Affordable Care Act 'Repeal and Replace': A Political Autopsy

The resurrected, failed and most likely final attempt at an Affordable Care Act repeal effort in the Senate was operating under a very tight timeframe to get a vote on the Senate floor before the end of September, so that it could pass with a simple majority vote and not have to be subject to filibuster.

But, the Graham-Cassidy plan was still facing many of the factors that defeated earlier attempts. There were no Democrats who would support the measure, and in addition to opposition from Sen. Paul Rand, the same trio of Senate Republicans that have held out in the past, McCain, Murkowski, and Collins, indicated they would not vote yes for this plan either. Compounding the problems for this attempt was the fact that not even one medical, insurance or consumer group would come out in favor of this plan and most vocally expressed their continued opposition.

(Related: Republicans Put Off Graham-Cassidy Vote)

The “Graham-Cassidy plan” focused on capping Medicaid spending and shifting to a block grant model in the states. This model would provide a fixed amount of money to each state and then give them decision-making authority on how it is spent. 

What sparked so much opposition is a combination of the millions of people that would most likely lose coverage from less Medicaid dollars and more restrictions at the state level to eligibility of coverage. Also, pre-existing coverage protections would be endangered having a particularly harsh impact on those most in need of health care.

What is so interesting is that the underpinnings of the Affordable Care Act is the expansion of Medicaid which led to the coverage of millions of previously uninsured people.