We know that all AOPA members are very interested in all health care reform efforts, as they have the potential to impact both the patients we serve, and how AOPA members plan and conduct their business. AOPA members who attended this year’s May Policy Forum had the opportunity to meet Senator Bill Cassidy (R-LA), and heard from him first hand his thoughts on how Congress might go about trying to attain universal health coverage in an alternative to the Affordable Care Act (ACA). While the Cassidy-Graham bill that emerged, and has dominated headlines in the past ten days, reflected some changes from the plan that Senator Cassidy had outlined at the Forum, it does reflect Senator Cassidy’s aspirations to move funding resources closer to the patient, while trying to come to grips with expansion of Medicaid coverage.
Because of the political impasse between Republicans and Democrats about the topic of “repeal and replace,” Republicans have sought to pursue legislation to address the ACA under the rules of “budget reconciliation,” which avoid the prospect of filibuster, and thereby avoid the need for 60 votes to bring debate to a close on a matter in the U.S. Senate. Because the federal government’s fiscal year ends, and the budget year concludes at midnight on Saturday evening, September 30, the opportunity to operate under these filibuster-proof rules expires at that time, and this in turn has generated a haste in trying to act on the Cassidy-Graham bill. Throughout this year, AOPA has viewed reform initiatives through the lens of impact on three patient-centric provisions: Cassidy-Graham would: (1) recognize the prospect of waivers available to states to modify the ACA’s essential health benefits (which could therefore impact the current “rehabilitative and habilitative essential benefit”); (2) patients with pre-existing conditions—including a substantial number of O&P patients—would be assured of being eligible for coverage, although state waivers might be invoked that could increase the cost of coverage for those with pre-existing conditions; and (3) Cassidy-Graham would shift Medicaid funds via block grants to the states in accordance with a formula, envisioning reduction of expansion of federal Medicaid funding over a period of years.
Right now, the outlook for Cassidy-Graham was mixed. With all 48 Senate Democrats aligned in opposition to the bill, and with at least three Republican Senators—Sens. Collins (R-ME), McCain (R-AZ) and Paul (R-KY)—stating that they intended to vote against the bill, the arithmetic looks adverse unless one of the Democrats or one of the three Republicans shifts position without any other Republicans gravitating to the opposition column. Clearly, this is an important deliberation in process, with the time pressures before September 30 limiting the extent of independent CBO analysis. We’ll keep AOPA members apprised of further significant developments on Cassidy-Graham and any other health reform initiatives.