The Senate is making one last-gasp effort to repeal ACA… Well, not actually repeal, just reconfigure. Lindsey Graham and Bill Cassidy have sponsored a bill, which will be eligible for consideration under budget reconciliation rules (i.e. 51 votes required to pass and not subject to filibuster). Under the bill the amounts paid by the federal government would be turned into a state block grant. The states could then choose how they would like to deploy the funds.
In addition, the bill would eliminate both the individual and employer mandates. The bill has some level of support; however, passage seems unlikely prior to the September 30 deadline. If it does pass, it would need to also clear the House or be coordinated with the House version and then a final bill would have to pass both chambers. Not sure if there are Vegas odds on this effort, but they would be very long.
Meanwhile, Republican Lamar Alexander and Democrat Patty Murray are working on a bipartisan bill to incrementally improve ACA. So far, this means allowing catastrophic coverage and liberalizing 1332 waivers. This sounds similar to Graham-Cassidy. The bill would also extend cost sharing subsidies for two years.
Bernie Sanders is once again trumpeting single-payer legislation and this is also gaining momentum in New York, California and other states. In the unlikely event this dramatic pendulum swing would pass, no doubt we would have a whole new set of objectors as the Americans who are adversely affected by this payment system would be equally as loud.
There are no easy answers for healthcare – costs continue to rise and it would be nice if Congress could turn their focus to reducing the cost of care. In past blogs, just a couple of examples here and here, I have suggested starting points such as reining in drug prices, tort reform and increasing the individual penalty. These would have to clear congress with regular order but, as we have seen with DACA, bipartisan cooperation is starting to peek through the dark clouds that have hung over Washington, D.C. for so long.
It’s not the payment system that needs attention… IT’S THE COST OF CARE. Why won’t they listen?