LCCHR Opposes the Graham-Cassidy Plan, ‘Which Will Destroy Medicaid’
On behalf of
The ACA and Medicaid are critical sources of health coverage for America's traditionally underserved communities, which our organizations represent. This includes individuals and families living in poverty, people of color, women, immigrants, LGBTQ individuals, individuals with disabilities, seniors, and individuals with limited English proficiency.
The ACA has reduced the number of people without insurance to historic lows, including a reduction of 39 percent of the lowest income individuals.[i] The gains are particularly noteworthy for Latinos, African Americans, and
Medicaid is also critically important, as it insures one of every five individuals in
People of color are more likely than White non-Hispanics to lack insurance coverage and are more likely to live in families with low incomes and fall in the Medicaid gap.[v] As a result, the lack of expansion disproportionately affects these communities, as well as women, who make up the majority of poor uninsured adults in states that did not expand Medicaid. For people of color who experienced some of the largest gains in health coverage since the implementation of the ACA and Medicaid expansion, the Graham-Cassidy proposal could mean vastly reduced access to needed health care, increased medical debt, and persistent racial disparities in mortality rates.[vi] Further, Medicaid provides home and community-based services enabling people with disabilities to live, work, attend school, and participate in their communities. The proposed cuts would decimate the very services that are cost-effective and keep individuals out of nursing homes and institutions. Finally, one in five people with Medicare rely on Medicaid to cover vital long-term home care and nursing home services, to help afford their Medicare premiums and cost-sharing, and more.
Despite the common myth that all low-income people could enroll in Medicaid, the Medicaid program had previously only been available to certain categories of individuals (e.g., children, pregnant women, seniors, people with disabilities) who had little to no savings or assets. Parents of children and childless adults were often excluded from Medicaid or only the lowest income individuals in these categories were eligible. For example, the Medicaid expansion greatly expanded coverage for LGBTQ individuals who previously did not fit into a traditional Medicaid eligibility category and for working people struggling in jobs that do not offer health insurance and pay at or near the minimum wage. Yet the Graham-Cassidy proposal repeals Medicaid expansion and cuts billions from Medicaid itself which will force states to cut eligibility and services.
We do not yet have a full CBO score that tells us how many people would have Medicaid or marketplace coverage taken away from them under the Graham-Cassidy bill, and we will not have that estimate before legislation may come up on the
The Graham-Cassidy bill makes fundamental changes to both the Medicaid expansion and the traditional Medicaid program, as well as dismantling ACA's reforms to the individual market. Graham-Cassidy destroys the Medicaid program, ending the federal-state partnership and dramatically altering the structure of the program by implementing a per capita cap. The bill would cut billions of dollars of funding to states, limiting the federal contribution to states based on a state's historical expenditures, which would be inflated at a rate that is projected to be less than the annual growth of Medicaid costs.[vii] Any costs above the per capita caps would be the sole responsibility of states, regardless of the cost of care. As a result, per capita caps will cause deep cuts in care for people with disabilities, seniors, women, and people of color who qualify for Medicaid. Women, who comprise the majority of Medicaid adult enrollees, would be particularly harmed, with women of color disproportionately impacted. Thirty percent of
With regard to the Medicaid expansion, under the Graham-Cassidy plan, ACA tax credits and Medicaid expansion funding would be converted into block grants to states. The Medicaid expansion would effectively end at the beginning of 2020, and the block grants would end entirely in 2026. Graham-Cassidy would cut funding for the expansion under the new block grant system, with funding for the block grants set at 17 percent less than current funding, providing insufficient funds to maintain ACA coverage levels. Beginning in 2021, Graham-Cassidy would also redistribute this reduced federal funding stream across states based on their share of low-income residents instead of their actual spending needs, punishing states that have enrolled more low-income people. Furthermore, and deeply troubling, the legislative language describing what purposes the block grants could be used for is very broad, with no requirement that block grant funds even be used to aid low or moderate-income people.
As the Center on Budget and Policy Priorities has noted, once the block grant funding stops in 2026, Graham-Cassidy would effectively repeal the ACA's major coverage provisions without a replacement. CBO has previously estimated that this approach would result in 32 million more people being uninsured.[ix] Graham-Cassidy is even more harmful than prior repeal approaches however, in part because states could not continue to cover Medicaid expansion enrollees in Medicaid with less federal funding.
