DFW Hospital Council raises concerns about Graham-Cassidy

There is much speculation regarding the Graham-Cassidy-Heller-Johnson bill introduced last week.

We expect a vote in Washington the week of September 25th.  We still do not have a Congressional Budget Office ( CBO ) score, but it appears a significant loss in coverage. The CBO said it may be several weeks to complete their analysis, especially on premiums and coverage. The Senate may not be able to move forward without a CBO score per rules of reconciliation. The Senate Parliamentarian becomes a very important part of this process as she must determine what process is appropriate.

This bill could hurt Texas since we continue to lead the nation in the uninsured because it is obvious the block grant would be less than current funding.  We also would face a huge cliff after 7 years when this block grant would expire. It is certainly going to raise premiums, especially for sicker patients.

Among our concerns with the Graham-Cassidy-Heller-Johnson bill:

    • The Bill Would Result in Millions Losing Health Coverage. The bill would repeal the ACA’s individual and employer mandate penalties, a change CBO previously estimated would result in 14 million fewer insured individuals after one year.  In addition, the bill would reduce the amount of funding for traditional Medicaid by transitioning financing for the program to a per capita cap model with trend factors that are generally below historic spending growth, potentially jeopardizing coverage and services for our most vulnerable.
    • The Bill Would Erode Key Protections for Patients and Consumers. The bill would repeal the ACA’s Medicaid expansion, Basic Health Program and Health Insurance marketplace subsidies effective January 1, 2020 and establish a block grant program for states to create their own health care programs from 2020 to 2026.  States could use the funds to help individuals enroll in coverage, but they also could use the funds for other health-related purposes.  This change would allow states to waive many insurance rules for coverage provided through the block grant program.  States could eliminate some or all of the essential health benefits and allow insurers to charge individuals with pre-existing conditions any amount in premiums, effectively pricing many individuals out of coverage.  Additionally, how would a fixed, block grant program address surge in demand like the tragic hurricane Harvey.
    • The Bill Would Not Stabilize the Insurance Market in the Short or Long Term. The bill fails to fund the cost-sharing reductions (CSRs) in the short term (2018 and 2019), while providing a separate fund for insurers to help stabilize the insurance markets in 2019 and 2020 (but not 2018).  CBO previously estimated that failure to fund the CSRs in 2018 would increase premium rates by 20 percent and increase the federal deficit by $6 billion that year.
    • In addition, the new grant program for states would end after seven years, potentially creating massive disruption in the health care system as millions of individuals may lose their source of coverage.