ACA Defense is a Marathon, Not a Sprint

The latest bill to repeal the ACA is by far the most destructive.

Remember the Better Care Reconciliation Act (BCRA) and the Affordable Health Care Act (AHCA) from earlier this summer? Well, ACA repeal is back with a vengeance and the replacement option is bad news for Montana.

With just five days left to repeal the Affordable Care Act (ACA) using the current reconciliation bill (which allows Republicans to pass the measure 51 votes in the Senate), Senators Graham and Cassidy are still working hard to try to get enough support to pass their repeal bill. Although Senator McCain dealt a major blow to their efforts when he came out in opposition to the bill last week, the President, Senate Republican leadership, and the bill sponsors appear still to be working hard to gain the necessary 50 votes. That means this week is a critical moment for Montanans to make sure our congressional delegation hears what is at stake for Montana.

This Graham-Cassidy bill is just as destructive – if not more – than any of the previous GOP-proposed health care laws.

What would Graham-Cassidy mean for Montana?

Graham-Cassidy would eviscerate protections for Montanans with pre-existing conditions and punish states like Montana, by cutting federal resources for expansion states.

The bill would convert the funding for ACA insurance subsidies and Medicaid expansion into an inadequately funded block grant for the first 10 years, at which point funding would be eliminated entirely. During the first ten years, the block grant would decrease overall federal funding below current law and redistribute large amounts of the remaining funding from expansion states like Montana to certain non-expansion states. The block grant also fails to provide flexible funding to deal with unexpected events like recessions or natural disasters.

A recent report from Manatt Health and the Robert Wood Johnson Foundation estimates that the block grant provision of Graham-Cassidy would result in a loss of $1.5 billion in federal funds to Montana by 2026.

But it gets worse. Graham-Cassidy also fundamentally alters the basic Medicaid program by creating a per capita cap for all of Medicaid (not just expansion), dramatically cutting funding to states for seniors, people with disabilities, and very low-income families. Recent accounts suggest that both Alaska and Montana may be exempt from the first 10 years of the per capita caps. However, according to recent estimates by AARP, from 2027 to 2036, when the per capita caps are in place, Montana would lose an estimated $2.6 to $6.4 billion from the caps.

In 2027, when the block grant funding ceases while per capita caps continue, federal funding to states will drop by almost $300 billion below current law in that year alone. Coverage for hundreds of thousands of Montanans is at risk, including American Indians, people with disabilities, seniors, and children.

Why the big push before September’s over?

The GOP-led Senate is ramming through this last-ditch effort to repeal the ACA because under the existing reconciliation bill, the Senate only needs a simple majority (including Vice President Pence as a potential tie-breaker) to pass ACA repeal legislation. The current reconciliation bill expires on September 30, after which the Senators who want to repeal the ACA would need 60 votes to overcome a filibuster.

Senate Majority Leader Mitch McConnell has said that the Senate will take a vote this week. We hope to see the CBO score early this week, but because of the rushed timeline, it is unlikely to have comprehensive numbers regarding potential premium increases or loss of coverage. It’s unconscionable that any public official would vote for a bill with such wide-ranging consequences for our health care system without a full understanding of its effects.

Let’s reenergize for one more week to stop this repeal and hopefully get closer to the end of this marathon battle to protect affordable health care in Montana. Our congressional delegation needs to hear from all of us.

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