TrumpGrahamCassidy. “Perhaps one of the biggest challenges for the bill will come next week when the Senate parliamentarian — an umpire of sorts for the chamber’s rules — takes a look at the bill…”

The Byrd rule, however, restricts what can be considered under budget reconciliation. If a provision of a bill is considered an “extraneous matter” or something “merely incidental” to the federal budget, it can be stripped out of the legislation….
A previous iteration of the Senate GOP’s healthcare bill, the Better Care Reconciliation Act, already showed what may happen with the waivers in the new bill. During the Byrd bath, the waivers in the BCRA that allowed the loosening of EHBs and other regulations were deemed to have nothing to do with the budget and were ordered stripped from the bill.
Health-policy experts say this could indicate that the waivers in the Graham-Cassidy bill will also have to be stripped.” (A)

“The fundamental thing to understand about Senate Republicans’ latest attempt to repeal Obamacare is that the bill under consideration would not just undo the Affordable Care Act—it would also end Medicaid as we know it and our federal government’s half-century commitment to closing the country’s yawning gaps in health coverage. And it would do so without putting in place any credible resources or policies to replace the system it is overturning. If our country enacts this bill, it would be an act of mass suicide…
The Graham-Cassidy bill goes even further than the bill passed by the House. It would bring to a virtually immediate end not only the individual and employer mandates but also the whole edifice of the Medicaid expansion, insurance exchanges, and income-based coverage subsidies set up under the A.C.A. Graham-Cassidy expects all fifty states to then pass, and implement, alternative health systems for tens of millions of people within two years—with drastically less money, in most states, than the current law provides. This is not just impossible. It is delusional.” (B)

What every state stands to gain or lose under Graham-Cassidy, according to CMS.
Highlight and click on http://www.beckershospitalreview.com/hospital-management-administration/what-every-state-stands-to-gain-or-lose-under-graham-cassidy-according-to-cms.html

“The states with populations that would be hurt most by such a scheme aren’t California and New York, but cash-strapped, smaller, mostly-rural states or Rust Belt states that decided to expand Medicaid, often in order to meet extraordinary statewide health crises. These states are not liberal bastions Graham claims are favored by Obamacare; rather these states—Louisiana, Arkansas, Arizona, Kentucky, Ohio, Indiana, Maine, Iowa, Alaska, New Mexico, North Dakota, West Virginia, and Montana—are largely dominated by Republicans, and make up a large swathe of the party’s geographic base.” (C)

“One area where states would get more discretion under the bill involves their obligation to cover Americans with pre-existing conditions. States would be permitted to waive pre-existing condition protection as long as they still provide “adequate and affordable” coverage — but what qualifies as “affordable” is left undefined.
What will be the effects of these changes? Consumers will almost certainly see rising premiums and health care costs because subsidies are being replaced. There may be less coverage provided if states aren’t able to do more with less, as Cassidy and Graham are purporting. But no one really knows the extent of the cost or coverage changes. Supporters of the bill are intentionally vague about what the effects will be, saying that states know better how to allocate money, that they shouldn’t have Obamacare forced upon them, and, essentially, that we’ll see what happens when it happens…
Adequate and affordable” coverage for consumers with pre-existing conditions is a concept that’s so nebulous it’s useless…”(D)

“Since money is fungible and the block grants have few strings attached, states can in effect use the cash to fund projects that have nothing to do with health care. This is how: All states would need to do is identify existing state health care programs that qualify for block grant funding, thereby freeing up the state dollars currently devoted to those program to be used in whatever way the state wishes. If this were a state’s goal, the legislation makes it easy to achieve….” (E)

“Coalitions of health professionals that have spoken publicly against the measure so far include the American Medical Association (“Provisions violate longstanding AMA policy”), the American Psychiatric Association (“This bill harms our most vulnerable patients”), the American Public Health Association (“Graham-Cassidy would devastate the Medicaid program, increase out-of-pocket costs, and weaken or eliminate protections for people living with preexisting conditions”), the National Institute for Reproductive Health (“the Graham-Cassidy bill preys on underserved communities … a clear and present danger”), and Federation of American Hospitals (“It could disrupt access to health care for millions of the more than 70 million Americans”). (F)

