The fight to protect quality health coverage for Nebraskans is at another critical moment. The Senate officially has until the end of September to use the budget reconciliation process to pass a bill that repeals the Affordable Care Act and dismantles Medicaid with only 50 votes.
In recent days, there are reports of momentum growing around a plan sponsored by Senator Bill Cassidy and Senator Lindsey Graham. This plan has become the rallying point for the Senate’s last ditch effort to repeal the affordability and quality protections within the ACA.
So, what’s in the plan, and how is it different from the plans we saw this summer? The Cassidy-Graham plan is — if you can believe it — actually more devastating than the House’s American Health Care Act, the Senate’s Better Care Reconciliation Act, or the so-called “Skinny Repeal” we saw earlier this summer.
The Bottom Line: Cassidy-Graham would phase out big portions of the ACA, take away protections for people with preexisting conditions, and slash funding for Medicaid — ending as we know it the program that helps thousands of Nebraska’s seniors, children, and people with disabilities get the care they need.
It will make health care costs go up
Cassidy-Graham would eliminate the ACA’s subsidies (premium tax credits), cost sharing reductions, and federal funding for Medicaid expansion. In their place, it would give states a block grant of federal money based on a very complicated formula. This block grant would be significantly less than current federal funding for coverage, and cuts would get deeper over time, with all funding phasing out after 2026.
States could use this money for a number of different purposes and wouldn’t have to use it to help people afford insurance. There would be no requirement that this money be targeted towards the Nebraskans who are most in need of assistance.
The Marketplace would be ended
Unlike other repeal proposals, Cassidy-Graham would end the Health Insurance Marketplaces that tens of thousands of Nebraskans currently use to compare plans and buy insurance. If states wanted to continue the programs they started under the ACA, they would be responsible for finding the money to continue them.
Cassidy-Graham would also allow states to gut protections for people with preexisting conditions. States could allow insurance companies to charge sick people higher costs based on their health status. They could eliminate the Essential Health Benefits (EHBs), which are the core benefits required in every insurance plan under the ACA, including maternity care, prescription drugs, hospital stays, and mental health treatment.
All in all, Cassidy-Graham is essentially “repeal without replace” –which many Senators have said they could not stand for — except worse because it also proposes extreme Medicaid cuts.
Medicaid as we know it would be over
Like other repeal bills, Cassidy-Graham would implement a “per capita cap” in paying for Medicaid, which would make big cuts to a program that allows tens of thousands of children, seniors, people with disabilities, and pregnant mothers get the care they need.
Currently, Medicaid is a state-federal partnership where the federal government and state governments split costs based on the state’s economic situation. When a state is doing well financially, the state takes on more of the Medicaid costs. If a state isn’t doing so well, the federal government pays more. It’s a flexible system that responds to changing economic conditions.
But, under a per capita cap, the state gets a set amount of money each year for each person enrolled in Medicaid. This system is not based on the person’s actual needs or how much health care actually costs. If that person’s needs exceeds that amount, the state is on the hook for finding the extra money or deciding that person just won’t get the care they need.
The per capita caps also will be funded at a rate that is lower than the growth of health care costs. So, the amount of Medicaid funding will start out too low, and then get even lower over time. This leaves states unable to respond to things like natural disasters, an aging population, or new advancements in medicine or pharmaceuticals.
The Big Takeaways
There is not an official Congressional Budget Office score yet to tell us how many people will lose coverage or the economic impacts of this bill. And reports indicate the Senate may vote on this bill without even waiting to see what the full impact will be on health coverage.
Estimates based on previous ACA repeal bills suggest that millions of Americans – and at least tens of thousands of Nebraskans – would lose their health insurance. People, especially those with preexisting conditions, would be forced to pay more for worse coverage. And Medicaid would be ended as we know it.
What can I do?
Action from people like you helped defeat previous repeal attempts, and it’s important for you to act now! Call Nebraska’s U.S. Senators and tell them they must OPPOSE the Cassidy-Graham health care bill.
Sen. Deb Fischer (202) 224-6551 Sen. Ben Sasse (202) 224-4224
Tell them how important affordable, quality health care is to you and your family. Let them know the Cassidy-Graham bill would make health care costs go up, remove protections that many Nebraskans need, and force the people who need health insurance the most to lose their coverage.