Sen. John McCain has put terror in the heartsof health insurance policy analysts throughout the country.

|

By announcing that he will oppose theGraham-Cassidy-Heller-Johnson Affordable Care Act change bill, he raised thepossibility that any Graham-Cassidy impact forecasts they havepublished this week, or are now working on, may already be asobsolete as ancient Etruscan guides to interpreting chickenentrails.

|

Republican congressional leaders have been rushing to pushGraham-Cassidy through the Senate by Sept. 30, in time to make useof special Senate budget reconciliation rules that let supportersof budget measures get those through the Senate with just 51 votes,rather than the 60 votes normally required.

|

Related: Insurers join hospitals, doctors opposing newObamacare repeal

|

McCain's opposition to Graham-Cassidy means thatRepublicans may have trouble rounding up support from even 50senators for the bill. Sen. Rand Paul, R-Ky., has already come outagainst it. At press time, Susan Collins of Maine and LisaMurkowski of Alaska had not expressed any joy about the idea ofvoting for it.

|

But McCain himself said he objects to the rushed, partisanprocess Senate Republicans have used to develop and consider theGraham-Cassidy proposal, not necessarily the content of thebill.

|

Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., were theleaders in developing the bill.

|

"I would consider supporting legislation similar to that offeredby my friends Senators Graham and Cassidy were it the product ofextensive hearings, debate and amendment," McCain said in thestatement explaining why he is voting against Graham-Cassidy. "Itake no pleasure in announcing my opposition. Far from it. Thebill’s authors are my dear friends, and I think the world of them.I know they are acting consistently with their beliefs and sense ofwhat is best for the country."

|

One possible conclusion is that, even if the current version ofGraham-Cassidy fails, it, or a new version of it, could return.Agents and brokers who be part of the ACA change game may be ableto find new ways to use the old Graham-Cassidy impact analyses, andother useful Graham-Cassidy-related documents.

|

Here's a look at 10 tools that might be useful for producers whowant to fuel their health insurance policymaking efforts withverifiable facts and numbers. Note that we had a much easier timefinding detailed analyses posted by critics than to find comparableanalyses posted by supporters.

|

Continued on next page >>>

|

1. The Graham-Cassidy bill, and supportingdocuments.

|

Graham posted the text of the bill, related documents, and arecording of the bill launch video here.

|

2. Comparisons of Graham-Cassidy with the ACA and majorACA change proposals.

|

Legal analysts at Faegre Baker Daniels L.L.P., a lawfirm, have posted a helpful comparison chart here.

|

The Faegre Baker chart includes the ACA and Graham-Cassidy.

|

It also includes two House Republican ACA change bills: theAmerican Health Care Act bill and the Better Care ReconciliationAct bill.

|

The Alaska Department of Health and Social Services have postedanother side-by-side analysis, prepared by analysts at ManattHealth, another law firm, here.

|

3. An analysis of how Graham-Cassidy would affect eachstate's federal health program funding level.

|

Graham-Cassidy would eventually replace the ACA Medicaidexpansion, Basic Health Program, ACA exchange plan premium taxcredit program, and ACA exchange plan cost-sharing reductionprogram with block grants for states.

|

Analysts at Avalere Health, a consulting firm with a wide rangeof clients, have published data on how the block grant programwould affect each state's funding level here.

|

Would-be health finance policy players might be able to use theAvalere Graham-Cassidy impact analysis to estimate how any effortto replace the current subsidy programs with state block grantsmight work.

|

4. Rating agency analyses.

|

Perhaps because the Graham-Cassidy proposal is still new, and,originally, appeared to be a dark horse challenger to thebipartisan ACA change efforts at the Senate Health, Education,Labor and Pensions Committee, the rating agencies have not producedhigh-profile, detailed analyses of the proposal.

|

Analysts at Fitch Ratings did post a commentary here.

|

The analysts suggested that states might have the flexibility todeal with changes in federal health program funding.

