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Who Is For and Against the Latest PPACA Repeal Bill

GOP takes heavy fire over pre-existing conditions

The Senate could potentially vote on the latest repeal-and-replace plan for the Patient Protection and Affordable Care Act (PPACA) next week. The bill has won mixed reviews inside and outside Congress, according to a report by The Hill.

The proposal, sponsored by Senators Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana), would largely dismantle the PPACA and convert its funding to block grants, The Hill says. States would get the funding to design their own programs, leaving some states with more money and others with less. Just what states would decide to do would likely vary across the country.

Here’s The Hill’s take on where key players and stakeholders stand.

Health Care Groups: Against

Powerhouse health groups like the American Hospital Association and the American Medical Association have come out against the Graham-Cassidy proposal in strong terms, warning that it could lead to coverage loses for millions of Americans.

Republicans, for the most part, have been unable to win over the support of these industry groups, which largely opposed every variation of the Senate’s repeal bills and the bill the House passed in May. Democrats have been able to point to this opposition as proof from experts that the repeal bills have been flawed and are bad for patients.

Governors: Mixed

The support of governors is crucial to the passage of the bill because not only do they have influence over the senators representing their states, but the Graham-Cassidy proposal would shift enormous responsibilities to their governments.

Ten governors—five Democrats, four Republicans and one Independent—signed a letter opposing the bill. The group includes Governors Brian Sandoval (R-Nevada), Bill Walker (I-Alaska), and John Kasich (R-Ohio). Walker’s opposition could weigh on Senator Lisa Murkowski (R-Alaska), one of three Republicans to vote against the earlier Senate bill. Republicans are unlikely to be able to survive her defection, The Hill writes.

Meanwhile, 15 Republican governors, including Wisconsin Governor Scott Walker and Arkansas Governor Asa Hutchinson, have announced their support. Arizona Governor Doug Ducey also endorsed the bill. Sen. John McCain (R-Arizona), another swing vote on the bill, could be influenced by his support.

Insurers: AHIP, BCBS oppose

America’s Health Insurance Plans, the main insurer trade group, has come out on against the bill, arguing it would destabilize the market. The Blue Cross Blue Shield Association said it shares “the significant concerns of many health care organizations” about the bill.

However, there are provisions in the Cassidy-Graham proposal that insurers could like, The Hill says. For example, insurers would be able to charge older customers up to five times as much as they charge younger customers, though states could overrule this. Current law only allows insurers to charge older people three times as much as younger customers.

Conservative Groups: Split

Conservative groups like FreedomWorks and Freedom Partners have approached the Graham-Cassidy bill with caution. Both groups have pushed for a full repeal of ObamaCare and have grown frustrated with Congress over the past few months for failing to do so. But as time is running out to use the 2017 repeal vehicle, FreedomWorks says senators should seriously consider the bill.

Senators

In the end, the only opinions that will count are those of the 100 senators. Cassidy has said the bill is just a few votes shy of the 50 votes it needs to pass, a total that would allow Vice President Pence to cast a tie-breaking vote. Only one GOP senator, Rand Paul (Kentucky), has said he won’t vote for the proposal. Cassidy and Graham have focused on trying to win over the three Republican senators who voted against the last repeal effort: McCain, Murkowski, and Susan Collins (Maine). Assuming the rest of the Republican conference supports the bill, excluding Paul, the bill could only afford one more defection.

Source: The Hill; September 21, 2017.

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