The Graham-Cassidy Bill: Yet another Attempt to Remove Health Care from Americans and Cut Taxes for the Rich

It had been my intention to write a multi-part series on Health Systems as a way to lead into further discussion about the direction our health system should take. There are also issues related to women’s health, the opiate crisis, mental health services (or their lack), and the role of the “unsung” in the history of medicine and science (who amongst you remembers Bernard Fantus ? More on him later).

But not today. Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) and their minions are trying to repeal the Patient Protection and Affordable Care Act (ACA), replacing it with legislation that will harm many of us. If you think I am overstating the issue and being excitable, read on. I will not reiterate here the pluses and minuses of the ACA, you may read the several pieces written by me as well as others on that issue. Here, I will “simply” point out the destruction that will be caused by this new attempt to strip health care from the American people.

What is in the Graham-Cassidy bill:

  1. Medicaid subsidies and the Medicaid Expansion will disappear: The bill removes direct Federal funding of Medicaid and the subsidies used to make the Marketplace plans affordable to working people. These are replaced with block grants that are cut by a third in 2026; they are then totally eliminated by 2027. Graham says that people can “…keep their [ACA plan] if they like it…”. This is, if not an outright lie, seriously disingenuous. If the funds to support the ACA plans are decreased by 33% in 2026 and eliminated completely in 2027, one has to believe in fairy dust and pixies to believe Graham. Up to 32 million people will be without healthcare by 2027.
  2. The States will control Healthcare Markets: Graham and Cassidy argue this would make the States more efficient in the way they spend money. What it will do, for sure, is allow the States to develop any kind of healthcare system they want; they could opt out of any ACA regulation by requesting a waiver, if they so desire. The bill’s authors claim that protection for individuals with pre-existing conditions would not be touched. They “forget” to mention that the States may remove these protections if they so desire; not exactly a ringing endorsement of protection. This means, for example, that a person with asthma could face a premium surcharge (on top of the normal yearly premium) of $4,340 per year; with diabetes one could pay an extra $5,600 per year. And of course, my favorite, since as we all know being a woman counts as a preexisting condition, a woman becoming pregnant could face a surcharge of $17,320 per year. You have to love these guys, they are so “pro-life” that they want women to pay extra to have babies.
  3. There will be less money sent to the States: Even though the bill’s authors claim that efficiencies will make up for any cuts, the states will see less money with which to care for its citizens; not only are the Marketplace subsidies and Medicaid Expansion removed by 2027, the Federal-State partnership for Medicaid is changed to a block grant approach. This means that, for example, Pennsylvania will be cut by about $250 per person per year by 2026; New York will lose about $1,000 per person per year; California about $750; Texas about $250. These cuts are mean spirited in that they will impact the weakest amongst us. These Medicaid cuts will adversely impact Children’s Health Services as well.
  4. Other damage caused by Graham-Cassidy: The individual and employer mandates are eliminated. Insurance companies are allowed to charge older Americans up to 5 times more than they charge younger customers.

Essential health benefits, specifically defined by the ACA, could be changed by States.  What is considered an “essential health benefit” – care of your diabetes ?; heart disease ?;obesity ?; opiate addiction ?; mental health ?; pre-natal care ? – can be changed based upon the desires of individual State administrations. Planned Parenthood, providing care to working and poor women, will be cut out of Medicaid funding for at least a year.

How bad is all of this ? Bad, really bad. The authors of this bill, Senators Graham and Cassidy, are pushing it very hard and very fast. They want it passed BEFORE the Congressional Budget Office has time to calculate the costs involved: how much money will be saved and how many people will lose their health care coverage.

However, based upon what we know so far, as many as 32 million of us will lose access to health care. And of the $299 billion Medicaid cuts we know of – and there may be more to follow – dollars to doughnuts these go to tax cuts for the rich.

In any civilized country, this kind of “reverse-Robin Hood” behavior would not be allowed. This bill is a disaster for the American people, for many of you. It must be stopped. Stand up. Stop it.

About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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