September 22, 2017
Republicans have revived efforts to repeal and replace the Affordable Care Act (ACA), with votes possible in both the House and Senate next week. The measure is being referred to as the Graham-Cassidy Trumpcare Bill, after its authors, Senator Lindsey Graham (R-SC) and Senator Bill Cassidy (R-LA). President Trump once famously referred to the House passed ACA repeal, the American Health Care Act of 2017 as “mean”. Well that description is too kind for this bill.
Before I get into the details of the proposal I want to share some very encouraging news. This afternoon Senator John McCain announced he would NOT support the legislation. This casts doubt on whether the votes will be there next week. Republicans cannot afford to lose votes on this because the margin is so tight.
Now, on to the legislation. Simply put, Graham-Cassidy would have a devastating impact on far too many Americans. It repeals the individual mandate as well as the employer mandate. This means that employers will be under no obligation to offer health insurance to their employees. It eviscerates Medicaid spending and turns what’s left of the money into a block grant program administered by the states. 34 states, including Massachusetts, will lose funds if this bill passes. The Center on Budget and Policy Priorities has reviewed the Senate’s latest attempt to repeal the ACA. According to their analysis, 16 states that voted for Trump would lose a combined $22 billion in funding if the Graham-Cassidy repeal effort passes. Some states losing out include Vice President Mike Pence’s home state of Indiana, Senator Rubio’s Florida, Senator Murkowski’s Alaska, and Senate Majority Leader McConnell’s Kentucky. Even Louisiana, which is Senator Cassidy’s own state, loses billions.
Graham-Cassidy lets states waive requirements that insurance companies cover essential benefits such as prenatal care. It also places coverage for pre-existing conditions in jeopardy because the legislation essentially allows insurance companies to charge whatever they want to consumers who have one. So you might technically be able to obtain coverage if you have asthma, diabetes or a heart condition – but you won’t be able to afford it. The legislation also bans federal funding to Planned Parenthood for one year. Remember, federal law already prohibits taxpayer dollars from being used to cover abortion services. This is money that Planned Parenthood uses to provide preventive care and cancer screenings.
The non-partisan Congressional Budget Office (CBO) has already announced there isn’t enough time for a thorough analysis of the legislation, but that isn’t stopping Republicans from speeding it to a vote. You see, there is a deadline that Senate Republicans are scrambling to make – September 30th which is the end of the federal fiscal year. Early in 2017, the Senate advanced budget legislation that also directed the relevant committees to explore health care legislation that focused on cost savings. By approaching health care from a budget perspective, only a simple majority of 50 Senators plus the Vice President is needed to pass a bill. Once that directive expires, 60 votes will be needed to repeal and replace the ACA.
By the way, EVERY SINGLE Medicaid Director from ALL 50 STATES is publicly opposed to this bill. Every health care group that has taken a public position is also opposed.
Interestingly, the Republican mantra for NOT waiting for a CBO review is because, according to Senator John Kennedy (R-LA) who appeared on CNN: “no one can determine what this bill will actually do because that will be up to the 50 states individually”. So Republicans admit they do not know what the impact of this bill will be, but they are apparently willing to roll the dice with the health insurance of 30 million Americans in the face of universal opposition from professional groups. To borrow a word from President Trump – now that’s mean.
I am closely following all developments on the status of Graham-Cassidy. If it passes in the Senate next week, Speaker Ryan has said the House will vote on it without amendments by September 30th. I will vote NO and will do everything I can to convince my colleagues that passing this legislation will result in millions of Americans losing access to quality health care.
I met this week with a group of local activists who are concerned about the state’s plans to provide a limited extension of service on the Fairmount Line to Foxboro. While this pilot program will give more commuters access to the Fairmount Line, there is concern that it will come at a cost to riders who rely on the core of the line which runs through Dorchester, Mattapan and Hyde Park. I share those concerns and wanted to hear directly from constituents who use the service. I want to be sure that their voices are heard as state officials develop this pilot program. We also exchanged ideas on how to enhance the rider experience as well as how best to prioritize improvements to the line.
Innovation in Cambridge
I enjoyed spending time at the Johnson and Johnson Innovation Center in Cambridge this week. The center offers support for start-ups and small companies seeking expansion. The general focus is on pharmaceutical development, medical devices, global health initiatives and health care research. The Innovation Center gives entrepreneurs and researchers access to the expertise and resources they need to grow. Officials with Alnylam Pharmaceuticals and the Biotechnology Innovation Organization (BIO) joined us yesterday. I participated in a lively roundtable discussion about the important role research and development has in the Greater Boston area. We talked about how National Institutes of Health (NIH) funding could be impacted in the next budget and the proposed Graham-Cassidy health care bill. We also talked about the challenges facing the biotechnology industry and the importance of providing adequate resources for research.
Behind the Curtain — More House and Trump Administration Actions You Don’t Want to Miss
Here are this week’s additions. If you need to catch up or share with friends, you can find the full list here.
- In September 2017 Politico reported that Secretary of Health and Human Services Tom Price used private jets five times in a week for government related travel. Locations visited included Maine, New Hampshire and Pennsylvania. In a follow up story today, Politico reported that Price had taken at least 24 private flights in the past few months. Private flights are significantly more expensive than commercial travel and it appears that Price has been traveling this way regularly. The Trump Administration’s budget proposes billions of dollars in cuts, including on health care spending. Yet somehow, there is plenty of money available to charter flights when commercial travel is a viable and more cost effective option.
- In September of 2017 the U.S. Office of Government Ethics reversed a policy that banned White House staffers with legal defense funds from accepting anonymous lobbyist donations for those funds. With the ongoing Russia probe, a number of White House staffers have already obtained legal counsel and others will surely follow suit. Legal fees are expected to be enormous and setting up a defense fund helps defray costs. Now, staffers can accept donations from lobbyists in another weakening of ethics rules.
- The Washington Post reported in September 2017 that taxpayer money was used for Administration staffers to stay at Mar-a-Lago, the so-called “Winter White House” in Florida. Reporters reviewed a lodging receipt for more than $1000 which also showed that the rooms were priced at the “rack rate” which is the standard room rate as opposed to a government rate. So it certainly appears as if Trump is personally profiting from government use of his businesses. There are plenty of other lodging options in the area, yet the luxurious Mar-A-Lago was rented.
- The Trump Administration is weakening oversight of the fledgling self-driving vehicle industry by not making safety assessments mandatory. Under previous guidelines, automakers were required to provide the National Highway Traffic Safety Administration (NHTSA) with safety assessment documents. Under the revised directives, manufacturers "may" prepare a Voluntary Safety Self-Assessment and need not submit anything to the federal government. This just makes no sense, particularly because the self-driving car industry is still in development and safety assessments should be an integral component of what they are required to analyze. Business interests are being given priority over the consumer.
What’s Up Next
The next House votes will take place on Monday September 25th. The House may consider health care legislation.