With the Fiscal Year 2017 budget reconciliation instructions expiring on Saturday, September 30, the Senate is making one last push to consider Affordable Care Act (ACA) repeal-and-replace legislation drafted by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA).
A Senate vote on the Graham-Cassidy proposal may take place as early as Wednesday. With all Democrats expected to oppose the bill, Republicans can only lose support from two senators and still have the bill pass, with Vice President Pence casting the tie breaking vote. On Friday, September 22, Senator John McCain (R-AZ) released a statement indicating he would vote no on the Graham-Cassidy bill. Senator Rand Paul (R-KY) has already announced his opposition, and Senator Susan Collins (R-ME) has said she is “leaning against” the bill. Senators Graham and Cassidy were still working on changes to the bill to attract support, and released a revised version (with another revision expected today) and revised State-by-State funding chart late Sunday night. House Freedom Caucus Chairman Mark Meadows (R-NC) predicted that the bill would pass the House if it is able to clear the Senate.
The Senate Finance Committee held a hearing today on the Graham-Cassidy bill, which would convert ACA insurance subsidies and Medicaid funding to a block grant program, for States to use to develop their own approaches to health care coverage. The Congressional Budget Office is expected to release a limited analysis of the Graham-Cassidy bill early this week. Prominent physician, hospital, and insurance trade associations, including the American Medical Association, American Hospital Association, and BlueCross BlueShield Association, issued a statement over the weekend urging the Senate to reject the Graham-Cassidy bill.
Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) had been working on an effort to stabilize the individual market. However, last week, President Trump and House Speaker Paul Ryan indicated they would not support this bipartisan effort, as the House would not be able to support legislation that continued ACA subsidies without repealing and replacing the law. In his statement announcing opposition to the Graham-Cassidy bill, Senator McCain noted that “We should not be content to pass health care legislation on a party-line basis, as Democrats did when they rammed Obamacare through Congress in 2009.” He further hoped that Senators Alexander and Murray would “resume their work should this last attempt at a partisan solution fail.”
Funding for the Children’s Health Insurance Program (CHIP) also expires September 30. According to a July issue brief released by the Medicaid and CHIP Payment and Access Commission (MACPAC), without a funding extension, “all states are expected to exhaust their federal CHIP funds during FY 2018….Three states and the District of Columbia are projected to exhaust their funds by December 2017.” On September 18, Senate Finance Chairman Orrin Hatch (R-UT) and Ranking Minority Member Ron Wyden (D-OR) introduced S. 1827, the Keeping Kids’ Insurance Dependable and Secure (KIDS) Act, a five-year funding extension for CHIP. Their agreement would preserve the ACA’s 23-percent increase in the Federal matching rate to States for 2018 and 2019, reducing the matching rate in 2020. The House Energy and Commerce Committee has not yet released a proposal.