After seven years of politically charged “warnings” about the Affordable Care Act and seven years of hollowed-out promises that there is a perfect, utterly impermeable antidote, Republican Senators have hit the eleventh-hour on their push to repeal and replace the historic health care bill. Their last-ditch effort to do so is the most egregious attempt yet.
Senators Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson announced Wednesday the release of yet another bill repealing the Affordable Care Act. This marks the fourth time the GOP has put forth legislation to undo the gains made under the ACA, and the third time such an attempt was made in the Senate.
September 30 marks the expiration date on the GOP’s window to pass health care legislation through a process known as “reconciliation,” which includes rigid time restrains, limits to debate, tight budgetary rules and, most notably, bill passage by simple majority—50 Senate votes rather than 60. While three Republican Senators—including Susan Collins of Maine and Lisa Murkowski of Alaska—voted no on a repeal bill earlier this month, it has been reported that this time, the party is closer than ever to reaching the halfway mark.
Emotions are running high as incumbent Republican Senators up for reelection next year are scrambling to redeem themselves from the previous repeal debacle and slide back under the good graces of President Trump, who this past week began working closer with Democrats—thanks to the commendable efforts of Senator Nancy Pelosi—than ever before. To be expected this week are meetings between Senator Mitch McConnell and the President, and more calls from the White House to GOP Senate offices begging for support. To avoid the embarrassment that ensued following the dramatic flop of the previous macabre repeal bill just wouldn’t die, McConnell won’t introduce the Graham-Cassidy bill if he suspects any chance of failure. Senate Republicans sent the bill to the Congressional Budget Office, demanding an expedited score in the next week or so, at which point more Republicans are expected to make a decision. The final repeal vote is set to take place the last week of September.
Like previous Republican repeal bills, the Graham-Cassidy bill would gut Medicaid spending, which currently provides one in five women of reproductive age with safe and affordable access to basic reproductive care—such as birth control, mammograms and pap smears. The bill would also roll back the expansion of ACA eligibility, which has extended health coverage to 13 million people, the majority of whom are women. And it would place the entire health care program, which serves a total of over 70 million people, on a tight budget through the ending of open-ended entitlement—a system that currently requires federal government match state expenditures that are used to guarantee coverage to certain people who meet an income criteria, most notably children and pregnant women. Instead, states would receive “per-beneficiary” allotments of federal money.
But Graham-Cassidy goes even further. A block grant system, which would allocate fixed amounts of federal money to each state for health care and health insurance, is written in. Within a block system, states are generally free to distribute funds as they see fit with little to no federal input. This lack of oversight almost invariable pulls money away from low-income women and women of color. The annual allotments will total roughly $1.2 trillion from 2020 to 2026, which falls just shy of what the federal government is currently expected to spend under the ACA on the expansion of Medicaid and on subsidies for reducing out-of-pocket costs for low-income people. What’s worse, states that expanded Medicaid under the ACA will lose large amounts of money—and states that didn’t, which are typically Republican-leaning states and are currently mostly states with Senators who voted for the previous repeal attempt—will see more money flowing in.
The bill would also increase state’s ability to waive Obamacare regulations, such as the directive that keeps insurers from omitting required benefits like maternity or mental health care, or charging higher premiums to people who are sick or suffer from drug addiction. Coverage for those with so-called pre-existing conditions is no longer protected, and is more endangered than ever. Furthermore, the temporary freezing of federal funding to Planned Parenthood, as well as the ending of the individual insurance mandate, is expected to alarmingly diminish access to care. All of this boils down to a loss of coverage and care for millions of women, which means, as Eleanor Smeal of the Feminist Majority reminds us, “we have to make sure our voices speak louder and longer than [GOP] money and influence.”
Jessica Merino is an editorial intern at Ms.