Another bill to repeal, replace Obamacare has failed

The latest attempt to repeal and replace the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, will not be put to a vote, U.S. Senate Republicans said on September 26. The Graham-Cassidy bill would have changed the way state Medicaid programs are funded, which could have affected recent advances made in improving pediatric dental utilization.

Instead of matching funds for qualified expenditures like the ACA, the Graham-Cassidy bill would have capped how much money states receive for Medicaid through block grants. The block grants were designed to give states more control over healthcare policy, according to bill author Sen. Bill Cassidy, MD (R-LA).

Gary L. Roberts, DDS, president of the ADA. Image courtesy of the ADA.

But dental experts were concerned that the changes would have negatively affected dental care utilization rates.

The California Dental Association (CDA) urged legislators to vote against the bill, and the ADA and American Academy of Pediatric Dentistry (AAPD) said that some of its provisions would be detrimental to Americans who rely on the Medicaid program.

"We are concerned that proposed fundamental changes to Medicaid funding could put the nation's overall oral health at risk," wrote ADA President Gary L. Roberts, DDS, and AAPD President James Nickman, DDS, in a letter to leading lawmakers. "While we support state flexibility and innovation, we also believe states should follow statutory guidelines when designing their Medicaid benefit programs because without such guidelines care can and may be reduced or eliminated entirely."

At least 3 votes short

Senate Republican leaders announced on September 26 they wouldn't vote on Graham-Cassidy after three Republican senators, John McCain (R-AZ), Susan Collins (R-MA), and Rand Paul, MD (R-KY), said they would oppose the legislation.

Sen. Collins feared the bill would harm Maine residents, while Sen. Paul was upset that it did not fully repeal the ACA. Sen. McCain voiced frustration about the rushed process to bring the bill to a vote before September 30, when Senate rules change and more than a simple majority will be needed to pass healthcare legislation.

"I would consider supporting legislation similar to that offered by my friends Senators Graham and Cassidy were it the product of extensive hearings, debate, and amendment. But that has not been the case," Sen. McCain stated in a press release. "Instead, the specter of September 30th budget reconciliation deadline has hung over this entire process."

CBO analysis

The Graham-Cassidy bill was so rushed, in fact, that the Congressional Budget Office (CBO) was not able to fully score it before the September 30 deadline. In its preliminary analysis, the CBO said that Graham-Cassidy would likely reduce the federal deficit by $133 billion but also leave millions of Americans without comprehensive health insurance compared with current estimates.

"The number of people with comprehensive health insurance that covers high-cost medical events would be reduced by millions compared with the baseline projections for each year during the decade," the CBO wrote in its analysis. "That number could vary widely depending on how states implemented the legislation, although the direction of the effect is clear."

As the Graham-Cassidy bill did not come to a vote, it appears that the ACA will remain the law of the land for the foreseeable future, but that doesn't mean that the Republican Party has entirely ruled out healthcare reform.

"We haven't given up changing the American healthcare system," Senate Majority Leader Mitch McConnell (R-KY) said to the New York Times on September 25. "We are not going to be able to do that this week, but it still lies ahead of us, and we haven't given up on that."