WASHINGTON — The Republican effort to repeal and replace the Affordable Care Act has sprung back to life — in the form of a Senate bill that would cost New York State tens of billions more than earlier health care reform bills.
The new effort, sponsored by Republican Senators Bill Cassidy of Louisiana and Lindsey Graham of South Carolina, would repeal federal subsidies for states that expanded Medicaid under Obamacare — including New York — as well as subsidies aimed at helping people buy health insurance.
In their place would be federal block grants to the states that deliberately shrink the funding going to the states that now spend the most on health care.
New York would lose more each year — growing to an $18.9 billion loss in 2026.
The next year, the block grant would disappear unless Congress acted to preserve it. If that happened, New York would be short $33.1 billion in 2027, according to research by the left-leaning Center for Budget and Policy Priorities.
Earlier GOP efforts would have cut funding for New York by only $7 billion to $8 billion a year.
Unlike earlier measures, the new Republican effort doesn't include an amendment pushed by Rep. Chris Collins that would have barred the state from forcing its upstate and Long Island counties to pay a share of the state's Medicaid costs.
The new GOP health bill aims to move federal health care funds away from states that now get the most — typically Democratic states — and toward states that didn't expand Medicaid and, therefore, get the least.
“Right now, 37 percent of the revenue from the Affordable Care Act goes to Americans in four states” — California, New York, Massachusetts and Maryland, Cassidy said. “That is frankly not fair.”
Gov. Andrew M. Cuomo said Tuesday the new GOP legislation would force the state to totally restructure its health care system.
"If they cut us by $19 billion...we could not fund our current health care system," Cuomo said. "It's just mathematically an impossibility."
The new GOP effort to replace Obamacare goes further than a bill that passed the House earlier this year and the Senate measure that failed in a dramatic late-night vote in July.
Those measures aimed to turn Medicaid, now an open-ended entitlement that provides health care to millions of lower-income Americans, into a block grant to the states. But the new GOP measure creates a much larger block grant program — one that combines federal Medicaid funding with the Obamacare subsidies aimed at encouraging people to buy insurance on the open market.
States would get a set, but annually shrinking, pot of federal money to design their own health care systems. The bill would abolish Obamacare's requirement that everyone have health insurance and that most employers offer health coverage.
"It would repeal the pillars of Obamacare and replace that failed law’s failed approach with a new one: allowing states and governors to actually implement better health-care ideas by taking more decision-making power out of Washington," said Senate Majority Leader Mitch McConnell of Kentucky, who is trying to line up support for a vote by the end of next week.
By budget rules, the Senate must act on the measure by Sept. 30 in order to pass it with a simple majority.
After then, Republicans would need to line up a 60-vote supermajority to pass it — and that would be a challenging threshold, since there are only 52 Republican senators.
“If you believe repealing and replacing Obamacare is a good idea, this is your best and only chance to make it happen because everything else has failed," Graham said.
Obamacare's most powerful advocate — Senate Minority Leader Charles E. Schumer, a New York Democrat — vowed to do everything in his power to prevent the Republican bill from becoming law.
“Trumpcare is back, and it’s meaner than ever,” Schumer said. “The GOP’s latest attempt to cut backroom deals that strip health care away from millions of Americans should be a red-siren for families across the country that their health care is on the line.”
Cuomo stressed the proposed bill wouldn't just threaten the state's health care funding. Under the measure, he said, some 2.7 million New Yorkers would be at risk of losing their health insurance.
The bill could destabilize the state's insurance market, said Donald Ingalls, vice president of state and federal relations for BlueCross BlueShield of Western New York.
"It appears to reduce the amount of federal support to help people buy coverage," Ingalls said.
The new proposal drew strong opposition from the Healthcare Association of New York State, the Coalition of New York Public Health Plans, Planned Parenthood, People Inc. and several unions that represent health care workers.
Susan Van Meter, senior vice president for federal relations at the Healthcare Association of New York State, said New York would lose more under the bill than 48 other states. “That is an astounding thing,” she said.
Independent health care policy analysts were not necessarily impressed either.
Bill Hammond, director of health policy at the right-leaning Empire Center for Public Policy in Albany, said the bill would require all 50 states to redraw their health care systems on a relatively short time frame. He said he was concerned that the bill appears to be gaining momentum in the Senate without a complete Congressional Budget Office analysis of its costs and effects.
"I would join the group of people who think that that's craziness," Hammond said.
The bill faces an unclear political future on both sides of Capitol Hill.
In the Senate, Republicans need to win the support of at least two of the three GOP members who voted against the last Obamacare replacement effort: Sens. John McCain of Arizona, Susan Collins of Maine and Lisa Murkowski of Alaska.
Some House Republicans, including Rep. Chris Collins of Clarence and Rep. Tom Reed of Corning, aren't willing to commit to supporting the bill unless and until it passes the Senate.
Reed said the absence of Chris Collins' Medicaid amendment — which was aimed at lowering county property taxes — gives New York lawmakers one less reason to support the new bill. He said he's also concerned that the bill could have a range of negative effects on state residents.
"I always try to keep my sights on the fact that there people behind these policies," Reed said.