United States Senate
Washington, DC   20510

Dear Senator:

On behalf of the millions of members and supporters of the National Committee to Preserve Social Security and Medicare, I write to urge you to vote against the legislation drafted by Senators Lindsey Graham and Bill Cassidy to repeal the Affordable Care Act (ACA).

Like the House-passed American Health Care Act, the Graham-Cassidy bill would leave millions of Americans uninsured and would be particularly harmful to older and disabled Americans.

Americans have a right to know what this bill will do to them.  Regretfully, the Majority Leadership is rushing the Senate to blindly consider Graham-Cassidy without a full Congressional Budget Office (CBO) score.  CBO previously estimated that repeal-without-replace would cause 32 million people to lose health coverage.  Senate consideration of any bill that would change the accessibility and affordability of essential health care for millions of Americans without a complete analysis would be the height of legislative malpractice.

This bill is particularly objectionable because it would:

  • Jeopardize long-term care and other supportive services by restructuring Medicaid into per capita caps or block grants.  Middle class Americans often rely on Medicaid for long-term services and supports when they exhaust their savings.  Nearly two-thirds of all nursing home residents’ care is financed in part by Medicaid.  In addition, Medicaid provides home and community-based services that allow seniors to stay in their homes.
  • End Medicaid expansion, which will take away health coverage from 11 million Americans, including low-income older adults under the age of 65.
  • Drive up seniors’ out-of-pocket costs by repealing the ACA’s tax credit and cost-sharing subsidies.
  • Allow insurance carriers to:
    • Charge certain enrollees with pre-existing conditions thousands of dollars more than healthier individuals. This proposal would be particularly harmful to the 40 percent of enrollees age 50 to 64 who have one or more pre-existing condition.
    • Pick and choose which essential health benefits – such as prescription drugs, chronic disease management and maternity care – their plans will cover.  Without the essential benefits requirement, health plans may not cover chemotherapy for cancer patients or insulin for diabetics. In a health insurance market without risk sharing, comprehensive coverage would be unaffordable because most plan enrollees would have pre-existing conditions.

The National Committee believes this legislation is so deeply flawed that Congress should instead turn to Senate Committee on Health, Education, Labor and Pensions Chairman Lamar Alexander and Ranking Member Patty Murray’s bipartisan effort to strengthen the ACA’s individual health insurance market reforms.  In that spirit, we believe Congress should prioritize lowering costs for all Americans regardless of health status and age and protecting existing programs like Medicaid and Medicare.

But first, we urge you to vote against the Graham-Cassidy bill because it would put seniors and people with disabilities at significant risk of ending up uninsured and losing access to needed care.


Max Richtman
President and CEO