GOP Healthcare Reform Bill on Life Support

Opposition to the Graham-Cassidy-Heller-Johnson amendment may sink latest effort to replace Affordable Care Act.

The future of the GOP’s effort to repeal the Affordable Care Act (ACA) may be threatened due to new opposition to the bill. Currently, Sen Rand Paul (R-KY), Sen John McCain (R-AZ), and Sen Susan Collins (R-ME) have publicly opposed the bill, which may table it for vote.

A co-author of the bill, Sen Bill Cassidy, MD, (R-LA), discussed the legislation and health care reform at this year’s National Association of Specialty Pharmacy (NASP) Annual Meeting and Educational Conference on September 19, 2017.

Dr Cassidy explained the downfall of the ACA and why action needs to be taken to ensure that patients no longer suffer from skyrocketing drug costs that threaten access to treatment.

“They [patients] feel as if there are costs being compounded that they have no clue about. If you go to an audience like this in a town hall and you say, ‘I want price transparency so that you know the cost of something before you have the procedure done, as opposed to finding out 6 months later,’ their eyes light up,” Dr Cassidy said during the session. “They do understand that price transparency is, if you will, giving the patient the power. They want to have a choice of what they purchase.”

Many legislators have pointed out that the ACA has driven up costs for the government, while failing to stabilize the individual insurance marketplace.

Dr Cassidy said that Medicaid expansion is a substantial contributor to the issues with the marketplace and high costs. Although the federal government currently pays for the entirety of expansion, in 2020, states will be responsible for footing a portion of the bill for Medicaid expansion.

Dr Cassidy entered the media spotlight with the so-called the Jimmy Kimmel test, a measuring stick for the quality of healthcare. This test, named after the late-night talk show host whose child was born with a congenital heart condition, is that no family should be denied medical care because they cannot afford it. Dr Cassidy reports that the ACA, as is, would not pass this test.

“I’m afraid that under the status quo, we’re not passing the Jimmy Kimmel test,” Dr Cassidy said.

“The question is, can we do it better? We hope so,” Dr Cassidy told the audience. “What we have set up with the Graham-Cassidy-Heller-Johnson amendment, we have taken the dollars that are in cost-sharing reduction credits and the Medicaid expansion and tax credits, and we give it a big pot and we give it to the state.”

In the latest GOP-led effort to repeal the ACA, Dr Cassidy—along with Sens Lindsay Graham (R-SC), Dean Heller (R-NV), Ron Johnson (R-WI), and former US Senator Rick Santorum (R-PA)—introduced legislation that would provide block funding for Medicaid expansion, tax credits, subsidies, and health plan dollars, according to the senator.

“This begins to allow states to create mechanisms to lower costs so that those who are currently priced out can now afford, and they now have access to, the coverage they need, and now their coverage passes the Jimmy Kimmel test,” he said.

Critics of the law suggest that this plan may increase the uninsured rate and not protect patients with pre-existing conditions.

Legislators have also recently pushed for bipartisan legislation to improve health care and reduce costs; however, Dr Cassidy said that a bipartisan approach was not possible for health insurance, forcing them to pursue a GOP-controlled effort, according to the session.

“It shouldn’t matter if you’re Democrat or Republican, it should only matter if you’re American and if you have a need,” Dr Cassidy said. “And so, we wrote this—if you will—agnostic as to whether a state was blue or red.”

During the session, Dr Cassidy acknowledged that the bill may not have the necessary support to bring it to a vote. Despite this, he was confident that the legislation would be passed.

“I hope it passes—not because the Cassidy name is on it, or any other reason, or because it kills Obamacare—but for the focal point,” Cassidy said at the meeting. “The focal point is we give the power to the patients. The power to the states, which they return to the patients.”

In addition to Sens McCain, Collins, and Paul, Sen Ted Cruz (R-TX) and Sen Lisa Murkowski (R-AK) have yet to announce whether they support the bill publicly, throwing further uncertainty into health care reform efforts.

Yesterday, Collins announced her opposition to the bill, citing several concerns with the legislation. Collins said that the bill makes changes to Medicaid that would be devastating to Americans, weakens protections for patients with pre-existing conditions, and would likely lead to higher premiums and reduced coverage, according to the statement.

“The Affordable Care Act has many flaws that need to be addressed,” Collins said. “The current state of health insurance, where premiums are skyrocketing, choices are limited, and small businesses are struggling, needs fixing. My focus will remain on remedying these problems.”