ACA remains health care law

Three GOP defections sink Graham-Cassidy bill as chance to repeal ACA with a simple majority runs out 

With only four days to undo the Affordable Care Act (ACA) with a simple majority vote, Senate leadership announced Sept. 26 their latest proposal referred to as “Graham-Cassidy” did not have the necessary support for a vote on the Senate floor. While stating they were not giving up on a health care bill, Senate Majority Leader Mitch McConnell (R-Ky.) said “where we go from here is tax reform.”

The admission of defeat came after a party luncheon, in which Republicans were trying to decide how to move forward after Sen. Susan Collins (R-Maine) joined Sens. John McCain (R-Ariz.) and Rand Paul (R-Ky.) in announcing opposition to the proposal. Other senators had expressed some reservations or had failed to endorse it, even after the bill was reworked.

Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) first introduced comprehensive legislation Sept. 13, intended to repeal and replace portions of the ACA, which came to be known as the “Graham-Cassidy” bill. Paul, the senator from Kentucky, immediately announced his opposition, stating the bill did not go far enough to repeal and replace the ACA. On Friday, McCain also announced his opposition.

Over the weekend, the Graham-Cassidy bill was revised and new legislative text was released. On Sept. 25, the Senate Finance Committee held a hearing on the proposal, which was initially delayed due to protestors. While the hearing was ongoing, the Congressional Budget Office (CBO) released a preliminary assessment stating that “millions” would lose health insurance. It was also during the hearing that Collins announced her opposition.

Graham-Cassidy was initially dismissed but had continued to gain momentum and attention over the last few weeks, with Leader McConnell vowing to bring it to the floor last week if it could secure the necessary 50 votes. The proposal contained many similarities to previous House and Senate efforts in that it would have placed a per capita cap on Medicaid and ended the ACA’s Medicaid expansion—both of which would have substantially shifted costs to counties. It also would have repealed the Prevention and Public Health Fund and only delayed, instead of repealed, the Cadillac tax on employer health plans.

Counties invest more than $80 billion annually in community health systems, and own or support approximately 1,000 hospitals, 900 nursing homes, 1,950 local public health departments and 750 behavioral health authorities. Counties spend approximately $25 billion annually to provide high-quality health benefits to their 3.6 million employees.