Maine Hospital Association opposes latest Obamacare-repeal bill

Photo / Peter Van Allen A plane trailing this banner flew over Portland Thursday morning, urging U.S. Sen. Susan Collins, R-Maine, to vote "no" when the Graham-Cassidy bill to repeal and replace Obamacare comes up for a vote next week.

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By James McCarthy

With Republican leadership in the U.S. Senate pushing for a vote by next Wednesday on the latest Senate Republican bill to repeal and replace the Affordable Care Act, U.S. Sen. Susan Collins, R-Maine, once again finds herself in the political hot seat as Majority Leader Mitch McConnell seeks the 50 votes he’ll need for passage under budget reconciliation rules that expire Sept. 30.

Collins was joined by U.S. Sens. John McCain, R-Ariz., and Lisa Murkowski, R-Alaska, in voting against the latest GOP repeal bill in July. With no Democrats or Independent U.S. Sen. Angus King expected to support the Graham-Cassidy bill, McConnell needs the votes of at least 50 of the 52 Senate Republicans for passage.

Once again, the fast-track effort to replace Obamacare puts the Senate in the position of voting on sweeping legislation without knowing fully its potential impact on coverage and premiums. The Congressional Budget Office said Monday its report on Graham-Cassidy could not be completed before the end of the month.

At a glance: Graham-Cassidy

The Washington Post reported that the Graham-Cassidy bill essentially would turn control of health care markets over to the states. The ACA’s individual mandate requiring Americans to have health coverage or pay a fine would be eliminated under Graham-Cassidy, although states could reinstate it if they choose.

Other proposed changes, as reported by the Washington Post:

The employer mandate would be eliminated.
Young adults could stay on their parents’ health insurance plan until they’re 26, as is currently allowed by the ACA.
ACA subsidies would be eliminated. Instead, states would receive block grants from the federal government to provide subsidies themselves.
Cost-sharing subsidies provided to insurers to help some lower-income ACA customers cover deductibles and co-payments would end in 2020 — although states would be free to choose using their block grant to continue those subsidies.
Insurers would be able to charge older customers up to five times as much as they charge younger customers, although states could overrule this if they choose.
Medicaid would be funded by giving states a per capita amount beginning in 2020.

Maine Hospital Association opposes bill

The Maine Hospital Association, which represents all of Maine’s 36 community hospitals, issued a statement Thursday that it opposed the Senate's Graham-Cassidy bill.

“The action is moving too quickly for us to have a fresh Congressional Budget Office assessment of its impact,” the association stated in a news release, noting that preliminary analyses show Maine receiving approximately $1 billion less federal support for health care by 2027 “However, Cassidy-Graham is not substantially different from the previous ACA repeal bill (the AHCA) rejected earlier this year. The CBO assessment of that proposed ACA replacement legislation demonstrated that it would have reduced the level of insurance coverage (14 million fewer in 2018 and 24 million fewer by 2026), would reduce federal support for Medicaid long term ($880 billion less federal spending over the next 10 years) and didn’t reduce the hospital cuts imposed by the ACA.”

“Graham-Cassidy replacement legislation does not help Maine and should either be amended or rejected,” the association stated, adding that it is urging Sens. Collins and King to oppose the bill

Maine Hospital Association's critique of Graham-Cassidy

In its news release announcing opposition to the Graham-Cassidy ACA repeal-and-replace bill, Maine Hospital Association raised three major concerns:

"1. ACA-imposed hospital cuts must be addressed in Graham-Cassidy: There were four sources of federal revenue that were used to finance the ACA benefits. Those sources include Medicare cuts to hospitals. Graham-Cassidy keeps those hospital cuts in place despite reductions in ACA benefits. Eliminating benefits while keeping cuts is patently unfair.

"2. Medicaid cuts must be removed from ACA: Graham-Cassidy would completely rework the Medicaid program, not just Medicaid expansion. It converts the Medicaid program to a block grant similar to the AHCA and substantially reduces federal support for the program. There is no reason to include reform to the broader Medicaid program in this bill. There simply hasn’t been time, hearings or debate devoted to this initiative. Medicaid wasn’t dramatically reworked by the ACA. The 'per capita cap' proposal should be saved for another piece of legislation that goes through the regular legislative process. Furthermore, rural Maine people and the hospitals that provide them care are disproportionately reliant on Medicaid. Rural hospitals had an aggregate operating margin of -1.1% last year and reduced federal support for Medicaid will make this difficult situation much worse for rural Maine.

"3. Graham-Cassidy eliminates subsidies for the individual market entirely: The proposal would convert the subsidies currently used by approximately 75,000 Mainers to a block grant to the states, but only in the short-term. In 2027, the block grant funding is entirely eliminated. Similarly, the Medicaid expansion funding is also eliminated in 2027. These are the two benefit pillars of the ACA. Yet, as mentioned above, the cuts to hospitals are preserved."