Republicans Cancel Plans to Vote on Graham-Cassidy

Senator Jeff Flake (R-Arizona) has reported that Senator Mitch McConnell (R-Kentucky) cancelled plans to vote on the latest legislative effort to repeal and replace the Affordable Care Act (ACA) after 3 members of the party announced that they would vote “no” on the Graham-Cassidy bill. Republicans could afford to lose only 2 votes and still pass the legislation.

On Monday, Senator Susan Collins (R-Maine) announced that she would not support the bill, saying that it was “deeply flawed.” Collins voiced concerns about changes and cuts to the Medicaid Program, weakened protections for individuals with pre-existing medical conditions, and the agreement among stakeholder groups that the bill would lead to higher premiums and lower coverage for millions of Americans.

Collins’ announcement came days after Senator John McCain (R-Arizona) released a statement saying that he would vote “no” on the bill, though he would consider supporting legislation similar to Graham-Cassidy if it were “the product of regular order in the Senate.” Senator Rand Paul (R-Kentucky) also expressed opposition to the bill, saying that it did not go far enough in repealing the provisions of the ACA, and calling it a “fake repeal bill.” Senators Collins, Paul, and McCain drew ire from President Donald Trump, who said, “We are disappointed in certain so-called Republicans."

The Congressional Budget Office’s (CBO) preliminary analysis of Graham-Cassidy indicated that the number of people with comprehensive health coverage would be reduced by millions if the bill became law, and that the number of uninsured could vary based upon how states chose to implement their block grants. Medicaid enrollment would decrease because of cuts to federal funding for the program, non-group coverage would drop as a result of reduced subsidies, and enrollment in all types of plans would be reduced as a result of the eliminated individual mandate. Funds would shift away from states that have expanded eligibility for Medicaid under the ACA to states that have not, and by 2020, states would receive approximately 10% less funding than they did under the March 2016 CBO baseline.

Avalere Health, a Washington DC-based consulting company, released its own analysis of the bill. Avalere’s report says that the September 25 version Graham-Cassidy would reduce federal funding to states by $205 billion through 2026, and by more than $4 trillion over a 20-year period.

The failure of this latest attempt to repeal and replace the ACA leaves the Biologics Price Competition and Innovation Act intact; the act, which provides a pathway for biosimilar approval, was passed into law as a part of the ACA.