On Sept. 30, you can sleep -- but not now. On that day, the reconciliation instructions, which currently enable congressional Republicans to repeal and replace the Affordable Care Act (ACA) with only 50 votes, run out -- and you can shut your eyes and dream sweet dreams of single-payer paradises and Medicare-for-all plans that we will one day achieve. But, right now, we need you to get down into the trenches with us one more time and fight to save the ACA from the greedy predations of the congressional Republicans who want to take it from us.
I know you thought we were done with all this when, on the floor of the Senate, Senator McCain thrust his thumb down just seven weeks ago, but we're not. Like a legislative Freddy Krueger, "repeal and replace" is back again. And it could pass if we fall asleep on the job and provide Republicans the cover they need to squeeze it through.
The most recent incarnation of the GOP's ACA replacement plan was formally introduced by Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) earlier this month. If you thought the passage of time and widespread public disgust with previous Republican health care plans would make the party reassess its priorities and come up with a health care proposal that doesn't cause irreparable harm to millions of Americans, then you are sorely mistaken. In fact, the Graham-Cassidy plan is, in many ways, even more destructive and draconian than both the Senate health care bill that was voted down in July and the House bill that passed in May.
As they have done all year, both the Center for Budget and Policy Priorities and health care writer Sarah Kliff over at Vox have come out with excellent and detailed descriptions of the myriad ways in which Graham-Cassidy would harm tens of millions of people.
For the specific purposes of people living with and impacted by HIV, here are some of the bill's lowlights:
- It brings back pre-existing conditions: Unlike the "skinny repeal" that was voted down at the end of July, the Graham-Cassidy bill would allow individual states to apply for waivers from the federal government to allow insurance companies to discriminate against individuals with pre-existing conditions. This means that if you are living with HIV, hepatitis C or any other illness you can think of, you could see your premiums skyrocket or even be denied coverage, depending on the state you call home.
- Medicaid as we know it would be decimated: The Graham-Cassidy bill would gut Medicaid more than perhaps any of the GOP replacement plans we've seen thus far. Like previous plans, Graham-Cassidy would fundamentally change Medicaid from an entitlement program mandating that the federal government pay a fixed percentage of states' Medicaid costs regardless of how many people are eligible, to a per capita cap program that places a limit on the amount of money the federal government provides per enrollee. The implementation of a per-capita cap system would cut federal Medicaid spending by an estimated $175 billion between 2020 and 2026. Given the fact that Medicaid covers more than 40% of people living with HIV who are in care, this would be devastating to the HIV community.
- Medicaid expansion and ACA subsidies would end, and states that utilized them would be punished: It is bad enough that Graham-Cassidy joins the other Republican ACA-replacement plans in eliminating the Medicaid expansion provision of the ACA that provided health care to all Americans living under 138% of the federal poverty level in the 31 states that have chosen to participate. But, even worse, in addition to getting rid of Medicaid expansion, the bill would also end the ACA's marketplace subsidies for low- and moderate-income Americans and replace them with a grossly insufficient and temporary block grant. The block grant is projected to be 17% below ACA-level funding by 2026. And, on top of all that, the formula Cassidy-Graham uses to distribute the block grant money would actually punish states that successfully enrolled low-income individuals in care through Medicaid expansion and ACA marketplaces and reward states that chose to leave their residents without access to affordable insurance by redistributing federal funding toward them.
Despite the hideousness of the contents of this bill, Graham-Cassidy has a very real chance of passage.
Right now, Senators Graham and Cassidy believe they have anywhere between 47 and 49 of the 50 "yes" votes they need for the bill to pass. Senator Rand Paul (R-KY) is the only Republican who has publicly stated that he won't be voting for Graham-Cassidy (he has derisively called the bill "Obamacare-lite"), but a number of senators are either on the fence or strongly leaning towards voting no, including Senators Collins (R-ME), McCain (R-AZ) and Murkowski (R-AK), the three Republicans who voted "no" on the skinny repeal in July. In addition, a number of other Republican senators -- such as Shelley Moore Capito (R-WV) and Rob Portman (R-OH), who wound up voting for the skinny repeal but have expressed misgivings over Medicaid cuts -- need to be pressed to vote "no" on Graham-Cassidy, as well.
Now is not the time for complacency, but the time for action! Over the next ten days, the HIV community needs to be more vocal and vigilant than ever in speaking truth to power and demanding that our elected officials preserve the gains we have made in health care coverage through the ACA. To this purpose, an HIV Advocacy Hotline has been set up at 866-246-9371 that will connect you directly to your senators, so you can tell them to vote "no" on this despicable piece of legislation.
We need you to call as much as possible, but in particular, we need you to call on Tuesday, Sept. 26, when HIV advocacy groups across the country will be holding an HIV Call-In Day to consolidate our power and make sure our voices are heard on Capitol Hill. In addition to calling, you can use AIDS United's action alert to send e-mails to your senators, letting them know that anything other than a "no" vote on Graham-Cassidy is unacceptable.