Speaking with reporters at his district office in downtown Louisville on Thursday, Congressman John Yarmuth said he was very concerned about the prospects of the latest bill to repeal and replace the Affordable Care Act — the Graham-Cassidy bill — passing when it comes to a vote in the Senate next week, warning that it would particularly devastate health coverage in states like Kentucky.
“More people will die than would have ordinarily died because of this legislation, if it passes,” said Yarmuth. “Because there will be hundreds of thousands of Kentuckians who will lose coverage and have no way of getting coverage… our health as a state would be severely jeopardized.”
The bill, sponsored by Republican Senators Lindsey Graham and Bill Cassidy, would block grant Medicaid funds to states on a per-capita basis until 2026, after which funds would be cut off for states that had expanded Medicaid.
The bill would also end subsidies based on income, age and geography for those purchasing a plan on the federal exchange, would no longer require that plans cover current essential health benefits, while eliminating the individual and employer mandates to purchase insurance.
Perhaps most controversially, the Graham-Cassidy bill would technically keep the ACA’s ban on insurance companies prohibiting those with a pre-existing condition from purchasing a plan, but states could allow insurers to charge such individuals a price so high that purchasing a plan would be impractical.
Yarmuth said states like Kentucky that expanded Medicaid under the ACA would be penalized the most under the Graham-Cassidy bill, citing a study showing that Kentucky would lose $6.9 billion in Medicaid funding by 2026. After 2026, he noted that all federal funding for the Medicaid expansion disappears, “which means that – at current rates – 500,000 Kentuckians would be subject to losing their coverage. At that point, it would be up to the state to come up with the funding to cover those people, and obviously, that would be virtually impossible for Kentucky to do.”
Adding that most of the 80,000 Kentuckians who buy insurance on the federal exchange are getting federal subsidies, Yarmuth said that these being eliminated “means that those people would have to pay for all of their premiums, which they are unlikely to be able to afford… so those people would be in serious jeopardy.”
While the bill potentially threatens protections against discrimination by pricing out those with pre-existing conditions on the individual market, Yarmuth said that protections against lifetime caps on benefits would also be in danger for employer-based group plans.
“A governor could say in Kentucky that you don’t have to offer maternity benefits, you don’t have to offer pharmaceutical coverage, you don’t have to offer whatever things they might decide are unnecessary,” said Yarmuth. “And we know Gov. Bevin, for instance, already in his waiver application decided to say that Medicaid doesn’t need to offer dental and vision coverage. So I wouldn’t consider the prospects for our citizens very good under Gov. Bevin.”
Yarmuth added that Democrats alone aren’t the only ones vocally opposing the Graham-Cassidy bill, as “there is virtually no one in the medical universe who supports this bill,” citing the near-universal opposition of every provider group representing physicians, nurses, hospital and insurance companies, in addition to the American Medical Association, American Cancer Society, American Lung Association and AARP.
By Friday morning, eight Republican governors whose states expanded Medicaid had also come out against the bill, and the National Association of Medicaid Directors — representing the Medicaid directors in all 50 states — issued a statement expressing strong concern about the potential damage of the Graham-Cassidy bill.
On top of these criticisms, Yarmuth also lambasted the process in which the Senate will debate and vote on the bill, noting that the Congressional Budget Office would not be able to score the bill before it is expected to be voted on next Wednesday, there would only be one hearing on the bill in the Senate Finance Committee, “and because this is an amendment to a House-passed bill, it’s only required to have 90 seconds of debate… That’s not a misstatement. Ninety seconds to discuss a bill on the floor of the Senate that would reshape close to 20 percent of the economy.”
The Senate is under a rush to pass the bill by Sept. 30, as this is the deadline for reconciliation rules that would allow a simple majority vote to pass the bill, instead of the usual 60 votes needed to break a Senate filibuster. However, Yarmuth suggested that this date is actually arbitrary, as the House and the Senate could always make new reconciliation rules, allowing a simple majority vote at any time.
McConnell and Bevin stand behind bill, while Paul opposes
While Yarmuth said that Kentuckians need to make their opinion heard on the Graham-Cassidy bill, he noted that their Sen. Rand Paul has already come out against it — though, for completely different reasons, arguing that the bill does not go far enough in repealing the infrastructure of Obamacare.
However, Gov. Bevin came out in support of the bill along with 14 other Republican governors this week, and Sen. Mitch McConnell approvingly spoke of the bill on the floor of the Senate on Tuesday, saying Graham-Cassidy would replace the “failed” approach of Obamacare with a new one “allowing states and governors to actually implement better health-care ideas by taking more decision-making power out of Washington.”
“Governors and state legislators of both parties would have both the opportunity and the responsibility to help make quality and affordable health care available to their citizens in a way that works for their own particular states,” said McConnell. “It’s an intriguing idea and one that has a great deal of support.”
