Cleveland Clinic president and CEO
Deciphering a dense piece of proposed federal legislation is no easy task. But in the case of the Graham-Cassidy proposal under consideration in the US Senate, one key question can provide crucial focus: Who benefits from this latest effort to gut the Affordable Care Act?
Not states. Overall federal funding for Medicaid and state coverage expansions would drop $160 billion between 2020 and 2026 under Graham-Cassidy, compared to current law, according to the Kaiser Family Foundation. Thirty-five states plus the District of Columbia would likely lose funding.
Not hospitals. More than one-in-five U.S. hospitals are already running in the red, while more than half are losing money on the administration of care. The decreased Medicaid funding in Graham-Cassidy will threaten the financial viability of hospitals nationwide.
And certainly not the American people. Under Graham-Cassidy, it’s likely that fewer people will be covered by health insurance, while those with pre-existing medical conditions may pay more, if they can secure coverage at all.
At least we think this could be some of the fallout of Graham-Cassidy, but it’s difficult to know for sure, because the bill is being rushed to a vote. It was only unveiled last week and will be voted on next week, without a score from the Congressional Budget Office and with no chance to fully vet the bill’s side effects.
What we do know, though, is not comforting.
We know that between 2020 and 2026 the bill will end direct support for purchasing coverage in the marketplace, including tax credits and federal support for states like Ohio that have expanded their Medicaid program.
We know that it will convert funds that would have been spent on federal support for coverage into block grants distributed to states, allowing each state to decide how these plans are administered. While per-capita cap allocations under Medicaid, done the right way, may make sense, a block grant for everything would force states to build 50 separate administrative infrastructures – a highly inefficient model.
We also know that Graham-Cassidy will allow states to set aside the ACA’s Essential Health Benefits – which require all insurance plans to cover 10 healthcare categories (such as doctors’ services, hospital care, prescription drugs, pregnancy and childbirth, mental health services, and more) – including restrictions on charging higher premiums for those with pre-existing medical conditions.
It’s true that the amendment requires insurers to offer “adequate and affordable” coverage to people with pre-existing conditions. However, it does not define what “adequate and affordable” means. So while a cancer survivor, for instance, may have access to the health insurance marketplace, it’s not true access if the coverage is unaffordable – as it often is in high-risk pools.
According to a recent Kaiser Family Foundation poll, nearly 70 percent of Americans want Congress to fix the ACA by stabilizing the insurance market. At a minimum, legislation should do just that, while also supporting widespread insurance coverage for Americans, maintaining coverage for pre-existing conditions and improving access to affordable coverage and care.
The Graham-Cassidy bill fails to deliver on any of those priorities. In fact, it actively pursues the opposite, which is why the medical community – doctors, hospitals, insurers, pharmaceutical companies, and patient advocacy groups – is universally opposed to this latest effort to “repeal and replace” the ACA.
Healthcare in the United States should be of the highest quality, affordable and accessible to all Americans. At Cleveland Clinic, it is our mission to deliver the best possible care to all the patients we serve. The proposed Graham-Cassidy healthcare bill does not support what our organization thinks healthcare in America should be, therefore we oppose the pending legislation. As an organization, we will continue to communicate with our policymakers to implement changes that have a positive impact on our nation’s healthcare system.
Official Cleveland Clinic Statement:
“It is our mission to deliver the best possible care to all the patients we serve. We believe that healthcare should be of the highest quality, affordable and accessible to all Americans. The proposed Graham-Cassidy healthcare bill does not support what our organization thinks healthcare in America should be, therefore we oppose the pending legislation. As an organization, we will continue to communicate with our policymakers to implement changes that have a positive impact on our nation’s healthcare system.”