Over the course of this week, the latest Senate proposal to repeal and replace current law gained traction. On Wednesday, Senate Majority Leader Mitch McConnell announced that the Senate would vote next week on the Graham-Cassidy proposal to replace current law. In addition, the Senate Finance Committee will hold a public hearing on the proposal on Monday, Sept. 25 at 2 p.m. ET–an unusual day for a hearing in the Senate.

What is igniting the momentum? Once again, the reconciliation process. This legislative process allows the Senate to vote on a measure with a simple majority vote (51 votes). The wheels were put in motion last year and essentially drove the efforts by Senate Republicans to repeal and replace the Affordable Care Act (ACA). The Senate umpire—the parliamentarian—indicated that the Senate had until Sept. 30 to use the reconciliation process before it expires at the end of the month.

Similar to other proposals introduced this year, the Graham-Cassidy proposal makes significant changes to the Medicaid program. Changes include:

  • Repealing enhanced match rates for states that expanded their Medicaid programs as of Jan. 1, 2020
  • Converting federal Medicaid spending to a per capita cap as of fiscal year 2020
  • Giving states the option to elect the Medicaid block grant instead of per capita cap for a period of five years beginning in FY 2020, referred to as Medicaid Flexibility Program Creating state option to conduct eligibility redeterminations every six months (or more frequently) for expansion enrollees
  • Eliminating enrollment simplification and marketplace coordination requirements as of Jan. 1, 2020
  • Creating a state option to require work as a condition of Medicaid eligibility
  • Repealing essential health benefit requirements as of Dec. 31, 2019

Among the provisions impacting the private market, states would be allowed to opt-out of the ACA’s requirement to cover essential health benefits but would prohibit plans from denying people coverage based on pre-existing conditions. However, plans would be able to charge higher premiums based on health status and waive other ACA market rules and consumer protection as part of their block grant program. 

In a nutshell, the proposal rolls up the federal dollars being spent on Medicaid expansion, tax credits, cost-sharing subsidies, and basic health plans, as provided for under the ACA, into a block grant set to expire in 2026.

According to analysis by Avalere Health, a D.C. based health care consulting firm, the Graham-Cassidy proposal would take $215 billion in federal funding out of the health system. It is anticipated that 34 states and the District of Columbia would lose funding. The Commonwealth Fund, a private-foundation, estimates that 15 to 18 million people could lose coverage in the first year (2019), 32 million people in less than 10 years.

As with other health reform proposals, the Alliance is opposed this measure. Organizations across the health and social service sectors have expressed concern and are urging senators to vote against the measure. Read more and take action


In breaking news Friday afternoon, Senator John McCain (R-AZ) indicated that he would not be voting in support of the Graham-Cassidy proposal. Senator McCain joined Senator Rand Paul (R-KY) in publicly opposing the bill. Senator Collins (R-ME) has indicated that she would likely oppose the measure. However, until Senate Majority Leader Mitch McConnell calls off the vote, it is important that your senators continue to hear from you.