A trio of moderate Republicans are pushing for a long-shot Affordable Care Act replacement plan that would put states back in control of their health insurance markets.
But judging by this week’s Senate hearings on ACA stabilization, some state officials aren’t eager to support it.
Sen. Bill Cassidy, R-La., Sen. Lindsey Graham, R-S.C., and Sen. Dean Heller, R-Nev., are the three architects of the plan. The main idea is to end the ACA’s two types of consumer subsidies and its enhanced Medicaid funding by 2020, and replace those policies with block grant funding to states that they’d then use to remake their individual markets and help consumers afford coverage.
Given that bill isn’t even finished yet—and Republicans have only until Sept. 30 to use the budget reconciliation process for a party-line vote on repealing and replacing the ACA—the measure faces long odds. Still, Cassidy used his time during this week’s Senate HELP Committee hearings to ask the various witnesses what they thought of his idea.
He got perhaps the most pushback from Democratic Montana Gov. Steve Bullock. State flexibility can be helpful, Bullock admitted during Thursday’s hearing, but “if the funding isn’t there, it’s fairly meaningless.”
“Some of the proposals that I’ve seen, talking long term, if I’d lose a third of my Medicaid funding, I’m not going to be able to do what I’m currently doing,” he added.
Playing devil’s advocate, Cassidy asked him if he’d support getting more flexibility to innovate if funding was adequate.
But Bullock—drawing a laugh from Cassidy—shot back that “adequacy defined by the terms of a senator or a governor may be two different things.”
Washington State Insurance Commissioner Mike Kreidler could also be counted among the Graham-Cassidy-Heller plan’s skeptics. During Wednesday’s hearing, he took issue with the idea that block grants to states might vary based on need, saying that could put higher-performing states at a disadvantage.
“We do a good job in Washington of holding down costs of care,” he said. “It’s really not appropriate that we should wind up being punished for doing a good job.”
Not only is it key to establish equity in funding, Kreidler added, but that must be guaranteed going forward “so that we don’t wind up with a diminishment as opposed to the entitlement that we’ve got today.”
Washington State Insurance Commissioner John Doak, however, needed no convincing from Cassidy.
“I am 100% in favor of all the funds coming to the state of Oklahoma,” he said, noting that would give the state a chance to put together the a plan designed to “take care of Oklahomans.”
“Amen, brother,” Cassidy responded.
Tennessee Gov. Bill Haslam, a Republican, also offered a favorable take when asked if states should get more flexibility to take innovative measures to bring down the cost of healthcare.
“There’s nothing that makes you innovate quite as much as having to balance your budget,” Haslam said, noting that most states are required to do so by their constitutions.