Relevant Policy Background:
Different state of play, but still a major threat out there (and some opportunities, but we'll get to those soon). For now, let's talk about the last Repeal bill standings: Graham-Cassidy
The Senate Bill:
The original Senate proposal has managed to take the House's American Health Care Act (AHCA) and make it worse. Instead of implementing drastic Medicaid cuts in 2020, Senators phased in cuts more slowly, then making up for it by cutting the program more drastically after 2026. They do this by linking federal caps to the general inflation rate in urban areas (Consumer Price Index or CPI-U) instead of the medical inflation rate (CPI-M). Since medical costs grow more quickly than the costs of most things in the economy, moving from CPI-M to CPI-U.[1]
The result is a long-term 37 percent cut to Medicaid instead of a 25 percent cut.
On the health exchanges side, they kept the basic structure of the exchanges, but drastically cut the subsidies to pay for premiums and eliminated cost-sharing reduction subsidies.
They called this piece of junk the "Better Care Reconciliation" Act
And remember, the primary reason to cut Medicaid is so that people making more than $250,000 a year can reap a collective $600 billion in tax cuts.
This was voted down in the Senate (though the underlying legislative vehicle is still available for amendment, which is why we're all still a bit scared)
Graham-Cassidy:
We don't quite know what it looks like, because Graham and Cassidy haven't released a bill yet. Naturally, Graham-Cassidy takes the basic structure of the BCRA and makes it worse. It keeps all the underlying Medicaid cuts. It keeps the ability for states to use waivers to further destroy Medicaid.
It also takes the money that the ACA uses to subsidize exchange plans and the Medicaid expansion and turns it into block grants for states to broadly on health initiatives – not necessarily insurance starting in 2020. Of course, the block grants will start out about 16 percent smaller, and grow slower than expected inflation, which exacerbates the cuts over time.
Worse, the formula distributing the grants is designed to punish states with generous health systems by biasing them toward states that didn't expand Medicaid, have low levels of exchange enrollment. All states will take large cuts over the long term.
Oh, and the grants disappear entirely after 2026.[2]
How do I turn that into an easy talking point?
Graham-Cassidy contains all the harmful cuts of previous GOP health bills, and will kick millions of people off of health insurance.
Phoning a Congressperson's office[3]
What to do:
- coordinate the topic, ask and timing with a group
- Call your Senator
- Call your other Senator
- Call your U.S. representative
- Go ahead and call both their Washington and their local offices
- Be polite but persistent
- Be specific to one topic
- have one ask (e.g. Vote no on the current attempt to repeal the Affordable Care Act)
- take notes on what you are told
- report the results back to the group and social media
TACTICS CHANGE: You should call both your Senators and representatives: States like Virginia
To find contact info for your reps and Senators look here: www.callmycongress.com.
What not to do:
- 1.Don't e-mail alone
- 2.Don't merely post on social media
- 3.Don't call reps who are not yours – they don't care because you can't vote in their district
- 4.Don't discuss multiple topics – it dilutes your message.
Sample Script:
"Hi, my name is X I'm a constituent of Senator/Rep Y, may please speak with [name of staffer who handles health policy?"]
- Give your name and address if asked (you don't have to, but doing this confirms you're in their district and gives you credibility)
- Ask who you are speaking with, record their name and title.
"I'm upset that the Senate would even consider passing Graham-Cassidy. I'm concerned about its long-term caps on Medicaid, and its block grants, which cut federal health spending.
[If you have a story here – this is a good place to put it]
"Can I count on Senator Y to work on a bipartisan bill to improve the ACA and reject Graham-Cassidy, which would destroy large portions of the U.S. Health system?
- Write down answer
- Thank them if they say yes.
- Stand your ground politely but firmly if they hand you a talking point, say "no," or try to hide behind the idea that they can't express and opinion for the Congressperson. Their bad talking points include:
- If they try to pull the "we're not going to take Medicaid away from anyone", tell them that the CBO report for the Senate Bill says that 14 million people will lose coverage and research suggests that more than 14,000 more people will die every year.[4]
- If they try the "we're going to replace it with something better" ask them what they have in mind. Tell them that Medicaid provides comparable access to employer insurance for a lot cheaper and provides excellent outcomes given the population has many more health problems.
- If they pull out the "we want to give states more flexibility talking point", ask them where states will get the money to provide better programs, considering that Medicaid is already extremely efficient. ("Flexibility" is code for "making them cut everything") and
- If they try to pull the "we don't know what's in Graham-Cassidy" or the "there is not "Graham-Cassidy bill", tell them to reject any bill that incorporates block grants, cuts Medicaid or cuts subsidies.
- If they pull the "We're not cutting Medicaid, we're actually giving more money to Medicaid than currently given," tell them that they are cutting the program from its current projected funding levels, which will still drastically hurt people.
Keep pressing them and if they won't make a commitment to vote down a bill like Graham-Cassidy:
"I don't know why your boss won't commit to stabilizing the ACA and I will be telling everyone I know that s/he plans to throw millions of Americans off health insurance."
- Thank the staffer for their time
- Report back to the group and post on social media about your encounter. If you got a particularly wrongheaded or rude response, write a letter to the editor documenting it.
Keep organizing!
ALL CALLS HELP, BUT PEOPLE TO PUSH HARD:
McCAIN (AZ) -- his comments in support of the concept of Graham-Cassidy led to this brouhaha. He's walked them back a bit, make sure they stay walked back.
FLAKE (AZ) – vulnerable, push him hard
HELLER (NV) – trying to be a co-sponsor of this bill, he's vulnerable, tell him to listen to his constituents and not to the Casino Magnates
PORTMAN (OH) – tell him to listen to his governor who is saying Medicaid expansion is a good thing
ALEXANDER (TN) leading the bipartisan effort, encourage him to keep working with Democrats in an open-process
RUBIO (FL) Useless, but Florida loses big under this bill.
Both NC Senators TILLIS and BURR (NC loses big under structure of Graham-Cassidy)
MOORE-CAPITO (WV): voted against straight repeal in the Senate, voted for "skinny repeal" but I'd imagine a bipartisan bill might be attractive for her
MURKOWSKI (AK) (Be nice and thank her for her past efforts to stand firm, encourage her to continue to work in a bipartisan manner on stabilization legislation)
COLLINS (ME) See notes for Murkowski
Any GOP representative from the states of California, New York Illinois, Virginia, North Carolina and Florida, all of whom would lose really big under the concept of Graham-Cassidy
[1] https://www.theatlantic.com/politics/archive/2017/07/the-senates-plan-makes-medicaid-a-time-bomb/532401/ (with links to Congressional Budget Office Analysis)
[2] For a summary of the effects of Graham-Cassidy, the Center for Budget and Policy Priorities has a nice overview here: https://www.cbpp.org/research/health/cassidy-graham-would-deeply-cut-and-drastically-redistribute-health-coverage-funding
[3] The Indivisible Guide has several techniques for working a phone call. The script I suggest below is the simplest. They suggest trying to get in touch with a policy staffer, which has the advantage of taking up the time of senior staff members and hitting closer to the representative himself. However, even flooding the zone of junior staffers and interns is useful. See https://www.indivisibleguide.com/ for more
[4] That's the low estimate. It's could be several times higher: see https://dash.harvard.edu/bitstream/handle/1/27305958/Mcaid%20Mortality%20Revisited%20DASH%20Version.pdf?sequence=1