Repeal Fever is Back on Capitol Hill and It’s Deadly Serious

By Jill Zorn

The Republican majority is feverishly working to pass the Cassidy-Graham bill and take health care away from 32 million people.  They just might succeed.

About the Bill

Cassidy-Graham uses block grants, beginning in 2020, to kill the Affordable Care Act (ACA) marketplaces and Medicaid expansion.  On top of that, the bill institutes per capita caps on the rest of Medicaid, draining financial support for this vital program that serves 70 million Americans.  Over time, these payment mechanisms will not keep up with medical inflation and drain federal funding from the states.  In 2027, this funding disappears all together.

The Center on Budget and Policy Priorities (CBPP) estimates that the bill means $80 billion cut by 2026.  After 2026 the picture gets even worse.  Support for the ACA subsidies and Medicaid expansion completely disappear and the funding dives off a cliff, becoming a $300 billion cut.  These dollars would then be available to allow Republicans to give even bigger tax cuts to “millionaires and billionaires”.

Like many of the other repeal bills, Cassidy-Graham would allow states to apply for waivers that would threaten hard-earned protections, including for people with pre-existing conditions.

But Wait, There’s More

There are three particularly insidious features of this bill that make it even worse than previous versions of repeal.

  1. The block grant funding, which is taken from the ACA subsidies and Medicaid expansion dollars, doesn’t actually have to be spent on retaining the insurance marketplaces and the Medicaid expansion. Instead, states have the “flexibility” to spend the money on other options such as setting up high risk pools.   Remember how well high risk pools worked prior to the ACA?  Hint:  not well!

Even if a progressive state chooses to use the funds for good rather than evil, the decrease in funding over time and its complete disappearance after 2026 does not bode well for positive coverage experiments and expansions.

  1. The second major outrage of this bill is that the block grants will be redistributed. Many red states that failed to expand Medicaid will be rewarded with funding increases, while states that expanded Medicaid will see more draconian cuts.

The map, below, shows which states are winners and which are losers under Cassidy-Graham by 2026. Connecticut, which right now cannot figure out how to close a large budget deficit, will lose over $2.3 billion by 2026 – a cut we can ill afford.  The state-by-state estimates for 2027, when the block grant disappears can be found here.  They are even more dire and show Connecticut’s loss to be over $4 billion. By the way, our entire 2017 state budget was $20.4 billion.


  1. The third despicable aspect of this bill is that it has upped the ante on attacks on women’s reproductive health. In addition to the “familiar” abortion restrictions it bans abortion coverage in any program that receives block grant money.  A state like Connecticut, for example, where abortions are covered by Medicaid, would no longer be permitted to cover this service.

How it Could Pass

This headline says it all:  Rushed Senate Consideration of Cassidy-Graham Would be Designed to Hide Bill’s Severe Flaws.  Why the rush?  The Senate must pass Cassidy-Graham by September 30.  After that, the opportunity to use the budget reconciliation process to pass the bill with a simple majority will be gone.

Word is that the Republicans are close to having the 50 votes they need to pass the bill in the Senate.  If they have the votes, this is how they plan to ram it through the Senate next week:

  • Two rushed hearings have now been scheduled, including one in the Homeland Security Committee – not a committee that normally deals with health care – to provide a fig leaf of “regular order” that may just satisfy Senator John McCain.
  • The vote will be taken with only a preliminary score from the Congressional Budget Office (CBO).   There is not enough time for the CBO to calculate detailed estimates of the impact of the bill on insurance coverage, deficit reduction and insurance premiums will be missing.
  • While the Democrats can try slowing down the business of the Senate, if Mitch McConnell decides to bring it to the floor, that will mean he has the votes and the bill can’t be stopped. Once on the floor, there is nothing to prevent McConnell from calling for a vote after “just two minutes of debate or less”.

If passed by the Senate, the bill would go over to the House.  Their vote would be not subject to the September 30 deadline.  But they would have to pass the bill with no changes.

What Can We Do?

Activists are sounding the alarm and mobilizing for a full-court press against Cassidy-Graham. A rally was held today outside the Capitol in DC and more are planned for next week.  People in states with target Senators have been urged to call and call again, asking their Senator to vote no.

Here in Connecticut, Senator Blumenthal is holding a rally to protect the ACA and Medicaid from this terrible bill at the Legislative Office Building in Hartford on Wednesday, September 20 at 1:30 pm.  Check the Protect Our Care Connecticut web site for information about this and other planned events and sign up to receive action alerts as more are scheduled.

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