14 CA Reps Still Silent As Revised Cassidy-Graham Still Threatens CA’s Care

The US Senate Finance Committee will hold a single hearing today on a radical proposal by Republican Senators Lindsey Graham and Bill Cassidy.to dramatically cut our nation’s health care system, a proposal that with only one hearing, only 90 seconds of Senate floor debate scheduled, and no Congressional Budget Office analysis of the coverage or premium impacts, is slated to be voted on on Wednesday or Thursday. The fact that California is disproportionately impacted is likely to come up in the hearing, by supporters as a selling point or opponents as an example of the bills’ unfair and unwarranted formulas.

While the authors are actively taking amendments to get the final votes for approval, fourteen California Congressmembers have been silent, refusing to denounce the proposal, despite California being disproportionally and intentionally singled out for harsher and earlier cuts. Over the weekend, for example, California Rep. Ed Royce was asked directly at an event at his Orange County office and refused to take a stand against this Graham-Cassidy proposal, despite the fact that it cuts California’s budget and health system by tens of billions of dollars and would leave over 6.7 million more Californians uninsured. Over 100 groups sent a letter to California’s Congressional delegation to urge public opposition to this proposal and slow momentum before the September 30th deadline for this legislation. None of the fourteen who voted for an earlier ACA repeal bill has expressed opposition to this new, harsher, and explicitly anti-California bill.

The legislation would phase out, block grant and ultimately repeal all funding for the Affordable Care Act, as well as cut and cap Medicaid—cutting California’s health care by a massive $23 billion a year by 2026, and a staggering $53 billion in 2027 and beyond, according to a new California Department of Health Care Services analysis released on Friday, which is in line with other analyses by the Center for Budget and Policy Priorities, Manatt, Avalere, and other independent researchers. The Congressional Budget Office has said they do not have the time to do their own analysis of impacts on coverage or premiums before the September 30th deadline.

We continue to be alarmed that such a draconian and devastating proposal is still even being considered, much less a few votes from passage. Congressional leadership is still trying despite the united opposition of patient, senior, doctor, hospital, and insurer groups, to this attempt to try to take health care away from millions of Americans, take way key patient protections for millions more, and other extreme proposals such as to cut and cap Medicaid. All states lose under Graham-Cassidy, but the cuts come harsher and sooner for California, in order to lessen the impact in other states–all to buy off votes in the Senate.

It is stunning that any California Congressmember, much less fourteen of them, would stay silent against such an devastating and disproportionate attack on California and our health system, especially one as explicit and intentional as this. Even the fourteen Representatives that voted for previous ACA repeal bills should realize how much worse this is for the country, but for California and the regions they purportedly represent. This is a moment of truth when we need our Congressmembers defend their California constituents–and not put party politics before protecting patients and the public.

WORSE FOR CALIFORNIA: While California’s two Senators and most of our Congressional delegation has been opposed to all of the ACA repeal proposals, given California’s success in improving the health system and cutting the uninsured rate under the law, fourteen California Congressmembers voted for a previous ACA repeal bill, the American Health Care Act (AHCA). But new DHCS and UC-Berkeley and other analyses all indicate that Graham-Cassidy is much worse, cutting California’s health system by an order of magnitude over the $20 billion cut under AHCA. The Graham-Cassidy proposal has many of the same provisions as harmful previous repeal bills (such as repealing the Medicaid expansion that covers 4 million Californians), but also includes language that explicitly attacks larger states that embraced the ACA and expanded coverage, specifically California, New York, Massachusetts, and Maryland, to lessen the impact of the cuts to other states from where the authors are seeking Senate votes. The bill would result in cuts to access, benefits, and the loss of protections for those with pre-existing conditions at a greater magnitude than in previous ACA repeal bills.

An author of Graham-Cassidy, former Senator Rick Santorum, said it plainly to Breitbart News on August 22nd: “What you can do is redistribute this money that has been heaped upon these four ultra-blue, very wealthy states.” He continues, “If California simply wants to expand Medicaid with this money, good luck. They’re going to have to cut their program dramatically because they don’t have the money with what they’re funding now.”

While Santorum and Graham have both referenced California “blue” political leaning, their argument is that California (and New York, Massachusetts, and Maryland) get a disproportionate amount of money from the Affordable Care Act. While exaggerated, this is due to three elements:

* California’s high poverty rate, meaning we have significant need;

* the fact that California expanded the Medicaid program to meet that need (and because 19 states have not expanded Medicaid as the law allows, by definition the Medicaid expansion states are getting a higher percetnage of the money expended); and

* the significant work that California has done to market, outreach and enroll its residents into coverage, both in Medi-Cal and Covered California–yet another option that was available to all states, but that only some took full advantage.

“California should be proud of our work–bipartisan between Governors and legislators of two parties–to implement and improve the ACA to maximize the benefit for our state. California should not be penalized for following the law.” said Wright. “We hope Senators considering taking the sweetheart bribes targeted to specific states realize that Graham Cassidy would set a disturbing precedent, that any benefit to any particular state can be easily undone. What California is threatened with this week–not just dismantling 5 years of progress under the ACA, but 50 years under Medicaid-could just as well happen to their state in another political cycle under this precedent.”

GRAHAM-CASSIDY COMPONENTS: Even with the revisions, the Graham-Cassidy bill would do three things, combining the worst of previous ACA repeal proposals and taking them to greater extremes:

* Graham Cassidy would cut, phase out, block grant, and by 2027, ultimately zero out the money that the ACA provided for the Medicaid expansion and for affordability assistance in exchanges like Covered California.  It would directly eliminate the Medicaid expansion, which now covers over 4 million Californians, in addition to money that helps people in Covered California and the other exchanges afford coverage. Between now and 2026, it cuts the money and redistributes the money in the form of a block grant, with a formula designed for California to be hit with cuts harsher and sooner. It’s unclear what kind of health care program California could quickly create with a dwindling and disappearing amount of money.

* Graham Cassidy cuts and caps the overall Medicaid program, impacting all 14 million Californians who depend on Medi-Cal coverage including half of all children, and two-thirds of our nursing home residents.

* Finally, Graham Cassidy undoes all the patient protections of the ACA, by allowing states to set their own rules, or no rules–with no federal requirements to abide by standards or policies such as no lifetime limits on coverage, no discrimination based on pre-existing conditions, essential health benefits, or other policies. Without the funding cut, even state like California would be under enormous pressure to lower premiums by scaling back benefits and consumer protections.

Earlier this month, the Senate Parliamentarian ruled that any attempts to pass legislation through the 2017 budget reconciliation process—and therefore by only needing 51 votes—expires on September 30. A budget reconciliation process for 2018 is expected to focus on tax changes and tax reform, rather than ACA repeal and health care changes, but that would be decided in a budget resolution in October.

References

Health Access Fact Sheet on Graham-Cassidy ACA repeal

Letter by 100 CA Groups to CA Congressional Delegation

CA DHCS Study Showing $23 Billion/Year Cuts to CA by 2026; a Staggering $53 Billion/Year Cut by 2027

UC-Berkeley Analysis Showing At Least 6.7 Million More Californians Uninsured

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