Joni Ernst is 'leaning yes' on Graham-Cassidy health care bill

CHARLES CITY, Ia. – U.S. Sen. Joni Ernst is “leaning yes” on the Graham-Cassidy health care overhaul.

The Iowa Republican said so Thursday at a town meeting here dominated by the latest GOP plan currently under discussion to repeal and replace the Affordable Care Act and by broader concerns over the future of health care.

Ernst appeared noncommittal on the bill until asked directly by an attendee more than halfway through the hour-long forum. She complimented the plan – which would allow states to spend a large chunk of existing federal health care dollars as they see fit – for allowing state-level innovation, focusing federal aid on the neediest populations.

Debate over the bill has dominated the national political discourse this week, with lawmakers, activists and interest groups across the country lining up for or against it. The Senate faces a Sept. 30 procedural deadline for passing it, likely setting up a vote next week.

To lock in her support, Ernst said she’ll need to see that the bill adequately funds Medicaid health care services for the elderly and disabled.

Many in the crowd of about 75 weren’t so sure the proposal could deliver.

In one impassioned exchange, Tami Haught, a community organizer from Nashua, told Ernst that she has been living with HIV since 1996, and worried the changes proposed in the bill could make her ongoing treatment unaffordable.

Before treatment breakthroughs, Haught said, she felt like she was living to die.

Now, “I am living to live, but I need access to my care, treatment and lifesaving medications,” she said. “I will die without them.”

Haught, who buys her insurance on Iowa’s individual market and said she was arrested outside Ernst’s Washington, D.C., office earlier this year during a health care protest, called Graham-Cassidy “one of worst versions of the health care repeal that has come out.”

“We will not let this tea-party GOP kill us now without a fight,” she told Ernst. “Kill the bill. Don’t kill us.”

Ernst’s reply suggested allowing states to innovate with care programs, as Graham-Cassidy aims to do, could lead to lower medical costs.

“Getting back to the cost of health care and finding an affordable way to maintain your quality of life and make sure you do live a long and happy life is very important,” she said.

Ernst joins her fellow Republican U.S. Sen. Chuck Grassley and Iowa Gov. Kim Reynolds in backing the bill.

Grassley said Wednesday he supports the bill and believes it would give states greater control in shaping health care benefits and regulations that fit their residents. At the same time, Grassley was circumspect about Graham-Cassidy’s benefits, telling reporters that fulfilling long-standing Republican campaign promises was just as important as the “substance” of the bill.

Reynolds voiced support for the measure this week as well, calling it “the only vehicle that we have to address Obamacare that is failing."

The Graham-Cassidy proposal would overhaul major parts of the American health care system, directing funding for the Medicaid health care program and other federal health care dollars into block grants handed over to the states on a per-capita basis.

States would have wide latitude in shaping health care benefits for residents, but could allow insurers to charge higher rates for sick patients and stop covering benefits currently required under federal law. The block grants would also grow at a slower rate than the current law allows for Obamacare and the wider Medicaid program, saving the federal government money but providing less public funds for health care.

Health industry and interest group analyses have warned the plan will cause millions of people across the country to lose coverage, undermine the viability of the market for individual health plans, and increase costs for people with pre-existing conditions.

On Thursday, Ernst was quizzed about the measure’s effect in rural Iowa and particularly the populations and providers that depend on Medicaid.

Luther College teacher Laura Wright, of Decorah, warned Ernst that block-granting and reducing the rate of funding increases for Medicaid would be devastating for a growing low-income population, rural hospitals and clinics, and mental health providers in northeast Iowa.

“How are you going to justify to rural Iowa a vote in favor of Graham-Cassidy that cuts Medicaid and affects every sector of our health care economy?” Wright asked.

Ernst replied by noting Medicaid dollars sent to Iowa will not decrease, but only rise more slowly.

“To say it’s a cut, it may be a cut from what was projected in Obamacare right now, but still will increase and it will continue increasing for those who are disabled and elderly, the most vulnerable in our population,” she said.

In general, Graham-Cassidy’s formula for granting federal dollars to states favors rural, lower-population states and those that did not opt in to Obamacare’s Medicaid expansion earlier this decade.

Grassley argued Wednesday that Iowa would see a net gain in federal dollars for health care under the proposal, citing information provided to his office by U.S. Sen. Bill Cassidy, one of the bill’s authors. As of Thursday afternoon, that data wasn’t available publicly.

Other analyses see a loss of federal dollars for the state, however.

A report released Wednesday by the health care consulting firm Avalere forecast no reduction in Iowa’s share of federal health care money between 2020 and 2026, but a $2 billion loss by 2027 and a $28 billion loss by 2036 – a 27 percent reduction in federal health care funding.

Another group, the progressive Center on Budget and Policy Priorities, estimates Iowa would lose $525 million in federal funding by 2026 and $2.3 billion by 2027.

The nonpartisan Congressional Budget Office will provide an analysis of the bill early next week, although that report will score only its effect on the federal budget – not its implications for health care coverage or premiums.

The American Medical Association, the AARP, the leading health insurance trade group and a bipartisan group of state governors, among others, have come out against the proposal.