As the Senate rushes towards yet another attempt to replace the Patient Protection and Affordable Care Act, several outlets, including Politico, are reporting that the long-besieged healthcare bill may remain intact, for now.

This does not mean we can rest.

Tomorrow, the National Disability Call-in Day to Save Medicaid will heat up D.C. switchboards in opposition to a dangerous volume of amendments modifying the ACA, and known only by the names of co-sponsors Graham-Cassidy-Heller-Johnson.

When considered among other healthcare-related bills that were introduced during the last several months, the Graham-Cassidy plan to “repeal and replace”, while its closest to failing at this moment, also goes much further than earlier attempts, brutalizing federal budgets for both ACA marketplace subsidies and Medicare, and setting up what I believe is an unavoidable war between states over health care funding.

Because this bill is a collection of amendments, little is known about the legislation’s overall effect. As of this writing, it still has not been scored by the CBO, and several Republican Senators remain skeptical. One of my Senators, Cory Gardner, is not among them — and even if he was, I’d be calling regardless.

Since health care reform has appeared (and re-appeared) over the course of this year, let’s aim to rid ourselves of the unwanted specter once and for all.

Facts and Figures

For the time being, based on a report from the Center on Budget and Policy Priorities (CBPP), this is what we know:

Cassidy-Graham would eliminate funding for ACA marketplace subsidies and the associated Medicaid expansion, replacing both with a federal block grant. Based on this 2005 report published in Milbank Quarterly, a multidisciplinary journal focusing on population health and health policy, it is a virtual impossibility for Medicaid to maintain existing coverage under a block grant structure. It would also cut per-beneficiary services to Medicare recipients by modifying the state-federal funding relationship.

Consider also that federal funding for these programs would completely disappear in 2026, leaving a massive financial gulf for states to fill.

Allow states to waive the ACA’s prohibition on charging higher premiums to patients with pre-existing conditions. This would hit not only patients with pre-existing conditions, but provisions for mental health, substance abuse treatment, and maternity care could also vanish under new rules set by the HHS director.

At best, this provision will create a handful of markets where chronic patients (such as myself) can affordably participate. At worst, it risks spawning 50 (or more) potentially unique health programs. My family is lucky that we could relocate to Colorado as part of my treatment: most folks in my shoes lack the necessary resources to evacuate themselves during a natural disaster, let alone hop from state-to-state, hoping someday they can build a life where healthcare won’t eventually be taken.

Up-end the individual insurance market, in the short run, by removing federal subsidies and repealing the ACA’s health coverage mandate. Insurance markets operate on the principals of calculated risk. If an insured population is ill, on the whole, insurance costs will rise. The individual health insurance market is already unsteady at best; by removing the penalty for failing to purchase insurance, healthy consumers may opt-out of the system entirely.

This pillar is perhaps the most dangerous, as it risks total collapse of the entire individual insurance market. Mandating coverage, I’m afraid, may have been a one-way street. But that’s okay because the very idea of a mandate can be traced to Stuart M. Butler of The Heritage Foundation, who, in 1989, drafted a plan requiring “all households to obtain adequate insurance.”

It’s a Republican idea that surfaced again during conversations and debates on the ACA but has remained largely taboo among their ranks ever since. GOP leaders, it seems, now seek to remove this safety mechanism by any means necessary.

A protester waves an American flag in the breeze outside the U.S. Capitol

Make the Call

If you’re remained silent up until now, make the call. The event listing for tomorrow’s call-in includes training documentation, and I’ve just given you a list of talking points and facts to back them up. My goal was to create a handy resource featuring concise data, relevant links, and friendly encouragement. Hopefully, this post provides fuel for your conversations tomorrow and in the future.

Ring the Senate switchboard at (202) 224-3121, where you will be automatically connected one of your Senators’ offices. Be polite but firm, and ask that they vote no if the Graham-Cassidy-Heller-Johnson legislation comes up for a vote.

Update 9/25/2016:

When I wrote and published the above text on Sunday, I knew that breaking news could upend my talking points.

A new version of Graham-Cassidy was released last night, though not to the public, in an attempt to win over skeptical GOP senators. Fortunately, [Politico obtained a copy][politico-developments] and published it alongside commentary from Larry Levitt of the Kaiser Family Foundation.

“This revised bill is tantamount to federal deregulation of the insurance market. If there were any doubt that people with pre-existing [conditions] were at risk of being priced out of individual insurance, this bill removes them.”

Indeed, the latest offering fails the Jimmy Kimmel Test even more spectacularly than the last, by allowing states to lift existing caps on out-of-pocket costs, which limits the types of plans insurers can offer on ACA exchanges. As a result, bare-bones policies which are attractive to younger, healthier people may see a return to market. Comprehensive coverage, required by patients such as myself, will again see premiums rise, if it’s available to chronically ill populations at all.

Consider individuals who are now able to live their dreams as small business owners thanks to ACA protections. Consider the sick and elderly who were exploited before the ACA offered hope.

We must defeat this bill now.