Dr. Leana S. Wen: Graham-Cassidy Health Care Proposal Is Detrimental to Nation’s Health

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The Graham-Cassidy bill scheduled to be voted by the Senate next week is even more detrimental than previous attempts to dismantle the Affordable Care Act (ACA). It will take away health insurance coverage from millions of people, devastate Medicaid, and eliminate protections for patients, including coverage for pre-existing conditions.

Cloaked under auspices of giving autonomy and flexibility to the states, this bill proposes to reallocate funding from the federal government to states. Such a block grant approach sounds good in theory, but when there is $299 billion less federal support, states will have far less funding. Maryland alone stands to lose more than $2 billion in state and federal funding in FY2020 through this proposal, and would lose $4.8 billion in federal Medicaid dollars by 2026. States will have to make difficult choices about which programs to cut, and will be on the hook for all unexpected costs, including hikes in prescription drug prices and public health emergencies such as outbreaks and natural disasters.

Independent analyses predict disastrous effects on Medicaid, which covers 1.3 million children in Maryland and provides 40 percent of the cost for long-term care for seniors. Maryland, along with the 30 other states that have taken advantage of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA), will be particularly affected with a sharp increase in costs and loss of coverage. A study published in the New England Journal of Medicinefound that expanded Medicaid coverage for low-income adults translates to a 6.1 percent reduction in mortality while saving costs. These gains will be rolled back if Graham-Cassidy passes.

In addition, Graham-Cassidy creates huge uncertainty for millions of Americans. It will harm insurance markets and increase costs by eliminating subsidies that help consumers purchase policies and provide reimbursements to insurers for offering price discounts. What’s worse is that it cuts core consumer protection provisions in the ACA. States will be able to remove protections for people with pre-existing illnesses such that people with chronic conditions will no longer be able to obtain insurance. They can force older residents to pay much higher premiums. Essential health benefits such as preventive care, emergency services, reproductive care, and mental health—which are called essential for a reason—may no longer be covered. Annual and lifetime caps—banned under the ACA—could come back, causing families to choose between survival and bankruptcy.

As a physician who practiced medicine before and after the ACA, I have seen how the ACA safeguards health and life. There is a reason why every major medical and patient advocacy organization opposes proposals to repeal it, including this most recent attempt through Graham-Cassidy. This bill endangers the health and well-being of millions of Americans. It is unconscionable to price people out of the ability to obtain the basic human right to health.

Dr. Leana Wen is the Baltimore City Health Commissioner. Twitter: @DrLeanaWen and @BMore_Healthy.

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