Like a zombie in a low budget horror movie, Republican efforts to repeal and replace the Affordable Care Act (ACA) are back from the dead. Once again.
Less than two months ago, Senate Republicans fell short of their goal to repeal the ACA after Sen. John McCain (R., AZ) joined Sens. Susan Collins (R., ME) and Lisa Murkowski (R., AK) plus all 48 Democratic Senators in defeating a so-called “skinny” repeal by a vote of 49-51. The “skinny” repeal was a last ditch effort after two other repeal efforts failed to pass that same week. At that point, it looked as though Republican efforts to repeal the ACA were not just stalled but were effectively dead in the water.
Enter Sens. Lindsey Graham (R., S.C.) and Bill Cassidy (R., LA). The two worked to put together a proposal that was, until very recently, not garnering much support. But with a September 30th deadline approaching to pass any repeal legislation through the budget reconciliation process, the proposal is now gaining traction.
Essentially, the proposed legislation would convert the ACA’s tax credits, subsidies and funding for Medicaid expansion into block grants to states through 2026. Each state would have discretion on how to use the funds. For example, some might decide to use it to set up high-risk pools or reinsurance programs while others might use it to lower out-of-pocket costs. States would also have discretion to waive many of the ACA’s consumer protections, such as the prohibition against preexisting condition exclusions.
Supporters of the legislation argue it will return power to the states and give them greater flexibility to create solutions for their particular needs. Opponents are concerned because states that expanded Medicaid under the ACA, such as California, New York and Massachusetts, will see significant cuts in funding whereas states that chose not to expand Medicaid, such as Texas, Florida and Georgia, will see significant increases in funding.
Majority Leader Mitch McConnell (R., KY) recently announced the Senate will vote on the legislation next week. The Congressional Budget Office has yet to release its estimate of the effects of the legislation on the budget or on the number of uninsured; however, it stated it will not be able to provide a full analysis before the scheduled vote. With the repeal zombie living to see another day, many are now scrambling to understand the potential impact of the legislation and some are probably wondering what it takes to actually kill a zombie.