Dissecting the Latest GOP Healthcare Reform Effort by Nicky Riordan
The latest attempt by Congressional Republicans to repeal and replace the Affordable Care Act (ACA) was put to rest on Tuesday when Majority Leader Mitch McConnell announced there would not be a vote. This is the fourth major blow to the repeal and replace effort this year. It’s hard to envision the Affordable Care Act being repealed this year with the budget reconciliation deadline looming at the end of this week. Even last minute concessions to wavering Senators could not get the new bill over the finish line, signaling a continuing lack of party cohesion at this crucial time.
Graham-Cassidy proposed the most drastic changes to the ACA yet. Whereas past efforts, such as the Better Care Reconciliation Act, kept the basic structure of the ACA in place, this bill completely altered the way healthcare would be federally funded. Most ACA funding would be converted into block grants with each state receiving a set amount of money annually to create their own insurance systems.
This new formula would inevitably result in some states losing funding, forcing them to fill in those holes with their own state budgets. Moreover, block grant reforms of federal social programs during the 1990’s resulted in several states using their allocations in unintended ways, diluting welfare programs and increasing poverty.
The bill would have also capped federal spending on Medicaid, cutting $100 billion in total spending over the next ten years. Independent estimates projected that tens of millions of Americans would lose coverage under this plan, many almost immediately upon implementation. In addition, the broad flexibility offered to states would have enabled essential health benefits and pre-existing condition coverage to be easily waived.
Republicans are already starting to signal their intention to revisit the goal of repeal and replace in 2018, alongside lofty tax reform legislation. Overhauling the healthcare system in an election year is a risky proposition as Democrats learned in 2010.
Each attempt at repeal this year has moved further to the right despite the fact that moderate Republican Senators are the largest hurdle to overcome. Members of Congress from both parties agree improvements to the healthcare system are needed. Following the lead of Senators like Lamar Alexander, and undertaking a bipartisan approach, is increasingly becoming the only option.
Nicky Riordan (@nriordan120), Political Analyst, Utica College Center of Public Affairs and Election Research