The mountain of false health care promises made by members of Congress is starting to avalanche: We won’t repeal without an adequate replacement. No one will lose coverage. No one will be discriminated against because of a preexisting condition. Premiums will go down. Congress will move through regular order. At one point or another, many Republican lawmakers made all of these statements, but if the Graham-Cassidy bill to repeal the Affordable Care Act (ACA) passes — which is looking increasingly likely — it will be clear that they were all lies.
The Graham-Cassidy proposal contains the same dangerous policies as the previous iterations of the ACA repeal bills. Just like the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA), the Graham-Cassidy bill repeals much of the Affordable Care Act and then on top of that ends the Medicaid program as we know it.
The bill takes all federal funding for the Medicaid expansion and the ACA subsidies and converts them to a rigid block grant to the states. This funding would not change based on a state’s needs and could be spent on almost any health care purpose. Moreover, all this funding is eliminated in 2026. It eliminates the Medicaid expansion, which has helped 11 million people get health coverage, and it eliminates the health insurance subsidies that have enabled low- and moderate-income individuals to afford coverage.
The bill would also allow states to choose skimpy coverage or let insurance companies charge more for patients with preexisting conditions.
That’s just the “ACA repeal” section of the Graham-Cassidy proposal. Instead of any sort of a replacement, there’s just an “end Medicaid as we know it” section. This bill goes far beyond repealing the ACA. The Graham-Cassidy proposal caps Medicaid, ending the guaranteed entitlement nature of the program. The Medicaid “per capita cap” in Graham-Cassidy doesn’t account for the fact that some states are going to have disproportionately higher health care costs. Currently, if there’s a health outbreak (like Zika) or a spike in the need for health services (like the opioid epidemic), Medicaid will automatically respond to cover those services.
Under the Graham-Cassidy proposal, in contrast, each state gets a capped amount of money, and if need or costs go up, too bad: It’s on the state to come up with the rest of the money, or alternatively, to cut benefits or eligibility.
Or say a state has a particularly old and aging population. That state is going to have higher health care costs that continue to increase over time, and the Medicaid cap doesn’t adjust for that. What’s worse is that Medicaid is not just capped, but its funding is then cut over time so the situation will continue to get worse for states as they have to come up with more and more money — billions of dollars they don’t have.
In 2027 alone, it is estimated that the Cassidy-Graham proposal would cut federal health care funding by nearly $300 billion. Within the next 20 years, Graham-Cassidy cuts federal health care funding by an astounding $4 trillion.
And then there’s the process. Let’s talk about how unbelievable this process is. This bill is being rushed through without proper hearings, without proper debate, without proper analysis of its impact in the same hyper-partisan manner as the AHCA and the BCRA were. At the last minute, Senate leaders hurriedly scheduled a hearing — one hearing — in the Senate Finance Committee two days before they hope to bring the bill to the Senate floor for a vote. They are using the same budget reconciliation procedure that allows the Senate to pass the bill without a filibuster and with a simple majority. And the Senate already used up nearly all the debate time in July. So there will be practically no time to actually debate this bill.
With a September 30 deadline to act, the Senate is rushing this bill so fast that the Congressional Budget Office won’t even be able to say how many people will lose coverage or how much premiums will go up. Senators are voting up or down for a bill that impacts one-sixth of the economy without knowing the full effect on their constituents or the country. The Center on Budget and Policy Priorities has estimated that more than 32 million people could lose health coverage — 32 million people!
What’s most frustrating is that the conversation on Capitol Hill has become more about the politics on this issue than the impact on real people. The personal stories need to come through. The importance of Medicaid has to come through.
The loud public outcry against cutting and dismantling the Medicaid program is what brought down the AHCA and the BCRA. The moral outrage against taking away health coverage from tens of millions of Americans and charging people with preexisting conditions unaffordable rates convinced enough senators to come out and oppose that legislation. And that is what can bring down the Graham-Cassidy proposal.
People showing up to congressional district offices, calling their senators again and again, writing to their local papers — that is what makes the difference. That’s what creates the real pressure that forces a senator to go to leadership and say, “I’m getting so much heat on this bill. Please don’t make me vote for it.”
It’s been a grueling nine months, but we can’t let up now. The consequences are too devastating not to act and speak up now.