|

"Negative implications for entities that rely on state support,including school districts, cities, counties, and public highereducation institutions could be more significant given theirgenerally more constrained budgetary flexibility," the Fitchanalysts said.

|

5. How efforts to include the cost of preexistingconditions in premiums might affect premiums.

|

Analysts at the Center for American Progress, a research centertypically viewed as being sympathetic to Democrats, posted ananalysis here that shows what could happen toindividual major medical insurance premiums if states used theGraham-Cassidy ACA rule waiver provision to let insurers includethe full cost of treatment for pre-existing conditions inenrollees' premiums.

|

The center analysts show, for example, that an enrollee withmetastatic cancer could face a rate-up of $142,650.

|

The chart does not appear to reflect how major medicalinsurance rate-ups actually worked in the past, before the ACAprohibited use of rate-ups for people with pre-existing conditions,but would-be health insurance policy shapers might find the chartuseful when they are thinking about some common catastrophicconditions might affect a health plan's claim costs.

|

Continued on next page >>>

|

6. How Graham-Cassidy might affect the number of peoplewith health insurance.

|

The Center for American Process posted another interestingforecast, of the number of people in each state who might losecoverage as a result of Graham-Cassidy changes, here.

|

Producers who like the ACA and oppose Graham-Cassidy could usethat data to oppose the Graham-Cassidy bill or other bills thatwould make similar changes in ACA programs and rules.

|

Producers who support the Graham-Cassidy bill and similar bills,or who want to analyze similar bills, might be able to use the datato something no analysts seem to have tried to do: Estimate howmuch the ACA and various proposed alternatives actually cost perextra insured life in each state.

|

It's possible that ACA opponents could use data from thecenter, which supports the ACA, in efforts to come up with cheaperalternatives.

|

7. How would Graham-Cassidy affect healthy,moderate-income 60-year-olds?

|

AARP has published detailed, state-by-state impact figureshere.

|

The AARP analysts show how they believe Graham-Cassidy changescould affect the premiums and out-of-pocket costs of an insurable60-year-old with an income of $25,000 in 2020.

|

8. How would Graham-Cassidy affect health insurers'taxes?

|

Health insurers strongly oppose the ACA health insurer tax.They argue that, in the end, the tax hurts the enrollees, becauseinsurers must include the cost of the tax in theirpremiums.

|

Marilyn Tavenner, the head of America's Health Insurance Plans,a major health insurer trade group, argues in a letter sent to Senate leaders thatGraham-Cassidy would leave the ACA health insurer tax provisionintact and lead to health insurance customers paying an extra $158per year.

|

Leaving the tax in place will lead to the customers paying anextra $267 billion for health insurance over 10 years, Tavennerwrites.

|

9. How would Graham-Cassidy affect federal support forMedicaid?

|

Analysts at the Center on Budget and Policy Priorities, aresearch center typically viewed as leaning toward Democrats, hasposted a table showing how the Graham-Cassidy Medicaid fundingchanges might affect federal support for each state's Medicaidprogram in 2020.

|

The end notes for the analysis, which is available here, includes helpful links to other datasources, such as Congressional Budget Office reports.

|

10. What do voters think aboutGraham-Cassidy?

|

We found one public poll report.

|

The report was sponsored by a group with an obvious ax to grind:Save My Care.

|

The group hired Public Policy Polling, an outside organizedbased in Raleigh, North Carolina, to conduct a survey of 638registered voters.

|

The group posted the survey report here.

|

About 50% of the survey participants said they disapprove ofGraham-Cassidy, 24% said they approve of Graham-Cassidy, and 27%admitted that they did not know what Graham-Cassidy is.

|

When asked about their preferred approach to the Affordable CareAct, 32% said they would like to see Congress repeal the act andstart over, and 63% said they would like to see Congress "keep whatworks and fix what doesn't."

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com
NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.

Allison Bell

Allison Bell, ThinkAdvisor's insurance editor, previously was LifeHealthPro's health insurance editor. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached at [email protected] or on Twitter at @Think_Allison.