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Graham-Cassidy bill won't see full CBO score in time for Senate vote

Preliminary effect on budget deficits will be ready next week, but score will lack the number of uninsured and the impact on premiums, CBO says.

Susan Morse, Managing Editor

Photo courtesy <a href=""> Gage Skidmore </a>Photo courtesy Gage Skidmore

The Congressional Budget Office is expected to have only a preliminary assessment of the Graham-Cassidy bill by the Sept. 30 deadline for the legislation to pass by simple majority vote.

The Association for Community Affiliated Plans and the American Medical Association have added their voices in opposition to the bill.

The CBO is aiming for early next week to show the bill's effect on the budget deficit in comparison to the House bill passed in May, the American Health Care Act, and its impact on deficits over the long term but the score is not expected to include the number of people who would lose their insurance coverage or the bill's effect on premiums.

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[Also: Senate committee to get consensus on health bill]

The CBO said it did not expect to have those estimates for at least several weeks.

Early estimates report millions would lose coverage under the bill that proposes to repeal the Affordable Care Act and give the power for individual health insurance and Medicaid coverage to states through the funding of block grants.

Republicans have until September 30 to pass the Graham-Cassidy bill in budget reconciliation by a simple majority vote. Democrats oppose voting on a bill without a full CBO score.

[Also: Graham-Cassidy bill GOP's last-ditch effort to repeal ACA]

Earlier GOP attempts to repeal and replace the ACA have met resistance from Republican Senators such as John McCain of Arizona, Susan Collins of Maine and Lisa Murkowski of Alaska. Graham-Cassidy could also come up against opposition from more conservative Senators who don't feel it goes far enough to repeal the mandates of the ACA.

Republicans only have a two-vote majority in the Senate which means the bill could sink without full support. But it's also seen as a last-chance effort to repeal President Obama's signature healthcare law, which could get reluctant Republicans on board with the plan.

It also competes with a more moderate, bipartisan bill coming out of the Senate Health, Education, Labor and Pensions Committee. The bill, being crafted by Republican Senator Lamar Alexander and Democratic Senator Patty Murray, does not repeal the ACA but would give states more flexibility in plan design through more flexible Section 1332 waivers that are already in the Affordable Care Act. About half of the nation's states have either applied or are considering a 1332 waiver.

More importantly for insurers, the Senate committee's bill is aimed at providing market stability and would give a guarantee of continuing the cost-sharing reduction payments at least through the end of 2018. 

The Association for Community Affiliated Plans supports the bipartisan bill and opposes Graham-Cassidy.

Margaret A. Murray, CEO of the Association for Community Affiliated Plans, said the Graham-Cassidy bill would allow states to opt out of ACA consumer protections ranging from essential health benefits to community-rating provisions.

"The bill would end the Medicaid expansion, convert the rest of the program to a per-capita allotment and then underfund those allotments," Margaret Murray said. "Compared with current funding, the cuts would amount to more than $80 billion nationwide in 2026 alone. What's more, a funding cliff would kick in the next year as the block grant ends--and cuts would increase to nearly $300 billion in a single year. This would have a devastating effect on health coverage for more than 74 million low-income Americans, 20 million of whom receive services through ACAP-member Safety Net Health Plans."

The American Medical Association also urged for market stabliization in funding CSRs and in keeping millions of Americans insured.

Uninsured coverage results in uncompensated care costs for providers.

"Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care," wrote AMA CEO and Executive Vice President James L. Madara, MD "We sincerely urge the Senate to take short-term measures to stabilize the health insurance market by continuing to fund cost sharing reduction payments."

Twitter: @SusanJMorse
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