U.S. Sen. Bill Cassidy (R-LA)

September 13, 2017

SENATORS INTRODUCE GRAHAM-CASSIDY-HELLER-JOHNSON

LEGISLATION BLOCK GRANTS OBAMACARE FUNDING TO STATES FOR HEALTH CARE

U.S. Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), Ron Johnson (R-WI) and former US Senator Rick Santorum (R-PA) today unveiled legislation to reform health care.
 
The Graham-Cassidy-Heller-Johnson (GCHJ) proposal repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states to help individuals pay for health care.
 
This proposal removes the decisions from Washington and gives states significant latitude over how the dollars are used to best take care of the unique health care needs of the patients in each state.
 
The block grant is run through CHIP and is subject to a mandatory appropriation.
 
The grant dollars would replace the federal money currently being spent on Medicaid Expansion, Obamacare tax credits, cost-sharing reduction subsidies and the basic health plan dollars.
 
The proposal gives states the resources and regulatory flexibility to innovate and create healthcare systems that lower premiums and expand coverage.
 
More specifically, GCHJ:  
 
  • Repeals Obamacare Individual and Employer Mandates.
  • Repeals the Obamacare Medical Device Tax.
  • Strengthens the ability for states to waive Obamacare regulations.
  • Returns power to the states and patients by equalizing the treatment between Medicaid Expansion and Non-expansion States through an equitable block grant distribution.
  • Protects patients with pre-existing medical conditions.
 
GCHJ also eliminates the inequity of three states receiving 37 percent of Obamacare funds and brings all states to funding parity by 2026. As an example, Pennsylvania has nearly double the population of Massachusetts, but receives 58 percent less Obamacare money than Massachusetts.
 
Graham-Cassidy-Heller-Johnson treats all Americans the same no matter where they live.
 
“Instead of a Washington-knows-best approach like Obamacare, our legislation empowers those closest to the health care needs of their communities to provide solutions,” said Graham.  “Our bill takes money and power out of Washington and gives it back to patients and states. It takes us off the path to single payer health care – which would be a disaster – and puts us on a path toward local control.  Our approach will have better health care outcomes, transparency, and sustainability than Obamacare.  This bill fundamentally transforms health care in the United States.”
 
“This past week, we heard testimony from Democrat and Republican governors and Medicaid directors who believe that, with increased flexibility and freedom from Washington, DC regulations, they can do a better job of providing coverage for the people of their state. We agree,” said Dr. Cassidy. “This amendment gives that flexibility to states while protecting patients and the federal taxpayer.”
 
“Doing nothing to try to solve Obamacare’s failures isn’t an option. Up until last month, Nevadans living in 14 of our 17 counties were not going to be able to buy insurance on the exchange next year. On top of that, the most disadvantaged Nevadans are forced to pay a fine for a product that they cannot afford,” said Heller. “The Graham-Cassidy-Heller-Johnson plan is the most viable solution to achieving our health care reform goals by recognizing Obamacare’s failed one-size-fits-all approach and returning power to the states. I thank Senators Graham and Cassidy for their leadership, and I urge my colleagues to join us in supporting a plan that allows our governors and legislatures the flexibility to support programs that are currently working in our states and to explore new options to address coverage and cost.”
 
“Obamacare continues to collapse, and we have no choice but to address this problem head on,” Sen. Johnson said. “Returning more health care decisions to the states and ensuring equal treatment for states like Wisconsin that spend taxpayer dollars wisely will allow local leaders to tailor their health care system to the needs of its citizens while maintaining protections for those with high cost and pre-existing conditions.”
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Republican National Committee
September 19, 2017

RNC Talking Points

On the GCHJ Bill Aimed at Repealing and Replacing Obamacare

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OBAMACARE IS COLLAPSING
 
Voters sent President Trump and Republicans to Washington to fix the Obamacare mess created by Democrats. They trust Republicans to enact real and meaningful change and offer solutions that will provide much needed relief.
 
Seven years after Obamacare first became law, premiums are still on the rise, insurers are pulling out of unstable marketplaces, and American working families are facing higher and higher health care costs in exchange for less options and worse care.
 
The outlook for next year is not promising.
The latest estimates show 1,478 counties, over 45% of the counties in America, will have just one insurance company in 2018.
 
The Congressional Budget Office estimates that average healthcare premiums are expected to rise 15% more next year.
 
SENATOR SANDERS' PLAN FOR GOVERNMENT-RUN HEALTHCARE
 
Senator Sanders’ plan would levy an enormous $32 billion burden on hardworking American taxpayers.
Sanders’ plan would mandate an exorbitant tax increase on middle class Americans.
 
