Cassidy-Graham ACA repeal bill gains steam; hospitals alarmed, but bill has a rural skew

Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana have offered up what may be the GOP's last-ditch effort to offer up an alternative to the Patient Protection and Affordable Care Act. Sens. Dean Heller of Nevada and Ron Johnson of Wisconsin were also involved in the planning. The Republicans must repeal the ACA by Sept. 30 if they want to do so by a simple majority. Sarah Kliff of Vox says the Graham-Cassidy plan is, in many ways, "the most radical one yet."

"The proposal would eliminate the health-care law’s subsidies for private insurance and end the Medicaid expansion. States could allow for waivers that let insurers charge sick patients higher premiums and stop covering certain benefits required under the Affordable Care Act, like maternity care or prescription drugs. The health insurance marketplaces would no longer exist as they are envisioned to continue under other Republican proposals," Kliff reports. "The federal government would convert some (but not all) of that spending into a lump-sum payment to states. States could choose to spend this money on providing insurance — or they could use it to fund high-risk pools, or do other activities to pay the bills of patients with high medical needs. States wouldn’t get this money for free: They’d be required to kick in a small percentage themselves."

Kliff writes that the plan leans toward rural states. "The complex funding formula used to divvy up the big pot of money would tilt more funding toward sparsely populated states. It advantages rural states that have fewer people per square mile than those with denser, more urban populations." As a Senate bill, that is not surprising.

Some hospital groups say the plan alarms them at first blush, but say they're still studying it, Harris Meyer reports for Modern Healthcare. "It will decimate the Medicaid program in California," said Jan Emerson-Shea, vice president for external affairs at the California Hospital Association, who estimated that as many as  5 million people in her state could lose coverage under the bill. "The redistributive effect of this proposal is worse than any other proposal surfaced this year."

L-R: Sens. Dean Heller, Bill Cassidy, Ron Johnson, and Lindsey Graham at a press conference this morning to discuss their bill. (Associated Press photo by Andrew Harnik)

Trump has guardedly supported the plan, saying in a tweet that he "applauds the Senate for continuing to work toward a solution to relieve the disastrous Obamacare burden" and "sincerely hopes that Senators Graham and Cassidy have found a way to address the Obamacare crisis."

In an interview with Al Cross, director of the Institute for Rural Journalism and Community Issues, Senate Majority Leader Mitch McConnell said the bill will come to the floor if his allies can find the votes. "There’s a lot of discussion, but the time is running on that," he said. "It could well come up. If we have 50 votes, we’ll go to it." At a press conference this morning, Cassidy "said his informal whip count stands at '48 or 49' GOP votes," Tom Howell reports for The Washington Post. With 50, Vice President Mike Pence would break the tie for passage. The last repeal-and-replace effort got 49, with Graham's running buddy, John McCain of Arizona, casting the deciding vote against it.