Furthermore, we are very concerned that Graham-Cassidy gives states the option to impose a work requirement as a condition of eligibility under the Medicaid program. Such a requirement not only fails to further the purpose of providing health care but also undermines this objective. Among adults with Medicaid coverage, nearly 8 in 10 live in working families and a majority are working themselves.[x] This work requirement would include penalizing any woman who does not meet work requirements just 60 days after the end of her pregnancy.
In addition, Graham-Cassidy would single out
Lastly, we are seriously concerned about the lack of transparency of the discussions leading to Graham-Cassidy, and the rush now to vote on the bill without adequate time for analysis, hearings, and a full CBO score, which would provide opportunity for both lawmakers and the public to understand the proposed legislation and participate in this discussion in which their very access to health care for themselves and their families is at stake. It is unconscionable to even contemplate dramatically altering one-sixth of the
We urge you to oppose passage of the Graham-Cassidy bill and instead focus on moving forward with bipartisan efforts on market stabilization and other critical issues to improve access to affordable health care for all people in
Sincerely,
National Health Law Program (NHeLP)
ACCESS
Access Living
Advocates for Youth
American Atheists
American-Arab Anti-Discrimination Committee
APSE-
Asian &
Asian Americans Advancing Justice-Los Angeles
Autistic Self Advocacy Network
Bend the Arc Jewish Action
Black Women's Blueprint
Black Women's Health Imperative
Black Women's Roundtable
Black Womens Roundtable,
Black Youth Vote!
Breast Cancer Action
CommonHealth ACTION
Community Access National Network (CANN)
EMILY's List
Empowering Pacific Islander Communities
Equal Rights Advocates
Equality
Family Voices
Farmworker Justice
Feminist Majority
GLMA: Health Professionals Advancing LGBT Equality
Guam Communications Network
Health Care for America Now (HCAN)
Hispanic Health Network
Indivisible
Justice in Aging
Korean Community Services of Metropolitan NY
La Cooperativa Campesina de
Latinos in the Deep South
LEAnet, a national coalition of local education agencies
LPAC
Medicare Rights Center
Mi Familia Vota
MomsRising
Movement
MoveOn.org Civic Action
NAPAFASA
NASTAD
National CAPACD
National Collaborative for Health Equity
National Disability Rights Network
National Network to End Domestic Violence
National Women's Health Network
National Women's
NOBCO:
OCA - Asian Pacific American Advocates
OneAmerica
Organizing for Action
Organizing for Action-Springfield
Out2Enroll
PFLAG National
PolicyLink
Positive Women's Network -
Presbyterian Feminist Agenda Network
Presbyterians Affirming Reproductive Options (PARO)
Project Inform
Public Citizen
Raising Women's Voices for the Health Care We Need
Resource Center
SisterSong: National Women of Color Reproductive Justice Collective
SiX Action
Slow Roll Chicago
South Asian Network (SAN)
Southeast Asia Resource Action Center
TASH
The Alliance
The Arc of
The National Campaign to Prevent Teen and Unplanned Pregnancy
The Voter Participation Center
UCHAPS:
UnidosUS
URGE: Unite for Reproductive & Gender Equity
US Women and Cuba Collaboration
Venas Abiertas
Voices for Progress
Women Employed
Women's Intercultural Network (WIN)
Women's Media Center
Young Invincibles
[i]
[ii]
[iii]
[iv] Summary Health Statistics:
[v]
[vi] Center on Budget and Policy Priorities, African Americans Have Much to Lose Under House GOP Health Plan, available at http://www.cbpp.org/blog/african-americans-have-much-to-lose-under-house-gop-health-plan.
[vii] National Health Law Program, Top 10 Changes to Medicaid Under the Graham-Cassidy Bill (
[viii]
[ix] Center on Budget and Policy Priorities, Like Other ACA Repeal Bills, Cassidy-Graham Plan Would Add Millions to Uninsured, Destabilize Individual Market (
[x]
[xi]
[xii]
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