Add Medicaid directors and McCain: Graham-Cassidy bill not the answer for reform

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McCain won't support the Graham-Cassidy bill without knowing its cost or impact on beneficiaries.
McCain won't support the Graham-Cassidy bill without knowing its cost or impact on beneficiaries.

The National Association of Medicaid Directors and Sen. John McCain (R-AZ) joined long-term care provider groups late last week in rejecting Republican lawmakers' latest Affordable Care Act replacement bill.

Both McCain and the Medicaid directors cited the rushed nature of the legislation, introduced by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), and its lack of cost analysis from the Congressional Budget Office, as their reasons for pushing back against the legislation.

“As I have repeatedly stressed, healthcare reform legislation ought to be the product of regular order in the Senate,” McCain said in a statement published Friday. “I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will [affect] insurance premiums, and how many people will be helped or hurt by it.”

Without McCain's support of the legislation the measure will likely fail, some observers said on Friday. If a bill isn't passed by Saturday, the threshold for passage rises dramatically to 60 votes in the Senate, which means at least some Democrats would have to vote for it.

The Board of Directors for the National Association of Medicaid Directors also expressed concerns over the proposal's reliance on shifting Medicaid to a per-capita or block system, and the “uncertain” impact that could have on state budgets and beneficiaries.

“Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country's history,” NAMD's statement reads. “While the block grant portion is intended to create maximum flexibility, the legislation does not provide clear and powerful statutory reforms within the underlying Medicaid program commensurate with proposed funding reductions of the per capita cap.”

NAMD also raised concerns about the bill's requirement that states implement block grants by the start of 2020, which “the vast majority of states” would not be able to accomplish, “considering the apparent lack of federal funding in the bill to support these critical activities.”

The bill garnered sharp criticism from LeadingAge and the American Health Care Association/National Center for Assisted Living last week, with both groups slamming its Medicaid provisions as “catastrophic” for long-term care funding.