Joint Statement on the Graham-Cassidy-Heller-Johnson legislation.

September 26, 2017

Over the weekend and earlier today, changes were made to the Graham-Cassidy-Heller-Johnson health system reform legislation.  These changes would primarily benefit a handful of states where Republican Senators have threatened to vote against the legislation on the floor.  In addition, changes were made that seem intended to address Senator Ted Cruz’s (R-TX) interest in providing still more flexibility to states under the proposed new block grant system.  Highlights of the recent changes include the following:


  • Directs more federal funding to key states, including Alaska, Arizona, Kentucky, and Maine:


  • Tightens language regarding pre-existing conditions:  states would have to describe how their health plans "shall maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions." The original language said each state had to show how it "intends" to have adequate and affordable access to coverage.


  • States are given broad new authority to allow insurance companies to design new insurance rules for individuals and insurers that receive money through the block grant program.   Under the new version, states would no longer be required to apply for waivers from many of the ACA’s patient protections; instead, states could let insurers impose deductibles that are higher than the limits set by the ACA, or remove the health law’s limits on the costs that an individual family can incur in a year entirely. They could also offer coverage that lacks some of the ACA’s essential health benefits, such as maternity care, prescription drugs or mental health. Plus, states could let insurers widen the gap between how much older people and young people are charged. And states could remove requirements that insurers cover preventive-health treatments and immunizations. This could result in insurers offering bare-bones insurance policies that feature cheaper premiums but higher out-of-pocket costs, thereby pricing out individuals with pre-existing conditions.


The AMA has been working with patient groups and others on public messages that highlight our shared concerns.  Attached is a statement released jointly on Friday by the AMA, the American Academy of Family Physicians, American Hospital Association, Federation of American Hospitals, Blue Cross and Blue Shield Association, and America’s Health Insurance Plans that highlights health stakeholder concerns about undermining patient protections, the Medicaid block grant, the destabilized insurance marketplace and the aggressive timeframe set forth by Graham-Cassidy.


If the floor vote does occur, it will likely be on Wednesday or Thursday this week.  A top line CBO score, which we expect to focus on budget lines and not include estimated insurance coverage impacts, is expected late today or tomorrow.  In the meantime, the AMA is continuing its grassroots efforts in opposition to the legislation.

Read the joint statement here

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