[NYAPRS Enews] Every State Medicaid Director, Big Insurers Assail GOP ACA Repeal Bill

[Harvey Rosenthal]

Medicaid Directors Issue Warning On New Obamacare Repeal Bill
The Hill  September 21, 2017

The National Association of Medicaid Directors (NAMD) warned Republicans on Thursday that the Senate's latest ObamaCare repeal bill would place a massive burden on states.

The bill, sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), would eliminate ObamaCare's Medicaid expansion and subsidies beginning in 2020, converting the funding to state block grants.

It would also change the federal government's funding of the traditional Medicaid program from an open-ended commitment to the states to a per-capita cap on each enrollee.

"Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country's history," NAMD's board of directors wrote in a statement Thursday.

The NAMD, which is a coalition of Medicaid directors from every state, noted that while the proposal is intended to create maximum flexibility, it does not provide the statutory reforms necessary "commensurate with proposed funding reductions."

The GOP bill would also require states create their own health-care programs by 2020, which the directors argue is a massive undertaking.

"The scope of this work, and the resources required to support state planning and implementation activities, cannot be overstated," the directors said.

"States will need to develop overall strategies, invest in infrastructure development, systems changes, provider and managed care plan contracting, and perform a host of other activities. The vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities."

The directors also hit Senate Republicans for not having a full Congressional Budget Office (CBO) score before a possible vote on the bill, "which should be the bare minimum required for beginning consideration."

"With only a few legislative days left for the entire process to conclude, there clearly is not sufficient time for policymakers, Governors, Medicaid Directors, or other critical stakeholders to engage in the thoughtful deliberation necessary to ensure successful long-term reforms," the directors said.

Senate Majority Leader Mitch McConnell's (R-Ky.) office has said the intention is to have a vote next week on the measure.

However, it's unclear if Republicans have the 50 votes needed for it to pass with Vice President Pence casting a tie-breaking vote. Lawmakers are also under pressure to secure the votes since the legislative vehicle Republicans are using for the bill expires at the end of September.

The last GOP effort to repeal ObamaCare failed in July, when Sen. John McCain (R-Ariz.) cast the deciding vote against it.
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Even the Insurance Industry Is Against the Latest GOP Health Care Plan
By Aric Jenkins Fortune September 21, 2017

Despite the general view that health insurance companies would benefit from a free and open market, two of the biggest trade groups for insurers - Blue Cross Blue Shield Association and America's Health Insurance Plans - announced their first opposition to the Republicans' latest plan to repeal and replace Obamacare.

Both the Blue Cross and the AHIP came out against the so-called Graham-Cassidy bill Wednesday, arguing that the legislation would lead to an unstable market that would harm both insurers and patients.

"The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions,'' the Blue Cross association said in a statement. "The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans' choice of health plans."

The AHIP doubled down on those sentiments, writing that the bill "would have real consequences on consumers and patients by further destabilizing the individual market" and could "potentially allowing government-controlled, single payer health care to grow," in a letter to Senate majority and minority leaders Mitch McConnell (R-Ky.) and Chuck Schumer (D-N.Y.).

The insurance trade associations' resistance joins a number of health care groups already speaking out against the proposed bill, including the American Medical Association, the American Hospital Association and the American Association of Retired Persons.

The Graham-Cassidy bill, named after two of its drafters, Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), has a voting deadline of Sept. 30. The Senate is expected to vote on the legislation next week after several previously unsuccessful attempts earlier this year.

President Donald Trump talked up the bill Wednesday, saying that it has "a very good chance" of passing in the Senate.

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