Divergent Health Care Proposals Emerge at the Federal Level

This week, two very different proposals related to the Affordable Care Act (ACA) and federal health insurance marketplaces were introduced by members of Congress. Washington continues to debate and discuss potential options to health care reforms, and we highlight some of this week’s activities below.

Graham-Cassidy Proposal

Led by Senators Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana), and cosponsored by Senator Dean Heller (R-Nevada), Senate Republicans have proposed to use $1.2 trillion in funds spent under the ACA’s tax credits, Medicaid expansion, and cost-sharing payments to instead provide states with large block grants. H.R. 1628 would also repeal the ACA’s individual and employer mandates, as well as the medical device tax.

Senate Republicans have until the end of September before key procedural powers expire that permit the passage of measures with only a simple majority. Typically major legislation requires 60 votes to gain passage in the Senate. With limited time remaining before this procedural power expires, the Graham-Cassidy proposal faces a difficult road to passage ahead. Several Senate Republicans have already expressed concerns about such measure, and Senators face an already-busy agenda for the remainder of September. Additionally, it is unclear if the Congressional Budget Office (CBO) would have enough time to issue an analysis on the measure before the end of the month.

Due to significant concerns over any attempts to reduce or cap Medicaid funding, CHEAC, along with California State Association of Counties (CSAC) and other California county organization colleagues, have signed onto a letter opposing H.R. 1628 by Senators Graham and Cassidy.


On the other end of the spectrum, Senator Bernie Sanders (D-Vermont) and 16 other U.S. Senators, including California’s own Kamala Harris (D-California), introduced a “Medicare-for-All” measure this week aimed at providing universal, single-payer health coverage to all Americans. The proposal would expand Medicare eligibility over time and provide for a greater range of benefits, including dental, vision, and hearing services. At this time it remains unclear how such a measure might be funded. Sanders did release a list of potential financing options, including increasing tax rates and imposing fees on financial institutions, upon introducing his proposal this week.

This measure certainly will not pass given the current Congressional makeup. However, when Sanders introduced a similar measure in 2013, he was unable to secure even one co-sponsor. With 16 high-profile co-sponsors this go-around, the concept of universal, single-payer health coverage is clearly gaining momentum among Democrats and signaling a continued political shift in Washington.

Bipartisan Efforts

A bipartisan approach to health care reform remains in the works by Senate Committee on Health, Education, Labor, and Pensions (HELP) Chair Senator Lamar Alexander (R-Tennessee) and Vice-Chair Senator Patty Murray (D-Washington). The Senate HELP Committee recently held a series of bipartisan hearings on how to tweak the ACA to stabilize insurance marketplaces. However, with another quickly-approaching deadline for insurance companies to commit to selling plans on ACA marketplaces and set final health plan prices at the end of the month, it is likely to be a heavy lift for the Republican and Democrat pair to have a proposal ready for Congressional consideration.

It remains to be seen what action, if any, Congress will take related to the ACA and federal health insurance marketplaces.