This week the Senate appears poised to attempt for a third time to “repeal and replace” the Affordable Healthcare Act (ACA) with a new bill called, Graham-Cassidy, which is circulating around the Senate.
Graham-Cassidy would scale back the federal role in the health care system and again relying on a system of block grants to the states. This new version of the “repeal and replace” would take the ACA taxes as well as dollars from Medicaid expansion and return it to the states through a block grant. As with the other iterations of block grants or per capita caps, this will be devastating to one percent of Medicaid that flows to schools.
Schools are part of the safety net for children and Medicaid plays a significant role, particularly in funding needed medical services for children in special education under IDEA through their IEP, but also for those students without IEPs who are eligible for Medicaid. These changes will impact the ability of students with disabilities and students in poverty to receive many critical health services in schools that enable them to learn. This includes services provided by the school nurse for example vision and hearing screenings and management for students with diabetes and asthma.
The Republican leadership has been trying to pass the “repeal and replace” legislation by using a Senate stratagem called budget reconciliation, which allows the Senate to pass a bill using only a simple majority of 51 votes; that maneuver will expire on September 30th.
Currently, Senators Rand Paul (R-KY) and John McCain (R-AZ) have come out against the bill. Additionally, Senator Ted Cruz (R-TX) has also announced his opposition to the bill. Senator Susan Collins (R-ME) has indicated that she is leaning against the bill. Senator Lisa Murkowski (R-AL) who opposed the former bills, has not indicated how she will vote on this bill.
Over the weekend the bill’s authors modified the bill by adding provisions aimed at the hold out senators that adding more federal funding to the states of Alaska, Arizona, Kentucky, and Maine. Additionally, they added provisions that would make it easier for states to reduce insurance regulations.
The Congressional Budget Office (CBO) has yet to score the bill, but they will be scoring the first version of the bill, not the modified version from over the weekend.
It appears that this bill does not have the votes needed to pass the Senate so it will not be brought to the floor for a vote.
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