Democrats are divided over the costs and even the most liberal members of the Party have criticized the plan.
 
Even in very liberal states, these government-run healthcare plans have failed because the costs are too high.
 
Obamacare failed spectacularly and devastated the American healthcare system. If we allow for a complete government takeover, hardworking families nationwide will face crippling tax increases, higher wait times, and worse care.
Read more on Bernie Sanders’ plan here.
 
GRAHAM – CASSIDY LEGISLATION TOPLINES
 
Senator Lindsey Graham and Senator Bill Cassidy have introduced legislation to repeal and replace Obamacare.
 
This is a second chance to make good on a promise and move forward with health care reform before the end of this year.
 
Republicans and Democrats must act on this legislation before the September 30 budget reconciliation deadline.
Once the deadline passes, it will require 60 votes to achieve meaningful healthcare reform.
 
The time has come for members of both parties to act.
 
 
LEGISLATION OVERVIEW
 
The Graham-Cassidy-Heller-Johnson (GCHJ) proposal repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states to help individuals pay for health care.
 
This proposal removes the decisions from Washington and gives states significant latitude over how the dollars are used to best take care of the unique health care needs of the patients in each state.
 
The block grant is run through CHIP and is subject to a mandatory appropriation.
 
The grant dollars would replace the federal money currently being spent on Medicaid Expansion, Obamacare tax credits, cost-sharing reduction subsidies and the basic health plan dollars.
 
The proposal gives states the resources and regulatory flexibility to innovate and create healthcare systems that lower premiums and expand coverage.
 
Legislation Key Components
 
Repeals Obamacare Individual and Employer Mandates.
 
Repeals the Obamacare Medical Device Tax.
 
Strengthens the ability for states to waive Obamacare regulations.
 
Returns power to the states and patients by equalizing the treatment between Medicaid Expansion and Non-expansion States through an equitable block grant distribution.
 
Protects patients with pre-existing medical conditions.

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Letter from 15 Republican Governors Supporting GCHJ

September 19, 2017

The Honorable Mitch McConnell
Senate Majority Leader
United States Senate
Washington, DC 20510 
 

Dear Senate Majority Leader McConnell,  

Obamacare is broken and the states are the best place to fix it.  

A better way to repeal and replace Obamacare is to examine how welfare reform became law in 1996.  After vetoing previous legislation, President Bill Clinton signed into law the third welfare reform bill passed by Congress that session.   

At the time, many liberals objected to the work requirements for able-bodied adults, while some conservatives complained that the states received too much money in the final version.  Today, more than two decades later, the facts show that the welfare reform law is an overwhelming success.   
 
Governors like Tommy Thompson from Wisconsin, Terry Branstad from Iowa, and John Engler from Michigan used the new resources from the federal government to dramatically reduce the rolls of public assistance in their jurisdictions.  They made welfare reform work in the states.   

The block grants given to the states remained stable through the years, saving federal taxpayers from increases in taxes prior to welfare reform. Today, states have a reliable source of funding from the federal government called Temporary Assistance for Needy Families (TANF) to help transition people from government dependence to true independence through the dignity of work.  
 
Welfare reform passed in the 1990s works because states were given maximum authority along with adequate funding. This model can work for the repeal and replacement of Obamacare.  

Adequately funded block grants to the states, along with maximum flexibility and control, is the best option on the table. We appreciate the work of Senators Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson to draft language that embraces this simple, yet profound concept.  We call on the members of the United States Senate to move quickly to repeal Obamacare and replace it with flexible block grants to the states.   

In 1981, President Ronald Reagan reminded us during his first Inaugural address that the federal government did not create the states, the states created the federal government.  Our founders were right.  They intended for the federal government to have limited powers and the rest be given to the states and - more importantly - to the people.   

Adequately funded, flexible block grants to the states are the last, best hope to finally repeal and replace Obamacare - a program which is collapsing before our very eyes. We stand ready to work with you and the other members of the Senate, the Speaker and the other members of the House, and with the President and his administration to repeal Obamacare and replace it with something that works - in the states.   

Thank you for your attention to this important issue. 

Sincerely,


Governor Scott Walker-Wisconsin

Governor Asa Hutchinson-Arkansas

Governor Eric Holcomb-Indiana

Governor Kim Reynolds-Iowa

Governor Sam Brownback-Kansas

Governor Matt Bevin-Kentucky

Governor Paul R. LePage-Maine

Governor Phil Bryant-Mississippi  

Governor Eric R. Greitens-Missouri

Governor Pete Ricketts-Nebraska

Governor Doug Burgum-North Dakota  

Governor Mary Fallin-Oklahoma

Governor Dennis Daugaard-South Dakota  

Governor Bill Haslam-Tennessee

Governor Gary H. Herbert-Utah

Vice President Pence‏Verified account @VP  Sep 19

Vice President Pence
Went to the Senate today to say @POTUS & I fully support Graham-Cassidy plan to repeal/replace Obamacare. Let's get this done.

