entirely after 2026, which means the complete elimination of Medicaid expansion and financial assistance for people who buy coverage in the individual market. Meanwhile, the annual growth rate for the Medicaid caps would be reduced starting in 2025, resulting in even deeper cuts as the capped funding levels failed to keep pace with rising health care costs in future years.
Yet even though Graham-Cassidy is the harshest version of repeal yet, Senate Republicans suddenly appear dangerously close to passing it in the next two weeks. And despite the widespread criticism of the secretive and rushed process used for the previous Senate repeal bills, they’re planning to allow even less scrutiny of Graham-Cassidy. Not only do they intend to vote on the bill with only 90 seconds of debate and no committee markups to consider amendments, but they’re planning to vote without a full Congressional Budget Office score to estimate the bill’s impact on health coverage and premiums.
Just like last time, this absurd lack of transparency is part of a strategy. Senate Majority Leader Mitch McConnell knows that his only hope of passing the bill is hiding its effects from the public—and his fellow senators—until it’s too late. That sad fact is all the proof we need that it’s time to finally abandon repeal and move on.
Thomas Huelskoetter is a health policy analyst at the Center for American Progress.