The Debate Continues Over Healthcare Reform

The effort to repeal the Affordable Care Act by Senate Republicans has, for the second time in two months, failed get enough support. The Graham-Cassidy bill drew significant concerns regarding the coverage of pre-existing conditions and the establishment of block grants to states for Medicaid expansion.  The preliminary analysis by the CBO of the Graham-Cassidy bill concluded:

  • Federal spending on Medicaid would be reduced by about $1 trillion from 2017-2026, and the program would cover millions fewer enrollees
  • Transitioning to block grants for states would result in market disruptions and other implementation problems even though the bill allocates funding to assist that transition
  • Block grants from 2020 to 2026 is about $230 billion less than what the CBO had predicted would be spent on subsidies for the Medicaid expansion population and marketplace enrollees under the ACA
  • Insurers in some states would be allowed to set premiums based on an individual’s health status which could results in premiums that would be a very large share of their income


Senator Bernie Sanders is proposing a Medicare For All single-payer approach for healthcare.  The idea has been gaining support from fellow Democrats, but critics argue that it will likely bankrupt the country, drive down the rate of health-care innovation, and not really improve health outcomes. Supporters argue that this plan solves the two biggest problems with American healthcare, access and cost. Everyone is included and the costs are covered by increased taxes. Many details have yet to be decided such as what services are covered, who manages these decisions and how costs will be controlled?

Additionally, there is a bipartisan Senate group called the HELP Committee who are working to stabilize the 2018 insurance markets and lower premiums.  It is being led by Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, R-Tenn., and ranking Democrat Sen. Patty Murray of Washington. This is a short-term fix that brings both parties to the table for negotiation.  The American Hospital Association and The American Academy of Family Physicians support the approach of stabilizing the market place and improving the Affordable Care Act, not repealing it. The CEO of Kaiser Permanente, Bernard Tyson, believes that payers would likely return to the ACA’s exchanges if the government addressed several key issues, including cost-sharing reduction payments.

Some of the elements of this bill include:

  • Allowing enrollees to buy “copper plans” which are less expensive and provide less coverage that are currently on offered to people under age 30.
  • Expansion of waivers that allow states to innovate and change regulations
  • Up to two years of funding of cost-sharing payments to insurance companies


Senator Alexander confirmed last week that they were close to an agreement.  “We need to get a significant number of Democrats and a significant number of Republicans, hand it to Senator McConnell and Schumer, and then we’ve got a matter of eventually persuading the entire Senate, the House of Representatives and the President, so we’re taking it a step at a time,” Alexander said.

Contributed by: Amy Noel