Sen. John McCain today put terror in the hearts of health insurance policy analysts throughout the country.
By announcing that he will oppose the Graham-Cassidy-Heller-Johnson Affordable Care Act change bill, he raised the possibility that any Graham-Cassidy impact forecasts they have published this week, or are now working on, may already be as obsolete as ancient Etruscan guides to interpreting chicken entrails.
Republican congressional leaders have been rushing to push Graham-Cassidy through the Senate by Sept. 30, in time to make use of special Senate budget reconciliation rules that let supporters of budget measures get those through the Senate with just 51 votes, rather than the 60 votes normally required.
McCain’s opposition to Graham-Cassidy means that Republicans may have trouble rounding up support from even 50 senators for the bill. Sen. Rand Paul, R-Ky., has already come out against it. At press time, Susan Collins of Maine and Lisa Murkowski of Alaska had not expressed any joy about the idea of voting for it.
But McCain himself said he objects to the rushed, partisan process Senate Republicans have used to develop and consider the Graham-Cassidy proposal, not necessarily the content of the bill.
Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., were the leaders in developing the bill.
“I would consider supporting legislation similar to that offered by my friends Senators Graham and Cassidy were it the product of extensive hearings, debate and amendment,” McCain said in the statement explaining why he is voting against Graham-Cassidy. “I take no pleasure in announcing my opposition. Far from it. The bill’s authors are my dear friends, and I think the world of them. I know they are acting consistently with their beliefs and sense of what is best for the country.”
One possible conclusion is that, even if the current version of Graham-Cassidy fails, it, or a new version of it, could return. Agents and brokers who be part of the ACA change game may be able to find new ways to use the old Graham-Cassidy impact analyses, and other useful Graham-Cassidy-related documents.
Here’s a look at 10 tools that might be useful for producers who want to fuel their health insurance policymaking efforts with verifiable facts and numbers. Note that we had a much easier time finding detailed analyses posted by critics than to find comparable analyses posted by supporters.
1. The Graham-Cassidy bill, and supporting documents.
Graham posted the text of the bill, related documents, and a recording of the bill launch video here.
2. Comparisons of Graham-Cassidy with the ACA and major ACA change proposals.
Legal analysts at Faegre Baker Daniels L.L.P., a law firm, have posted a helpful comparison chart here.
The Faegre Baker chart includes the ACA and Graham-Cassidy.
It also includes two House Republican ACA change bills: the American Health Care Act bill and the Better Care Reconciliation Act bill.
The Alaska Department of Health and Social Services have posted another side-by-side analysis, prepared by analysts at Manatt Health, another law firm, here.
2. An analysis of how Graham-Cassidy would affect each state’s federal health program funding level.
Graham-Cassidy would eventually replace the ACA Medicaid expansion, Basic Health Program, ACA exchange plan premium tax credit program, and ACA exchange plan cost-sharing reduction program with block grants for states.
Analysts at Avalere Health, a consulting firm with a wide range of clients, have published data on how the block grant program would affect each state’s funding level here.
Would-be health finance policy players might be able to use the Avalere Graham-Cassidy impact analysis to estimate how any effort to replace the current subsidy programs with state block grants might work.
3. Rating agency analyses.
Perhaps because the Graham-Cassidy proposal is still new, and, originally, appeared to be a dark horse challenger to the bipartisan ACA change efforts at the Senate Health, Education, Labor and Pensions Committee, the rating agencies have not produced high-profile, detailed analyses of the proposal.
Analysts at Fitch Ratings did post a commentary here.
The analysts suggested that states might have the flexibility to deal with changes in federal health program funding.
“Negative implications for entities that rely on state support, including school districts, cities, counties, and public higher education institutions could be more significant given their generally more constrained budgetary flexibility,” the Fitch analysts said.
4. How efforts to include the cost of preexisting conditions in premiums might affect premiums.
Analysts at the Center for American Progress, a research center typically viewed as being sympathetic to Democrats, posted an analysis here that shows what could happen to individual major medical insurance premiums if states used the Graham-Cassidy ACA rule waiver provision to let insurers include the full cost of treatment for pre-existing conditions in enrollees’ premiums.