Donald J. Trump‏Verified account @realDonaldTrump  Sep 20
I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does! A great Bill. Repeal & Replace.


IN OPPOSITION
Democratic National Committee

September 19, 2017

Cruel Impacts Of Graham-Cassidy-Heller-Johnson

As Republicans work in secret to force a partisan health care repeal bill to a vote, the damage their repeal would cause to millions of Americans across the country is even worse than their previous failed repeal bills.
 
Graham-Cassidy-Heller-Johnson would bring back preexisting conditions.
 
Vox: “The new Republican plan to repeal Obamacare would bring preexisting conditions back to the individual market, allowing insurers to charge sick people higher premiums — or deny them coverage outright.”
 
It slashes health-care spending more deeply and would likely cover fewer people than previous failed health care repeal attempts.
 
Washington Post: “The latest Obamacare overhaul bill gaining steam on Capitol Hill slashes health-care spending more deeply and would likely cover fewer people than a July bill that failed precisely because of such concerns. What’s different now is the sense of urgency senators are bringing to their effort to roll back the Affordable Care Act, with only a dozen days remaining before the legislative vehicle they’re using expires.”
 
It would gut Medicaid, making it impossible for states to maintain coverage for the poor.
 
Star Ledger Editorial: “Among the structural defects of Trumpcare 4.0: It would drastically restructure Medicaid, making it almost impossible for states to maintain the expansion and coverage for the poor; and it would drastically reduce federal spending, turning Obamacare into a block-grant program that gives cash-strapped states the freedom to devise their own systems with few strings attached - before the block grants are eliminated entirely after 2026.”
 
It offers states block grants that would provide billions less in funding than what they would receive under current law.
 
New York Times Editorial: “It would offer states block grants they could use to help people get insurance but would leave people at the mercy of individual state legislatures and, over all, would provide $239 billion less than what the federal government would spend under current law between 2020 and 2026, according to the Center on Budget and Policy Priorities.”
 
It would defund Planned Parenthood.
 
CNN Money: “In keeping with longstanding Republican beliefs, the legislation prohibits federal funding for Planned Parenthood. But the restriction is only for a year, beginning when the bill is enacted.”
 
More simply put, this bill is flat out cruel.
 
New York Times Editorial: “It is hard to overstate the cruelty of the Graham-Cassidy bill.”

American Medical Association
For immediate release: Sep 19, 2017

AMA Urges Senate To Oppose Graham-Cassidy Legislation

Millions would lose their health insurance coverage while destabilizing health insurance markets under new bill

CHICAGO –The American Medical Association (AMA) today outlined its opposition to the Graham-Cassidy legislation in the U.S. Senate, citing the loss of affordable health insurance coverage for millions of patients across the country.

“Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care,” wrote AMA CEO and Executive Vice President James L. Madara, M.D.  “We sincerely urge the Senate to take short-term measures to stabilize the health insurance market by continuing to fund cost sharing reduction payments.”

The full text of the letter is below and can be downloaded in PDF format.

Dear Majority Leader McConnell and Democratic Leader Schumer:

On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing to express our opposition to the Cassidy-Graham-Heller-Johnson Amendment to H.R. 1628, the “American Health Care Act of 2017.”  We also urge the Senate to reject any other legislative efforts that would jeopardize health insurance coverage for tens of millions of Americans.  Instead, in the short term we urge Congress to pursue legislation that will stabilize health insurance premiums in the individual insurance market by continuing to fund cost-sharing reduction payments.

Earlier this year the AMA put forward our vision for health system reform consisting of a number of key objectives reflecting AMA policy.  Throughout the debates this year we have consistently recommended that any proposals to replace portions of current law should ensure that individuals currently covered do not become uninsured.  Proposals should maintain key insurance market reforms, such as coverage for pre-existing conditions, guaranteed issue, and parental coverage for young adults; stabilize and strengthen the individual insurance market; ensure that low- and moderate-income patients are able to secure affordable and meaningful coverage; and guarantee that Medicaid, the Children’s Health Insurance Program (CHIP), and other safety-net programs are adequately funded.

