With only 11 days to undo the Affordable Care Act (ACA) with a simple majority vote, a new healthcare proposal by Senate Republicans is quickly gaining momentum, setting up the stage for potential floor action next week. On Wednesday, September 13, Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wisc.) introduced the legislative text for their health care proposal, which is being referred to as “Graham-Cassidy.” Senate Majority Leader Mitch McConnell (R-Ky.) has vowed to bring it the floor if they can secure 50 votes.
Graham-Cassidy was initially dismissed but has continued to gain momentum and attention. Hearings were scheduled in two different committees early next week, including the powerful Senate Finance Committee. In addition, the Congressional Budget Office (CBO) announced they would release a preliminary assessment of the proposal’s budget deficit reduction by early next week, a prerequisite to meet procedural rules. Introduction of the Graham-Cassidy proposal has quieted recent efforts to engage in bipartisan efforts to stabilize the ACA or fund other key health programs that expire at the end of the month.
Graham-Cassidy contains many similarities to previous House and Senate proposals in that it would place a per capita cap on Medicaid and end the ACA’s Medicaid expansion—both of which would substantially shift costs to counties. It also repeals the Prevention and Public Health Fund and delay, instead of repealing, the Cadillac tax on employer health plans until FY 2025. The largest difference between previous proposals and Graham-Cassidy is the inclusion of a block grant program based on a complex formula that is intended to equalize federal contributions to Medicaid across states.
At this point, only one Republican Senator — Rand Paul (Ky.) — has officially opposed the bill. It would take three “no” votes from Senate Republicans to effectively kill the effort. All eyes are on Senators Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and John McCain (R-Ariz.), who sunk Republicans’ last effort. If the bill were go to the floor, it would face the amendment process and must also pass the House before being signed into law by the president.
Until last week, this last-ditch effort to repeal and replace the ACA had largely been viewed as a distraction, as Senate Republicans had been moving on to tax reform and stabilizing the existing healthcare system. However, the Senate Parliamentarian ruled that September 30 is the final date for Republicans to utilize budget reconciliation as a fast-track procedure. This announcement led Republicans to refocus on passing some version of a healthcare bill before the impending deadline.
NACo will continue to analyze the policy implications of the Graham-Cassidy proposal to counties and monitor legislative developments over the next two weeks. To view our initial summary of Graham-Cassidy, click here.