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Healthcare Legislation Rises from the Dead: The Graham-Cassidy Bill

Healthcare providers breathed a sigh of relief after the defeat of the Better Care Reconciliation Act (BCRA) in July. The bill, which aimed to repeal and replace the Affordable Care Act (ACA), would have left millions uninsured and replaced cost matching by the federal government with block grants for states to do with as they please. Had the BCRA passed, many healthcare providers, already working with thin budgets, would be facing insurmountable odds to stay in operation. As many of these fears dissipated with the bill's failure, it seemed as though things were back to normal. That is, until Republican Sens. Lindsey Graham and Bill Cassidy raised it from the dead.

This development comes as the Senate health committee was working to create a bipartisan bill that would help stabilize the health insurance markets and prevent price increases under the ACA. For now, this effort has seemingly been put on the sidelines as the Graham-Cassidy Bill speeds through the Senate at an alarming rate.

The Graham-Cassidy Bill is similar to the BCRA in many ways, including the fact that it aims for a tremendous cut to Medicaid. These cuts — manifest in the block-grant structure that would give states a set amount of federal dollars to spend on healthcare programs each year, rather than the open-ended federal funding they currently receive — pose an existential threat to healthcare providers and long-term care facilities. If the bill passes, providers can expect to see a significant reduction in Medicaid funding and reimbursements.

Though it has yet to receive a score by the Congressional Budget Office (CBO), reviews of previous iterations of the bill have shown a reduction of over $800 billion toward Medicaid funding. It is extremely likely that the Senate hearing on Graham-Cassidy is going to go forward with only a partial CBO analysis of the bill. Senate Republicans must pass the bill by Sept. 30 in order to take advantage of reconciliation rules, which would allow the bill to pass with only 50 votes. After Sept. 30, the bill would require 60 votes, a nearly impossible feat given the split of the Senate — 52 Republicans and 48 Democrats — killing the Republican effort to repeal and replace the ACA once more.

In a breaking news story from The Orlando Sentinel, Republican Sen. John McCain has said he will not vote for the bill. One reason he cited was not knowing the proposal's impact on insurance coverage and premiums, which would be included in CBO estimates. Republican Sen. Rand Paul of Kentucky has voiced opposition, and Rep. Susan Collins of Maine has indicated she is leaning against it. With all Democrats opposing the bill, at this point it appears doomed.

Meanwhile, as Republicans attempt to fast-track the bill without a complete CBO score, many provider groups are already speaking out against the legislation. “The latest effort to repeal and replace the Affordable Care Act once again tries to solve the complicated question of health care reform by slashing hundreds of billions of dollars from the Medicaid program that funds essential care for the aged and disabled,” said AHCA/NCAL president and CEO Mark Parkinson in a news release stating the group's opposition. The legislation, Parkinson said, will amount to an average additional cut of nearly $200,000 per center each year.

“Medicaid already underfunds nursing center care by $7 billion annually,” he noted.

Medicaid currently covers over 74 million Americans, including approximately two-thirds of people in nursing homes and long-term care facilities. However, with such massive cuts on the horizon, many of these facilities may be forced to close their doors for good. In fact, Medicaid funding in blue states are projected to be hit the hardest, with states such as Oregon, Massachusetts, and New York losing over $2,000 in federal funding per-person, putting healthcare facilities in jeopardy of even more massive cuts to funding.

Though there is much uncertainty in the air as we await both the Senate vote and the CBO's analysis of the bill, the similarity to previous healthcare legislation put forth does come with an advantage — we have already created a guide on the best ways to prepare your facility for the impacts of Graham-Cassidy-esque legislation, along with what your facility should be doing to remain compliant as it looms.

This is the last chance for Republicans to repeal and replace the ACA before the Sept. 30 deadline. As we monitor the progress of the bill, we will keep you updated with everything you need to know to prepare your facility for the sweeping changes that may come.

Wondering how we got here? Read our analysis of how healthcare legislation has changed and traveled from the campaign trail to the Senate.

About the Author

As Compliance Expert at SmartLinx, Tom Jegou oversees SmartLinx innovations in our payroll and compliance systems. Tom is focused on transforming client needs into leading-edge products. Tom leads cross-functional teams from a product's conception through to its launch. Tom led the design of the 1095-C and Payroll-Based Journal reporting features in the WorkLinxTM suite. Since 1996, Tom has worked with every aspect of Human Capital Management Systems. He has defined, supported, implemented and managed Payroll, Time and Labor and HR systems. Tom is a Certified Payroll Professional through American Payroll Association.

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