States Face New, Stark Obamacare-Repeal Effort

A cutoff date at the end of this month gives opponents of the Affordable Care Act, aka Obamacare, what looks like a hard deadline to revive a repeal effort that has died dozens of times in Congress and the courts. “It was dead like a good zombie,” said Brian Lehrer, host of a public radio show on Wednesday. “Now it’s back with the September 30th deadline.”

Republican efforts to kill Obamacare will not die. The latest proposed replacement is among the harshest yet, experts say.

Visual: Inhauscreative via Getty

This zombie is hungry. If passed, a new Senate bill would dissolve the existing marketplaces for individual health insurance plans as well as federal subsidies for consumers, within two years, effectively requiring states to come up with their own solutions and straining state governments and revenue. A procedural option to pass the bill with only 51 votes, rather than 60 votes, will expire in nine days.

A total of 34 states would lose federal funding for health insurance under the bill, according to an analysis reported on Wednesday by the Washington Post.

Congressional budget analysts estimated this summer that partially repealing Obamacare under a Senate bill that failed to pass in July would have resulted in 32 million more uninsured Americans by 2026. The latest bill has yet to receive a score for its impact.

A primary component of the new effort, called the Graham-Cassidy bill, is to convert the taxes and fees that currently fund Obamacare into block grants for states. The grants would start paying out in 2020 but drop to zero by 2027, transforming the intervention from “repeal and replace” to “repeal with no replace” at the federal level.

The approach appeals to conservatives’ mantra of reducing the role of the federal government in health care and other social welfare arenas.

“Instead of a Washington-knows-best approach like Obamacare, our legislation empowers those closest to the health care needs of their communities to provide solutions,” bill co-sponsor Senator Lindsey Graham, a South Carolina Republican, said in a prepared statement. “Our bill takes money and power out of Washington and gives it back to patients and states.”

By 2020, all 50 states would devise their own health care coverage programs in the absence of Obamacare’s federal guidance, standards, or administrative infrastructure aimed at expanding the coverage of low-income Americans and reducing health care costs. That’s a tight deadline, some critics say.

The formula for determining the amount of each state’s grant, a fixed pot of money, would depend on the number of poor and near-poor residents.

It sounds fair, but the net result would be less funding for states that have embraced Obamacare by participating in the federal insurance exchange and expanding Medicaid, said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, a research and policy think-tank, during a call on Tuesday with reporters.

The bill also would place a cap on Medicaid funding for the first time, rather than allowing it to expand and contract to meet state need-levels. That move could add to the financial uncertainty facing states, not to mention Medicaid recipients, most of whom are seniors, people with disabilities, and families with children.

And then there’s the funding cliff in 2027. At that time, Congress could re-authorize the block grants for another set of years, said Senator Bill Cassidy, a Louisiana Republican and the bill’s other co-sponsor. However, the nation’s block grant costs will balloon to a daunting figure of about $2 trillion in 10 years, Park said, so the prospects for Congress reauthorizing a bill that large are “unlikely.”

It’s tempting to skim or even skip the fine print in the incessant debates about how federal health policy will affect Americans. Comedian Jimmy Kimmel said earlier this week on his late-night TV show, “They want us to treat [this bill] like an iTunes service agreement.”

But as with tech firms that routinely trample on individual privacy, it likely behooves Americans to do their best to keep up and to get reliable information about the latest proposed legislation from somewhere other than Facebook.