The latest attempt to repeal the Affordable Care Act (ACA) is known as Cassidy-Graham, and it very well may be the greatest threat to Kentucky’s health care we’ve seen. The state’s recent success in getting people coverage, and even health care gains achieved decades ago, are at risk of being undone with this legislation.
The bill, sponsored by Senators Bill Cassidy and Lindsey Graham, is perhaps the final attempt at tearing up the ACA and doing permanent damage to Medicaid. It’s being rushed through before policymakers and the public can understand its implications. That’s because after September 30, the Senate can no longer pass a partisan repeal bill with only 51 votes due to chamber rules.
The Cassidy-Graham bill, like all previous ACA repeal bills, would undermine Kentucky’s historic gains in coverage and health. It would cause hundreds of thousands of Kentuckians to lose coverage, while undermining insurance protections for millions more.
Medicaid expansion, which has extended coverage to 475,000 Kentuckians, would be eliminated.
The ACA’s marketplace subsidies, which help over 81,000 afford coverage, would be gone.
Instead, states would get a much smaller, temporary “block grant” of money. Because the amount of money would be fixed each year, Kentucky would be on the hook for any and all unexpected costs from recessions, public health emergencies like the opioid epidemic or a Hepatitis C outbreak and prescription drug price spikes. What is truly devastating is that after 2026, this money would disappear altogether.
In addition, the core Medicaid program — not just the expansion of Medicaid under the ACA — would be radically restructured and cut, putting at risk care for seniors, people with disabilities and families with children, including services such as long-term, home and community-based care for especially vulnerable Kentuckians.
The bill would slash federal funding for health coverage in Kentucky by nearly $7 billion in 2027 alone as a result of these changes. This is a massive cut: by comparison, the entire state of Kentucky’s 2017 General Fund was $10.5 billion.
Protections for people with pre-existing conditions would be left to the whims of each state. In fact, Kentucky lawmakers could let insurers charge people with health conditions exorbitant, unaffordable premiums and sell plans that leave out essential benefits like maternity care and mental health care. The bill would also mean annual and lifetime caps on what an insurer will spend on your care could make a comeback, reviving the risk of medical bankruptcy from an illness or injury.
This threat is happening even while real health care issues loom that need to be addressed. The Children’s Health Insurance Program is about to run out of money. Community health centers that provide a large share of the health care in the commonwealth need congress to reauthorize their funding, too. Senators Alexander and Murray have a serious bipartisan proposal to help give insurers the confidence they need to reduce the cost of quality coverage. But all of these are being pushed to the side for a bill that would fundamentally harm a $3 trillion slice of the American economy.
Senator McConnell and Senator Paul need to ensure we don’t turn back the clock with this bill, and instead focus on ways to continue moving our health forward.
One repeal bill is left standing. Let’s make sure it’s the last.
This column originally ran in the Lexington Herald-Leader on Sept. 19, 2017.