It appears that the U.S. Senate will make one more push this month to repeal the Affordable Care Act (ACA). Ohio Academy of Family Physicians members are asked to contact U.S. Senator Rob Portman to express their concerns.
- 224.3353 (Washington, DC, Office)
- 684.3265 (Cincinnati Office)
- 522.7095 (Cleveland Office)
- 469.6774 (Columbus Office)
- 259.3895 (Toledo Office)
- @robportman or @protmanpress (Twitter)
In addition, use AAFP SpeakOut to contact Sens. Portman and Brown via email.
The current repeal effort is being pushed by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA). On Wednesday, September 13, these two senators, along with Senators Dean Heller (R-NV) and Ron Johnson (R-WI) introduced the “Graham, Cassidy, Heller, Johnson” (GCHJ) proposal. On Wednesday, September 13, the AAFP sent a letter to Senate leadership expressing concerns with the proposal.
This legislation seeks to repeal the Medicaid program as a federal/state partnership and the Health Insurance Marketplaces and their subsidies, and instead, establish state-by-state block grants that would be provided to the individual states to provide health care coverage for these populations. The impact on states varies, but the largest cuts in funding would significantly impact those states like Ohio that expanded Medicaid.
There are numerous problems with this legislation, but the overarching concerns remain the same. First, this legislation would result in millions losing their health care coverage due to decreased funding in Medicaid and a lack of stability in the individual/small group market. Second, it allows states to forgo the insurance reforms and consumer protections under current law, i.e. pre-existing conditions, prohibition on annual and lifetime caps, etc. Third, while it allows state flexibility in benefit design, it continues prohibitions on certain medical services such as reproductive health. Fourth, it is not permanent or a protected entitlement. Starting in 2026, the funding would need Congressional approval to continue. In short, the money could disappear in the future, forcing millions to lose their health care coverage.
- Eliminates ACA premium tax credits and cost-sharing reduction payments for low and moderate income marketplace consumers.
- Eliminates the ACA enhanced Medicaid match financing starting in 2020.
- Replaces the current marketplace subsidies (premium tax credits and cost-sharing reductions) and Medicaid expansion funding with a state-by-state block grant. Block grant funding would be an estimated $26 billion below current levels in 2020 and $83 billion below current levels in 2026. The block grants would end entirely in 2026 unless reauthorized and funded by Congress.
- Converts a majority of the Medicaid programs financing to a state-by-state per capita cap. Implements an initial $175 billion cut before establishing per capita caps.
- Allows states to forgo compliance with requirements that insurance products and/or Medicaid adhere to the consumer protections and insurance reforms under current law.
- Repeals the ACA individual mandate effective immediately. This would destabilize health insurance markets in 2018, well ahead of the dramatic cuts in funding proposed under the bill.
The bill has not been evaluated or scored by the Congressional Budget Office (CBO), but based on their analysis of other, similar proposals, AAFP estimates that coverage losses will be in the tens of millions. It is anticipated that CBO may have a score available later this week.