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Advocacy Alert - Graham-Cassidy ACA Repeal & Replace Bill

A Message from Sr. Carol Keehan, DC
CHA President and Chief Executive Officer



The Senate is expected to vote next week on legislation introduced by Senators Lindsey Graham (R-SC) & Bill Cassidy (R-LA) to repeal and replace the Affordable Care Act (ACA) and restructure the Medicaid program.

I urge you to contact your Senators today and tell them to:

  • Vote “NO” on the Graham-Cassidy legislation to repeal and replace ACA—which eliminates Medicaid expansion coverage, premium tax credits, and cost-sharing reduction subsidies and replaces them with state block grants.
  • Oppose the complete restructuring and deep funding reductions to the Medicaid program in the bill—capping & cutting federal Medicaid funding, through both per capita caps and block grants, fundamentally undermines the health care safety net and our ability to serve beneficiaries.
  • Instead enact bipartisan legislation to stabilize the individual insurance market. 

Unveiled on September 13, the Graham-Cassidy ACA repeal and replace legislation retains many features of the Better Care Reconciliation Act (BCRA), which was voted down by the Senate in July. The new bill includes measures to cut and cap federal funding for all Medicaid populations and eliminate the individual and employer mandates.

The legislation also establishes a seven-year block grant to states, entitled the Market-based Health Care Grant Program, by eliminating federal funding for the premium tax credits, cost-sharing reduction subsidies and Medicaid expansion coverage after 2019. The new block grant funding is estimated to be $239 billion less over ten years than under current law, resulting in large cuts for many states. States that have expanded Medicaid or have high Marketplace costs and/or enrollment will face the deepest cuts as funding would not be tied to actual costs of coverage or the number of individuals enrolled. There are no requirements that people who are currently covered under Medicaid expansion or those receiving premium tax credits will continue to receive assistance or remain covered.

States would have significant flexibility to use their block grant funds for coverage, payments to providers or any other health-care related purposes. They also would be allowed to waive various federal rules governing coverage including restrictions on premium variation; essential health benefit requirements; minimum medical loss ratios; caps on annual and lifetime out-of-pocket charges; and protections keeping those with pre-existing conditions from being charged higher premiums. It is also completely unclear what will happen in the insurance market after 2026, when the Health Care Grant Program funding ends.

In addition, funding cuts and structural changes to the traditional Medicaid program would inflict permanent and far-reaching damage on communities and lead to coverage losses for millions of our nation’s most vulnerable populations. Caps and block grants simply shift the cost burden onto local and state governments, individual beneficiaries and health providers. States will be unable to make up for the estimated $175 billion in Medicaid cuts over 10 years.

Thank you for all your efforts to preserve health care coverage for the millions of people across our country. A sample letter is available for your use in contacting the Senate, and we will provide more information about the legislation in the next Washington Update.

Please urge your Senators to continue working on bipartisan solutions and to:
Vote “NO” on the Graham-Cassidy ACA Repeal and Replace legislation

Now is the time for bipartisanship