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San Francisco Marin Medical Society Blog

CMA Federal Health Reform Update on Graham Cassidy Bill

Graham Cassidy Bill to Repeal & Replace the Affordable Care Act (ACA) with a Block Grant falls short. 

On Monday night, Senator Susan Collins (R-ME) released a statement declaring the third “NO” vote on the Graham-Cassidy legislation joining Rand Paul (R-KY and John McCain R-AZ).  After a Senate Republican Caucus meeting on Tuesday morning, Senator Cassidy announced that he did not have the votes and therefore, the Senate would not hold a vote before the budget reconciliation deadline of September 30, 2017. Further action is unlikely this year as Senate Republican Leader, Mitch McConnell, said the Senate would now turn its focus to overhauling the tax code.  However, several Republicans vowed to continue to work into next year to repeal the ACA. 

CMA, AMA and organized medicine were united in opposing Graham-Cassidy.

The block grant was significantly underfunded and disproportionately harmed states, especially California, that expanded health insurance coverage to the uninsured. Even states that did well under the block grant would experience devastating funding cuts over time from the Medicaid funding caps on children, the elderly and disabled. And finally, the bill would have allowed states to waive protections for pre-existing conditions and essential health benefits, including maternity and mental health services. 

Millions of Californians would have lost their coverage, and many others would have been seriously underinsured. 

See the attached joint letter from CDA, CHA and CMA – when physicians, hospitals, dentists and insurers unite in opposition – you know it’s a bad deal for California. Also attached is the letter from the AMA coalition of physicians, hospitals, patient groups and insurers opposed to Graham-Cassidy.

Bipartisan Senate talks to pass a short-term individual market stabilization bill have resumed.

The Senate Health Committee Chair, Lamar Alexander (R-TN), and the Committee’s top Democrat, Patty Murray (D-WA), were making significant progress on a limited bill to stabilize the ACA individual market when the Graham-Cassidy effort stopped those negotiations. 

The Health Committee held multiple hearings during September and were drafting a bill to fund the cost-sharing subsidies that help patients with copayment and deductibles, as well as provide more reinsurance to cover catastrophic cases. It would also provide more flexibility for states. Many insurance experts believe these provisions, along with stronger enforcement of the individual mandate, would reduce premiums by 10-20 percent.

Alexander and Murray are on a tight timeframe, and insurers need to declare their participation for 2018 by October 1, 2017.  CMA and AMA are strongly supporting this bipartisan effort to address the immediate problems in the health care system.

It has been a long and difficult year for physicians who want to make constructive improvements to the health care system. 

The ACA has its flaws – and none of the House and Senate proposals thus far have met the CMA principles for health care reform. While the future is difficult to predict, CMA will keep fighting to ensure that Californians do not lose access to a physician’s care and affordable coverage, as well as protect the Medicaid safety net.

CMA thanks all of the county medical societies and physicians who engaged with their members of Congress this year. There is more to come.


Elizabeth McNeil

Vice President

Federal Government Relations

California Medical Association

415 310 2877

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