The Cassidy-Graham bill — the last Affordable Care Act (ACA) repeal and replacement bill left standing — has a dubious chance of passing. It currently has the same problem past iterations of Republican Senate health bills had: it can’t get 50 votes.

The bill — authored by Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) — starting in 2020, would repeal ACA subsidies and the Medicaid expansion. Instead, states would be given temporary block grants. By the end of implementation, every state could create a whole new health system.

According to David Anderson, research associate at Duke University’s Margolis Center for Health Policy, state flexibility could come at a cost to some states:

Credit: David Anderson, Research associate at the Duke-Margolis Center for Health Policy.

The block grants end entirely by 2027. Additionally, the bill eventually makes cuts to the overall Medicaid program — which provides insurance to low-income adults, seniors, and people with disabilities — by imposing a per-capita cap, which its drafters argue help maintain costs.


Cassidy and coalition are running up against a critical deadline: September 30, which is the last day the bill can pass with a simple majority. Cassidy said his bill has the support of about 48 members. Unlike past efforts, the president and Republican leadership have not passionately rallied behind the Cassidy-Graham bill.

Additionally, senators who killed the Republican health bill last time have not pledged support for this bill. The bill’s severe cuts to the Medicaid program make it unlikely that Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK) would vote yes. Sen. John McCain (R-AZ) has said he’d vote no on a bill if it hasn’t gone through regular order, and there have been zero hearings on this bill. Some Republicans have even taken to Twitter to trash it:

#GrahamCassidy sales pitch: if you like your Obamacare you can keep your Obamacare. No thanks. — Senator Rand Paul (@RandPaul) September 15, 2017

Cassidy has been the bill’s most staunch advocate. During a sales pitch to reporters Friday, he cited A Peace to End All Peace, a book about the history of the Middle East and the founder of Israel David Ben-Gurion, as reason behind his ardent attempts to repeal-and-replace the ACA.


“David Ben-Gurion was of the type that said, ‘If you continue to do what is right, good things happen,’” Cassidy said, as reported by the Hill. “So we figured we’d just keep plugging away and doing what’s right, and something good would happen.”

Cassidy is probably the most optimistic about his bill’s chances of passing, and has pointed to his some supporters, like a handful of governors, whom this bill, while calling for state flexibility, is tailored for. But it’s unlikely he’ll garner the support from even his own governor. Democratic Gov. John Bel Edwards said that the previous iteration of repeal-and-replace, the Better Care Reconciliation Act, “raise[d] several red flags for the state of Louisiana.”

Edwards worried about the cuts to the Medicaid program under the Republican health bill. The conservative Democrat championed for expanding Medicaid when he ran for office in 2015, and expanded the program within his first week in office. To this day, he continues to highlight the program’s benefits in his state. Medicaid covers over 436,375 working poor families across Louisiana. And due to Cassidy-Graham bill’s block grant and per capita caps on Medicaid, Louisiana would lose $7,277 million of federal funding by 2027, according to the left-leaning think tank, the Center on Budget and Policy Priorities. Edwards also pushed back against passing major legislation without proper congressional vetting and wider input. The Cassidy-Graham bill would have less than two weeks to hold hearings.

Cassidy ran largely on repealing and replacing the ACA, during the 2014 midterm election.

“I read the bill. It was clear there would be canceled plans, expensive premiums, no guarantee you could keep your doctor. I voted no,” Cassidy said in a midterm election television advertisement. Cassidy primarily ran against the ACA individual and small group marketplace and the current health law’s tough regulations.


The Medicaid program — which Cassidy’s bill changes drastically — is popular in his home state. Nearly three-fourths of Louisiana residents approve of the state’s decision to expand Medicaid, according to a recent state survey.

Consumer advocacy group, Louisiana Center for Health Equity (LCHE), expressed concerns about the health care bill promoted by its elected official. “Medicaid is the backbone of health care in Louisiana,” Alma Stewart, the director of the LCHE, told ThinkProgress. “Even without the expansion, over 1 million Louisiana residents were enrolled in the Medicaid program, the majority of whom are children. Medicaid also plays a major role in providing long-term care, including the care of the elderly and people with disabilities.“

Most Republican voters still want to repeal the ACA, but what replaces it is the point of contention.

Louisiana resident Angela Lorio voted for Cassidy in 2014. “We thought he was going to fight for us. We thought we would be safe with a doctor going to Washington,” Lorio told ThinkProgress in July. Lorio, with Trach Mommas of Louisiana, mobilized against Republican health bills over the summer because of the big cuts to Medicaid.

Trach Mommas of Louisiana provides support parents, caregivers, and individuals with a tracheostomy, breathing tube. Lorio founded the group because her own son John Paul has a tracheostomy. He was born pre-mature, at 27 weeks and has significant health issues which require intensive medical care. The Lorio family qualifies for a Residential Options Waiver (ROV) through the Louisiana Medicaid Home and Community-based Waiver Program.

Credit: Angela Lorio

ThinkProgress caught up with Lorio to see if she and Trach Mommas of Louisiana were still mobilizing against the GOP health bill. But, they have had to redirect their attention. Trach Mommas of Louisiana has been actively engaging in hurricane disaster relief for individuals with special medical needs, like those who require tracheostomy.

Her team did request a meeting with the senator to discuss his stance on the ACA and Medicaid program — Cassidy believes people should wean off the entitlement program and buy private insurance, but they have not heard back. They’ve repeatedly asked to meet with their senator, and even visited Washington, D.C. over the summer to meet him face-to-face. He did not. ThinkProgress repeatedly reached out to Cassidy’s office to see if they intend to coordinate a meeting with Trach Mommas of Louisiana, but has not received a response.

“We have no control over loss of life in disasters, but he does have a control of loss of life with the policies he will put into place,” said Lorio.

An earlier version of this article neglected to specify that Louisiana would lose millions of federal funding. The article has been updated to clarify that.