Last-ditch effort to repeal and replace ACA fails

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With only four days to undo the Affordable Care Act (ACA) with a simple majority vote, Senate leadership announced today 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 Senator Susan Collins (R-Maine) yesterday joined Senators 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.

Last Wednesday, September 13, Senators Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wisc.) first introduced comprehensive legislation intended to repeal and replace portions of the ACA, which came to be known as the “Graham-Cassidy” bill. Senator Rand Paul (R-Ky.) immediately announced his opposition, stating the bill did not go far enough to repeal and replace the ACA. On Friday, Senator John McCain (R-Ariz.) also announced his opposition.

Over the weekend, the Graham-Cassidy bill was revised and new legislative text was released. Yesterday 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 Senator 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 this 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 It also would have repealed the Prevention and Public Health Fund and only delayed, instead of repealed, the Cadillac tax on employer health plans.

Graham-Cassidy had shelved bipartisan efforts initiated by Senators Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) to stabilize the ACA, and it is unclear if these efforts will resume. It also had sidelined efforts to fund key health and human services programs that expire at the end of this week. These include the Children’s Health Insurance Program (CHIP), the Maternal, Infant, Early Childhood Home Visiting (MIECHV) Program, Community Health Center funding and Disproportionate Share Hospital (DSH) reductions.

The nation's 3,069 counties, parishes and boroughs are on the front lines of ensuring the health and well-being of our residents. We invest over $80 billion annually in community health systems, and own and support approximately 1,000 hospitals, 900 nursing homes, 1,950 local public health departments and 750 behavioral health authorities. We spend approximately $25 billion annually to provide high quality health benefits to our 3.6 million employees.

NACo will continue to educate Congress on why we need a strong federal-state-local partnership for Medicaid and our nation’s healthcare infrastructure. We look forward to continuing to work with Congress in support of pragmatic, common sense reforms to our nation’s healthcare system that improve health outcomes and provide savings to local taxpayers. 

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