By Suzanne Wikle

After the Senate rejected last year’s efforts to repeal and replace the Affordable Care Act (ACA), the Trump Administration has shifted this year to undermining our health care safety net through Medicaid waivers, regulatory retrenchment and litigation.  However, activities this week show that Congressional Republicans have not abandoned their legislative goals of rolling back the ACA and block granting Medicaid. 

This week House Budget Committee Chair Steve Womack (R-AR) released a 2019 budget resolution calling for more than $2 trillion in health care cuts over 10 years.  His proposal would turn Medicaid into a per-capita block grant and mandate cumbersome and bureaucratic rules related to work. The collective effect, if this were to become law, would be greater financial burden on states and force many people to lose Medicaid because of increased red tape. It’s a lose-lose situation for states and their low-income residents who work hard but struggle to afford health care. These cuts would help pay for the massive tax giveaways to corporations and the wealthy passed by Congress just six months ago.

Several conservatives released another health care proposal this week that recycles ideas from unsuccessful attempts in 2017 to repeal and replace the ACA. This newest proposal closely mirrors the Graham-Cassidy legislation that failed to gain enough support last year in Congress. Both proposals would significantly harm access to health insurance and put states at fiscal risk. The core of the new proposal is to provide block grants to states—an idea that has been rebuked again and again as a bad deal and a sure way to increase the rate of people without insurance. Those who would remain insured would no longer be guaranteed coverage of essential health benefits, meaning that mental health, maternity care, or hospitalizations may not be covered.

Senate Majority Leader Mitch McConnell (R-KY) has said he will not attempt to use the “reconciliation” process, which allows bills to pass with a simple majority, on health care this year. Therefore, these activities are more of a message statement than an active threat. With elections less than five months away, Congress has little time to take up major new legislation. But these proposals foreshadow the possibility of more serious legislative proposals next year.

Whatever 2019 brings, CLASP will stand with hundreds of other advocates in collectively fighting attempts to repeal and replace the ACA, cut Medicaid, or tie Medicaid eligibility to a bureaucratic process of proving work hours. The health care advocacy community came out of 2017 stronger than ever, and we will be ready again should renewed attacks on the ACA and Medicaid return.