Yarmuth rejected the premise behind what this flexibility given to states would mean, saying that in reality “it absolutely gives states more freedom to reduce coverage and reduce benefits.” He also disagreed with McConnell’s often-used criticism that the individual insurance market under the ACA is collapsing as premiums skyrocket, saying this viewpoint is “absolutely not true.”
“The CBO as recently as last week said actually things are stabilizing under the ACA, the individual market is stabilizing under the ACA, premiums should not rise very significantly over the next few years, and the market is correcting,” said Yarmuth. “And in terms of the Medicaid expansion and Medicare, the ACA is working extremely well.”
While McConnell is reportedly trying to corral 50 votes to pass the bill next week — needing less than three Republicans to vote against it — Yarmuth said he thought that the Senate majority leader had actually been “ominously silent about defending” the Graham-Cassidy bill and hadn’t heard McConnell talk up specifically why it would be good for Kentuckians.
“I think Mitch is in a very difficult spot, because he has members who demand a vote, who want to be seen as doing everything they can to repeal the ACA,” said Yarmuth. “Yet he knows that if they pass a bill that has less than 20 percent support in the country, that’s not good for preserving his majority. So my sense is that he’s doing what he has to do to show that he’s making an effort, but that he doesn’t really want a bill passed.”
While conceding that some Republicans may just want to pass a bill to give President Donald Trump a “win” — or, in McConell’s case, keep the president off his back — Yarmuth said most Republicans are more concerned about “the pressure they’re getting from their base to fulfill the promise of repealing and replacing Obamacare.” Sen. Chuck Grassley, R-Iowa, even said this week that he could find many problems with the Graham-Cassidy bill, but it should still be passed in order to keep his party’s promise that it would repeal Obamacare.
While hospital groups around the country have strongly criticized the potential effects of the bill, particularly on rural hospitals, Yarmuth noted that the Kentucky Hospital Association has “mystifyingly” not come out against it. Though Louisville’s hospitals have warned that the bill going into effect in conjunction with the state’s withdrawal of their previous uncompensated care funds would have negative results, Yarmuth theorized that a lot of the hospitals within the KHA “are afraid of what Gov. Matt Bevin would do to them. Gov. Bevin does have some power, and I think he’s intimidated a number of the hospital operators.”
The ‘Jimmy Kimmel Test’
This summer, Sen. Cassidy coined “The Jimmy Kimmel Test,” pledging to the late-night talk show host — whose son had to undergo major heart surgery after his birth — that his bill would protect the insurance coverage of people with pre-existing conditions and continue to prohibit lifetime caps on coverage. While Cassidy maintains that belief, Kimmel has roasted him in multiple monologues this week as a “liar,” saying that his bill would allow states to charge such individuals extraordinarily high premiums and effectively price them out of coverage.
Yarmuth said that Cassidy’s bill did not pass the Jimmy Kimmel test, calling this “one of those political lies, where you can say technically he didn’t lie, but in effect he did.”
Noting that states could receive a waiver to allow insurance companies to charge based on pre-existing conditions, Yarmuth cited one estimate in which “if you have asthma, your premiums would go up $4,500; if you had diabetes it would go up $5,600; pregnancy, it would be $17,000; if you have cancer, it’s $28,000,” he said.
“So yes,” he added, “you can buy insurance and you can’t be turned down for insurance if you have a pre-existing condition, but you will have to pay so much that your right to buy it is meaningless, because you can’t afford it. And there’s no federal assistance to help you pay for it.”
Yarmuth isn’t feeling Bernie’s health care bill
Not only did Yarmuth criticize the Graham-Cassidy bill, but also that of Sen. Bernie Sanders, the independent who gave a strong primary challenge to Hillary Clinton in 2016 and recently filed a “Medicare-for-all” bill.
While Yarmuth said that he is a supporter of single payer and Medicare for all, he added that Sanders’ bill “is not Medicare for all.”
“He calls it that,” Yarmuth said. “Bernie Sanders’ bill is something brand new and something that is very impractical. It’s basically ‘everybody gets all of the coverage they need and don’t have to pay anything for it.’ So it’s much more generous than Medicare and much different than Medicare. He can call it that, but it’s not.”
Saying that virtually every American has their health insurance directly or indirectly subsidized, Yarmuth said that the country already has a single-payer system, just one that is “organized very inefficiently.”
“I believe that we should consider extending Medicare as it exists now, to other segments of the population,” said Yarmuth. “Whether we start at 55-year olds or do something else. But Medicare is one of the most efficient segments of the health insurance business, so I would like to see it expanded. And eventually, that or something else that guarantees coverage to everyone, the single payer way or not.”