Once again, the U.S. Senate is just days away from a critical vote on the latest in a series of health-care plans that threaten to make America sicker by reneging on its promise to provide affordable health care. The potential local impact of the Graham-Cassidy bill, named for the senators who crafted the proposal, could not be more stark or concerning: Pennsylvania and New Jersey patients will suffer major losses under this plan.
In June, when the Senate was considering the Better Care Reduction Act, I wrote a piece in the Inquirer calling on Congress to set out a goal to cover more people, not fewer. Instead, it appears that Congress may be heading down the same precarious path with the new bill, which estimates suggest could take coverage from up to 32 million Americans — 18 million of them in the first year of the plan — who gained coverage through the Affordable Care Act (ACA).
The legislation would fundamentally change the Medicaid program — a vital safety net for our most vulnerable patients — by transitioning it to a federal block grant program that would shift responsibility to cash-strapped states across the nation. This step would effectively end the Medicaid expansion that has provided affordable health-care coverage to more than 1.2 million people in Pennsylvania and New Jersey, and imperil the important patient protections that were enacted through the ACA, such as guaranteed coverage for individuals with preexisting conditions.
These facts alone should be enough to ensure that our elected leaders from Pennsylvania and New Jersey oppose this legislation.
Even more concerning for those in our community, Graham-Cassidy would redirect federal funding from states that expanded Medicaid, like Pennsylvania and New Jersey, to states that failed to take advantage of ACA provisions that allowed states to offer Medicaid to more of their poor citizens. In fact, after California and New York, Pennsylvania stands to lose the most federal funding — $11 billion between 2020 and 2026, according to analysis from the Kaiser Family Foundation. Meanwhile, states like Texas, Georgia and Mississippi — whose politicians have already eschewed doing the right thing for their people — would be rewarded with sizable increases over the same time period. Thus, in the Graham-Cassidy plan, every year more innocent people in Pennsylvania and New Jersey will be punished to reward those states that turned their backs on their most vulnerable citizens.
Those who argue that the block grants proposed by Graham-Cassidy will give states the option to continue providing current levels of coverage ignore the fiscal challenges states are already facing amid growing budget shortfalls. The more likely outcome here in Pennsylvania and New Jersey: reduced benefits, lower payments to health-care providers, and significant cuts to the number of Medicaid enrollees. Senior citizens and individuals with preexisting medical conditions could be forced to pay significantly higher premiums as a result of loopholes allowing states to seek waivers from certain federal ACA benefit requirements. Businesses may become exempt from requirements to provide insurance for all employees. Over time, we would a see creeping and unnecessary return to a time when the percentage of uninsured in our state stretched well into the double digits — more than twice where it stands today.
I am not alone in my concerns. The health-care community is largely aligned in its opposition to the Graham-Cassidy bill with physicians, hospitals, and patient and senior citizen advocacy organizations all expressing opposition to the legislation. Collectively, these organizations represent those with the greatest stake in this debate.
Congress should heed their warning. This bill, and the broken legislative process that has brought it to the Senate floor, is not the path forward.
We expect the elected leaders of our states to fight for policies that protect our children, our elderly, and those among us with chronic and life-threatening diseases. Legislators who vote for this plan would be turning their backs on constituents who need their help most.
Ralph W. Muller is CEO of the University of Pennsylvania Health System.