Pushing health care to the states is no solution


By Al Norman

The U.S. Senate recently found itself in a mad rush to beat the clock and repeal the Affordable Care Act (ACA) before Sept. 30. It was an act of desperation to support a bill that simply kicked the problem down to the states. Here is the background:

Senate republicans introduced a new healthcare bill led by senators Lindsey Graham (R-Florida) and Bill Cassidy (R-Louisiana) which would repeal major elements of the Affordable Care Act, make changes to other ACA provisions, fundamentally alter federal Medicaid financing, and reduce federal spending for health coverage. The Graham-Cassidy bill would:

  • Repeal the ACA Medicaid expansion and individual insurance market subsidies – including premium tax credits, cost-sharing reductions, and the basic health program – as of 2020.
  • Create a new block grant program to states, which replaces the ACA’s Medicaid expansion and insurance subsidies, for years 2020-2026. States would have flexibility to use these funds to cover the cost of high-risk patients, assist individuals with premiums and cost-sharing, pay directly for healthcare services, or provide health insurance to a limited extent to people eligible for Medicaid.
  • Convert federal funding for the traditional Medicaid program from an open-ended basis to a capped amount. The bill also repeals the penalties under the ACA’s individual and employer mandates and allows states to waive benefit requirements and community rating in the individual and small group markets. The proposal would fundamentally alter the current federal approach to financing health coverage for more than 80 million people who have coverage through the ACA (Medicaid expansion or marketplace) or through the traditional Medicaid program.
  • Overall federal funding for coverage expansions and Medicaid would be $160 billion less than current law under the Graham-Cassidy Bill over the period 2020-2026. Thirty-five states, plus the District of Columbia, would face a loss of funding.
  • Medicaid block grants under the Graham-Cassidy Bill end in 2026. If they are not renewed, federal funding for coverage would decrease by $240 billion in 2027 alone.

Specifically in Massachusetts, under the ACA, for the period 2020 to 2026, the commonwealth would receive a total of $20.8 billion in federal revenues. Under Graham-Cassidy, total federal revenues during this six-year period would fall to $18.97 billion, a loss of $1.6 billion, or an 8 percent cut in revenue. In addition, under the block grant provisions of Graham-Cassidy, Massachusetts would lose $1.8 billion in federal spending, and under the Medicaid per enrollee cap, the state would lose $1.7 billion, for a total loss of $3.5 billion. In 2027, if Congress does not extend the block grant, and Medicaid remains on a per enrollee cap, Massachusetts would lose $4.24 billion in that one year alone.

Congress should never make legislation out of desperation, because it only results in desperation on the part of the people that Congress serves.

Al Norman is the executive director of Mass Home Care. He can be reached at info@masshomecare.org.