Unfortunately, the Graham-Cassidy Amendment fails to match this vision and violates the precept of “first do no harm.”  Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care.  We are particularly concerned with provisions that repeal the ACA’s premium tax credits, cost-sharing reductions, small business tax credit, and Medicaid expansion, and that provide inadequate and temporary block grant funds (only through 2026) in lieu of the ACA’s spending on marketplace subsidies and the Medicaid expansion.

We are also concerned that the proposal would convert the Medicaid program into a system that limits federal support to care for needy patients to an insufficient predetermined formula based on per-capita-caps.  Per-capita-caps fail to take into account unanticipated costs of new medical innovations or the fiscal impact of public health epidemics, such as the crisis of opioid abuse currently ravaging our nation.  In addition, the amendment does not take steps toward coverage and access for all Americans, and while insurers are still required to offer coverage to patients with pre-existing conditions, allowing states to get waivers to vary premiums based on health status would allow insurers to charge unaffordable premiums based on those pre-existing conditions.  Also, waivers of essential health benefits will mean patients may not have access to coverage for services pertinent to treating their conditions.

Furthermore, we are concerned with other provisions of the legislation beyond those directly affecting insurance coverage.  The ACA’s Prevention and Public Health Fund was, according to the Department of Health and Human Services, established to “provide expanded and sustained national investments in prevention and public health, to improve health outcomes, and to enhance health care quality.”  These activities are key to controlling health care costs and the elimination of support for them runs counter to the goal of improving the health care system.  We also continue to oppose congressionally-mandated restrictions on where lower income women (and men) may receive otherwise covered health care services—in this case the prohibition on individuals using their Medicaid coverage at clinics operated by Planned Parenthood and other similar organizations.  These provisions violate longstanding AMA policy on patients’ freedom to choose their providers and physicians’ freedom to practice in the setting of their choice.

We sincerely urge the Senate to take short-term measures to stabilize the health insurance market by continuing to fund cost sharing reduction payments.  Over the longer term, we urge Congress to work in a bipartisan, bicameral manner to increase the number of Americans with access to quality, affordable health insurance, and we extend our commitment to work with you to achieve this goal.

Sincerely,

James L. Madara, MD

cc:  United States Senate

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Media Contact:
Jack Deutsch
AMA Media & Editorial


About the AMA
The American Medical Association is the premier national organization dedicated to empowering the nation’s physicians to continually provide safer, higher quality, and more efficient care to patients and communities. For more than 165 years the AMA has been unwavering in its commitment to using its unique position and knowledge to shape a healthier future for America. For more information, visit ama-assn.org.

Letter from Ten Governors (5 Dem. and 5 Rep.) Opposing GCHJ

September 19, 2017

The Honorable Mitch McConnell
Majority Leader
United States Senate
317 Russell Senate Office Building
Washington, D.C. 20510

The Honorable Charles E. Schumer
Minority Leader
United States Senate
322 Hart Senate Office Building
Washington, D.C. 20510

Dear Majority Leader McConnell and Minority Leader Schumer:

As you continue to consider changes to the American health care system, we ask you not to consider the Graham-Cassidy-Heller-Johnson amendment and renew support for bipartisan efforts to make health care more available and affordable for all Americans. Only open, bipartisan approaches can achieve true, lasting reforms.

Chairman Lamar Alexander and Ranking Member Patty Murray have held bipartisan hearings in the Senate’s Health, Education, Labor and Pensions (HELP) Committee, and have negotiated in good faith to stabilize the individual market. At the committee’s recent hearing with Governors, there was broad bipartisan agreement about many of the initial steps that need to be taken to make individual health insurance more stable and affordable. We are hopeful that the HELP committee, through an open process, can develop bipartisan legislation and we believe their efforts deserve support.

We ask you to support bipartisan efforts to bring stability and affordability to our insurance markets. Legislation should receive consideration under regular order, including hearings in health committees and input from the appropriate health-related parties. Improvements to our health insurance markets should control costs, stabilize the market, and positively impact coverage and care of millions of Americans, including many who are dealing with mental illness, chronic health problems, and drug addiction.

We look forward to continuing to work with you to improve the American health care system. Sincerely,

John Hickenlooper
Governor
State of Colorado

Bill Walker
Governor
State of Alaska

John Kasich
Governor
State of Ohio

Steve Bullock
Governor
State of Montana

Tom Wolf
Governor
State of Pennsylvania

John Bel Edwards
Governor
State of Louisiana

Charles D. Baker
Governor
State of Massachusetts

Terence R. McAuliffe
Governor
State of Virginia

Brian Sandoval
Governor
State of Nevada

Phil Scott
Governor
State of Vermont