Holcomb signs letter backing Senate GOP’s health care bill

Indiana Gov. Eric Holcomb has joined 14 other Republican governors in backing a last-ditch GOP effort to repeal former President Barack Obama's signature health care law.

The governors sent a letter Tuesday to Senate Majority Leader Mitch McConnell, a Kentucky Republican, writing that they "appreciate" the bill by GOP Sens. Bill Cassidy and Lindsey Graham.

"We call on the members of the United States Senate to move quickly to repeal Obamacare and replace it," they wrote.

Most states could take a stiff budgetary hit if the latest Senate health care bill becomes law, according to an independent analysis released Wednesday.

In Indiana, that would result in a federal funding cut that could make people lose coverage or wind up paying more, Indiana Sen. Joe Donnelly, a Democrat, said Wednesday.

The independent study by the consulting firm Avalere Health found the Graham-Cassidy bill could lead to an overall cut in Indiana of $7 billion between 2020 and 2027.

The state currently relies on Obama's law, known as the Affordable Care Act, for the vast majority of funding for the Healthy Indiana Plan, which is often referred to as HIP 2.0.

HIP 2.0 was developed by Vice President and former Gov. Mike Pence to capitalize on money made available through the ACA. It currently insures more than 400,000 low-income people in the state.

"The Graham-Cassidy proposal, like previous partisan efforts to repeal the health care law, would harm Hoosiers—forcing people to lose coverage, raising health care costs for seniors, ending the bipartisan HIP 2.0 program as we know it," Donnelly said.

The Senate Republican proposal calls for replacing current funding with federal block grants, which would end after 2026 unless they are renewed.

"Adequately funded block grants to the states, along with maximum flexibility and control, is the best option on the table," the governors wrote. "We appreciate the work of Senators Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson to draft language that embraces this simple, yet profound concept."

The latest push to repeal Obama's law is the third major attempt by Republicans to make good on a campaign promise that helped them rise to power. But thus far, they have been unsuccessful amid widespread pushback from Democrats, hospital groups and advocates for the elderly.

Senate Republicans must act on their proposal by Sept. 30 or face a potential Democratic filibuster. That's because current budget rules, which will expire at the end of the month, allow them to pass the bill with a majority, rather than the 60 votes they will need later. Republicans currently hold 52 seats in the chamber.

Study findings

The Avalere analysis comes as Senate leaders are rushing a vote on the legislation by the end of the month, before the expiration of special budget rules that allow passage by a simple majority. The findings could take on added importance, because the nonpartisan Congressional Budget Office says it can't complete a full analysis of the bill by the Sep. 30 vote deadline.

Funding for the Avalere report was provided by the Center for American Progress, a liberal think tank. Avalere said it maintained full control over the research and the think tank did not influence the findings.

Named for Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, the bill would repeal much of the Obama-era Affordable Care Act and limit future federal funding for Medicaid. That federal-state health insurance program covers more than 70 million low-income people, ranging from newborns to elderly nursing home residents. Compared to current projected levels, Medicaid spending would be reduced by more than $1 trillion, or 12 percent, from 2020-2036, the study found.

The bill would also end Obama's health insurance subsidies and put money into a big pot that would distributed among the states. Governors and legislatures would have broad leeway on how to spend the money, and could also seek waivers from ACA insurance requirements. Though insurers would still have to cover people with medical problems, in some states they may be able to charge them more.

The Avalere study also found that over 20 years cuts could potentially total more than $4 trillion, but that scenario appears unlikely. It's based on a literal reading of the bill, under which legal authority for the big pot of money to subsidize coverage would expire after 2026. Typically, Congress renews expiring programs.

Still, the study found more losers than winners. Thirty-four states would see cuts by 2026, while 16 would see increases. Among the losers are several states that were key for President Donald Trump, including Florida, Pennsylvania, Michigan, and Ohio.

Arizona and Alaska would be losers, a detail that could be important. Sens. John McCain, R-Ariz., and Lisa Murkowski, R-Alaska, are seen as undecided on the legislation, and Republican leaders cannot afford many defections.

New Jersey Republican Gov. Chris Christie said Wednesday he is opposed to the Graham-Cassidy bill because of cuts to his state, estimated by Avalere at $10 billion from 2020-2026.

Texas would be the biggest winner, with a $35-billion funding increase by 2026. Georgia, Alabama, Tennessee and Virginia would also see funding gains, as would Wisconsin and Wyoming.

Within states, the analysis found that there could be winners and losers among people at different income levels. Because the GOP bill focuses on providing money to cover poor people and the near-poor, states may decide to reduce support for middle-class people who now receive subsidies under Obama's law.