Sen. Susan Collins, R-Maine, today became the third Republican senator to announce that she will oppose quick passage of any version of the Graham-Cassidy-Heller-Johnson bill.

Sens. Rand Paul, R-Ky., and John McCain have already said they intend to vote against the Affordable Care Act change bill.

Collins said in a statement about her decision that there appear to be at least four versions of the Graham-Cassidy proposal in circulation.

“Sweeping reforms to our health care system and to Medicaid can’t be done well in a compressed time frame, especially when the actual bill is a moving target,” Collins said. “The fact that a new version of this bill was released the very week we are supposed to vote compounds the problem.”

(Related: McCain to Oppose Graham-Cassidy ACA Change Bill)

Collins said she objects to Graham-Cassidy because she believes it would make devastating cuts in Medicaid funding; weaken commercial health insurance protections for people with pre-existing conditions; and lead to higher commercial health insurance premiums and reduced coverage access.

The Graham-Cassidy bill would replace the current Affordable Care Act Medicaid and individual major medical insurance subsidy programs with grants for states, and it would let states apply to adjust the current Affordable Care Act major medical insurance standards.

Republicans have just 52 seats in the Senate and need at least 50 votes to pass a bill. If Collins, Paul and McCain continue to oppose Graham-Cassidy, and no Democrat or independent crosses party lines to vote for it, the bill will die.

After Collins came out against the bill, Senate Majority Leader Mitch McConnell tweeted comments implying that he believes prospects for passing the bill are bleak. Sen. Orrin Hatch, R-Utah, chairman of the Senate Finance Committee noted that the bill has no Democratic votes. But, in the House, in the spring, Republican leaders managed to get another Affordable Care Act change bill, H.R. 1628, passed after first going through a stinging loss on the House floor.

Collins issued her statement shortly after the Senate Finance Committee concluded a hearing on the bill, and shortly before analysts at the Congressional Budget Office gave a preliminary assessment of the bill.

The Hearing

Two of the lead sponsors — Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La. — spoke in favor of the bill at the Senate Finance hearing.

Rick Santorum, a former Republican senator from Pennsylvania, also testified on behalf of the bill.

Graham, Cassidy and Santorum talked about why states should have flexibility to adjust the Affordable Care Act, and why they believe the Graham-Cassidy grant formula would be fair.

Dennis Smith, an official who managed Medicaid under former President George W. Bush, was the only witness supporting the bill who talked about why he thought the provisions in the bill would work.

Dennis Smith (Photo: Senate Finance)

Dennis Smith (Photo: Senate Finance)

Smith, who is now a senior advisor for Medicaid and health care reform at the Arkansas Department of Human Services, said the Graham-Cassidy grant program would help the individual major medical insurance market by giving states the ability to combine the individual major medical risk pool with the Medicaid risk pool.

Up till now, Smith said, many have talked about shoring up the individual market by putting more money into the individual market.

“The solution is to put more people into it,” Smith said. “That’s what will truly stabilize the pool.”

The Affordable Care Act Medicaid expansion program is bigger than policymakers had expected, and the exchange program is smaller, Smith said.

The people who do qualify for Affordable Care Act exchange plan subsidies tend to be low-income people with health problems, Smith said.

Combining the exchange subsidy users with Medicaid enrollees would create a bigger, younger, healthier risk pool, Smith said.

Smith did not address the kinds of concerns Democrats, and some Republicans, have expressed about how Graham-Cassidy might affect would-be commercial health insurance buyers with health problems.

The copy has posted a video recording of the hearing, and written versions of the witnesses’ testimony, here.

The CBO Review

Analysts at the Congressional Budget Office posted a preliminary assessment of the Graham-Cassidy bill here.

The CBO analysts predicted that the bill would narrow the federal budget deficit by at least $133 billion over the period from 2017 through 2016, or by about $13 billion per year.

The federal government could spend about $4.1 trillion in the 12-month period that starts Oct. 1, according to President Donald Trump’s preliminary budget proposal for fiscal year 2018.

The number of people with comprehensive major medical coverage would be “reduced by millions” compared with what the coverage numbers would be under the current rules, according to the CBO analysts.

“That number could vary widely, depending on how states implemented the legislation, although the direction of the effect is clear,” the analysts write.

Graham-Cassidy would cut enrollment by reducing Medicaid enrollment and individual major medical subsidies, and it would also reduce enrollment by eliminating the Affordable Care Act coverage ownership mandate and employer coverage offer mandate, the analysts write.

—-Read GOP Health Care Bill Is Fair to All States on ThinkAdvisor.


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