“Americans by more than a 20-point margin prefer the existing federal health care law to the latest, imperiled Republican alternative — another challenge to the GOP’s long-held effort to repeal and replace Obamacare.
The public supports Obamacare over the proposed Graham-Cassidy bill by 56-33 percent in a new ABC News/Washington Post poll. Intensity of sentiment also is on the current law’s side: Forty-two percent strongly prefer it, nearly twice as many as strongly prefer the GOP plan.
The result is similar to public views on the previous GOP repeal-and-replace effort, which failed in July. Americans preferred Obamacare to that plan by 50-24 percent, again with a 20-point advantage for the current law in strong sentiment.” (G)

“For months now, proposals to repeal and replace the Affordable Care Act have risen and fallen in the House and the Senate, almost always uniting health care providers and patient advocacy groups in opposition but winning support among conservatives, including Republican policy makers. But the version drafted by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana — and hastily brought into the spotlight last week — went further.
It brought much of the health care world together to stop it, an effort that appears to have succeeded — not for ideological reasons, but for the simple reason that administrators, caregivers, advocates and insurers believed it could not work.” (H)

The president had embraced the legislation in recent days, making telephone calls to wavering senators and dispatching Vice President Mike Pence to Capitol Hill to try to build support for its passage. Mr. McCain’s announcement that he would not vote for it came just hours after the president had warned in a Friday post on Twitter that any Republican who opposed the measure “will forever (future political campaigns) be known as ‘the Republican who saved ObamaCare.’ ”
On Saturday, Mr. Trump appeared to be nurturing hopes that the legislative effort could be kept alive. He expressed hope that Mr. Paul would rethink his opposition to the Graham-Cassidy measure, without explaining why the Kentucky senator, who had complained that the bill left the Affordable Care Act’s essential structure intact, might do so.” (I)

(A) The healthcare bill could blow up in the GOP’s face because of an obscure Senate rule, by Bob Bryan, http://www.businessinsider.com/graham-cassidy-health-care-bill-byrd-rule-2017-9
(B) If the U.S. Adopts the G.O.P.’s Health-Care Bill, It Would Be an Act of Mass Suicide, by Atul Gawande, https://www.newyorker.com/news/news-desk/if-the-us-adopts-the-gops-health-care-bill-it-would-be-an-act-of-mass-suicide
(C) The Real Losers of the Graham-Cassidy Health-Care Bill, by VANN R. NEWKIRK II, https://www.theatlantic.com/politics/archive/2017/09/graham-cassidys-false-redistribution/540438/
(D) John McCain’s no vote won’t necessarily kill Graham-Cassidy health bill, by Jennifer Fitzgerald, https://www.cnbc.com/2017/09/22/graham-cassidy-repeal-bills-huge-unknowns-for-consumers-commentary.html
(E) What the CBO Might Have Said about Graham-Cassidy, by ROBERT VERBRUGGEN, http://www.nationalreview.com/corner/451642/what-cbo-might-have-said-about-graham-cassidy
(F) Doctors: No. Physicians rarely agree on anything as strongly as they do that the Graham-Cassidy health-care bill is harmful, by JAMES HAMBLIN, https://www.theatlantic.com/health/archive/2017/09/do-no-harm/540333/
(G) Public prefers Obamacare to Graham-Cassidy, 56-33% (POLL), by GARY LANGER, http://abcnews.go.com/Politics/public-prefers-obamacare-graham-cassidy-56-33-poll/story?id=50031499
(H) Why the Latest Health Bill Is Teetering: It Might Not Work, by SHERYL GAY STOLBERG, and ROBERT PEAR, https://mobile.nytimes.com/2017/09/23/us/obamacare-repeal-graham-cassidy-mccain-trump.html
(I) Trump Laces Into McCain Over His Opposition to Health Care Bill, by JULIE HIRSCHFELD DAVIS, https://www.nytimes.com/2017/09/23/us/politics/trump-mccain-graham-cassidy-health-care-obamacare.html?mcubz=0

Share on LinkedInShare on Google+Share on FacebookTweet about this on Twitter