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Coffee CAHC policy round-up: September 20, 2017

Coffee CAHC is a twice-weekly newsletter where we round up and comment on the latest health coverage policy developments both nationally and here in Maine. We hope you find these updates helpful!

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Coffee CAHC

115th Congress, 1st session

128th Maine Legislature, adjourned

 

Wednesday, September 20, 2017

 

I have Conference Brain. The 5th annual Health Care for Maine conference is just six days away. Because of that, I’m afraid that I completely hit a wall trying to think of something clever or witty to write here. That being said, I’m getting really excited for our conference, and can’t wait to see many of you there next week!

 

National level

Red alert!

With the clock ticking down more and more loudly to the September 30th deadline for their reconciliation vehicle, Senate Republicans seem determined to leave it all on the field as they make a last push to repeal and replace the ACA.

I got into some of the specifics around Graham-Cassidy on Friday, but here are a few more fun details that have emerged in the past few days:

  • The bill torches protections for pre-existing conditions by leaving it up to the states whether they want to cover them or not. Remember how, just a few months ago, there was all that talk of the “Jimmy Kimmel test”? Jimmy Kimmel had something to say last night about this newest bill.
  • The two Senators whose names are on the bill (Lindsay Graham, R-SC, and Bill Cassidy, R-LA) admitted in interviews and in speeches on the Senate floor that their bill redistributes funding because they feel that the ACA, and states that have expanded Medicaid, “favors…blue states against the rest of us”.
  • The bill would immediately exclude any plan that covers abortion from being considered a “qualified health plan”, or QHP – a big problem in California in particular, where state law requires QHPs to cover abortion.

On top of that, a comprehensive new analysis out today from Avalere Health shows which states are net losers under the new funding structure in Graham-Cassidy. Maine, for instance, will lose $1 billion in federal funding between 2020-2026, $2 billion between 2020-2027, and a stunning $17 billion from 2020 to 2036.

No wonder Sarah Kliff says that, after “[covering] the GOP repeal plans since day one” that this one “is the most radical.”

Most disappointing of all, GOP leadership is going all-in on this one, and pulled the plug on the bipartisan talks in the Health, Education, Labor, and Pensions (HELP) Committee that seemed to be on a positive trajectory.

So, where things stand now is that the Senate Finance committee will hold a hearing on Graham-Cassidy next week. I say “hearing” as kind of a joke. This bill is a dangerous and radical overhaul of one of the largest segments of the U.S. economy, completely upends the current bargain between the federal government and states on health care, would result in millions of people losing coverage, and can’t even be explained by many of the senators who are rushing to vote for it – and so naturally one hastily-arranged hearing should be plenty for the Senate to figure out what they need to know, right? …right?

Which gets us to vote-counting.

Right now, all eyes are on four senators.

Senator Susan Collins of Maine has opposed every version of the repeal/replace legislation so far. She has not stated opposition to this one yet, but there’s nothing in here that seems to assuage any of her concerns about the versions that came before it. On top of that, she was firmly in support of bipartisan hearings, and introduced new bipartisan legislation yesterday.

Senator Lisa Murkowski has also opposed every other version that came before. Again, it’s hard to see what in here gets her vote – especially since, according to the Avalere analysis, Alaska is going to lose about 11% of the federal funding they currently receive under the ACA. Sen. Murkowski cited Alaska Governor Bill Walker’s concern as (I’m quoting Sen. Murkowski quoting Gov. Walker here) “I like flexibility, but if I get half as much money, flexibility doesn’t help me.”

Senator Rand Paul of Kentucky has been most vocally opposed to Graham-Cassidy so far, but there is widespread belief that if push came to shove, he might not oppose his party’s last, best shot to undo Obamacare.

And then there’s Senator John McCain.

Of course we all remember that it was his dramatic opposition in the dead of night that tanked the repeal rush back in late July/early August. He’s been hard to read over the past week. Many commentators note that he and Senator Graham are particularly close friends. Sen. McCain also said that his governor’s support for the bill would be crucial to his voting for it; that support materialized earlier this week. However, he has also been insistent that any bill must go through “regular order” – that is, a full hearing process and a 60-vote threshold. It is widely believed that the rushed Finance “hearing” on Monday is an attempt to convince Senator McCain that this has happened – to which McCain himself sarcastically replied “Do you think that’s regular order?” when a reporter asked him for his reaction to the hearing.

So…who knows. There’s also, I think, a fair question mark about a bunch of Senators from states where a lot of federal funding would disappear under this bill. Ohio and West Virginia, for instance, both take big, bit hits under this new formula, and those are two states – West Virginia in particular – with Senators who were, at one point or another, slightly more “on the fence” about repeal/replace because of the impact it would have on their constituents.

What is certain is what we do now. You know the drill. We’ve been here before. Call, write, and stay in touch with your elected officials to let them know what you think of this. They listened to you before. We stopped this thing before. Time to get it done one last time.

 

State level

Another quiet stretch here. Expect to hear more soon about the status of the health care study task force that we’ve talked about before – there should be appointments made to that commission soon.

 

Would you like to know more?

Politico has a good round-up on the mounting opposition to Graham-Cassidy, including from a growing number of governors across the political spectrum.

If you’re looking for something OTHER than Graham-Cassidy to read about, here’s a Health Affairs post, co-authored by Tim Jost (‘natch) and friend-of-CAHC Katie Keith, that digs in to exactly what is contained in Senator Bernie Sanders’ (I-VT) Medicare-for-all bill. I’ve read a lot (like, a lot) of opinion pieces or very shallow reporting on the bill – this is the best, most comprehensive, most even-handed deep-dives on the bill. Well worth a look.

 

Until next time, friends, I remain,

-Steve

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