Today, The Leadership Conference on Civil and Human Rights, the National Health Law Program, the National Partnership for Women & Families, along with 234 other organizations, sent a letter to Senators urging them to oppose the Graham-Cassidy proposal to eliminate affordable quality health care for millions of Americans by gutting the Affordable Care Act (ACA); slash federal funding and destroy Medicaid by turning its funding into per capita caps; eliminate the Medicaid expansion; and defund Planned Parenthood health centers.

The letter states in part: “Graham-Cassidy would leave tens of millions of people in the United States significantly worse off than under current law. Without a full score from the Congressional Budget Office (CBO), we do not yet have a complete understanding of the full devastation that Graham-Cassidy would bring, but what we do know is more than enough for all our organizations to unequivocally oppose this bill. We strongly urge you to oppose the Graham-Cassidy proposal and urge Congress to instead move forward with bipartisan efforts on market stabilization and other critical issues to improve access to affordable health care for all people in the United States.”

The letter is posted below:

Dear Senator:

On behalf of The Leadership Conference on Civil and Human Rights, the National Health Law Program, the National Partnership for Women & Families, and the undersigned 234 organizations, we urge you to oppose the Graham-Cassidy proposal (Graham-Cassidy). This proposal will eliminate affordable quality health care for millions of Americans by gutting the Affordable Care Act (ACA); slash federal funding and destroy Medicaid by turning its funding into per capita caps; eliminate the Medicaid expansion; and defund Planned Parenthood health centers. Graham-Cassidy would leave tens of millions of people in the United States significantly worse off than under current law. Without a full score from the Congressional Budget Office (CBO), we do not yet have a complete understanding of the full devastation that Graham-Cassidy would bring, but what we do know is more than enough for all our organizations to unequivocally oppose this bill. We strongly urge you to oppose the Graham-Cassidy proposal and urge Congress to instead move forward with bipartisan efforts on market stabilization and other critical issues to improve access to affordable health care for all people in the United States.

The ACA and Medicaid are critical sources of health coverage for America’s traditionally underserved communities, which our organizations represent. This includes individuals and families living in poverty, people of color, women, immigrants, LGBTQ individuals, individuals with disabilities, seniors, and individuals with limited English proficiency.

The ACA has reduced the number of people without insurance to historic lows, including a reduction of 39 percent of the lowest income individuals. The gains are particularly noteworthy for Latinos, African Americans, and Native Americans. Asian Americans, Native Hawaiians and Pacific Islanders have seen the largest gains in coverage. The nation and our communities cannot afford to go back to a time when they did not have access to comprehensive, affordable coverage. Further, due to the intersectionality between factors, such as race and disability, or sexual orientation and uninsurance, and issues faced by women of color, many individuals may face additional discrimination and barriers to obtaining coverage if the ACA is weakened as a result of this bill.

Medicaid is also critically important, as it insures one of every five individuals in the United States, including one of every three children, 10 million people with disabilities, and nearly two-thirds of people in nursing homes. Medicaid coverage, including the Medicaid expansion, is particularly critical for underserved individuals and especially people of color, because they are more likely to be living with certain chronic health conditions, such as diabetes, which require ongoing screening and services. People of color represent 58 percent of non-elderly Medicaid enrollees. According to the Kaiser Family Foundation, African Americans comprise 22 percent of Medicaid enrollment, and Hispanics comprise 25 percent. Medicaid also serves as a crucial program for Asian Americans, 17 percent of whom receive Medicaid, and Native Hawaiian and Pacific Islanders, 37 percent of whom receive Medicaid.

People of color are more likely than White non-Hispanics to lack insurance coverage and are more likely to live in families with low incomes and fall in the Medicaid gap. As a result, the lack of expansion disproportionately affects these communities, as well as women, who make up the majority of poor uninsured adults in states that did not expand Medicaid. For people of color who experienced some of the largest gains in health coverage since the implementation of the ACA and Medicaid expansion, the Graham-Cassidy proposal could mean vastly reduced access to needed health care, increased medical debt, and persistent racial disparities in mortality rates. Further, Medicaid provides home and community-based services enabling people with disabilities to live, work, attend school, and participate in their communities. The proposed cuts would decimate the very services that are cost-effective and keep individuals out of nursing homes and institutions. Finally, one in five people with Medicare rely on Medicaid to cover vital long-term home care and nursing home services, to help afford their Medicare premiums and cost-sharing, and more.

Despite the common myth that all low-income people could enroll in Medicaid, the Medicaid program had previously only been available to certain categories of individuals (e.g., children, pregnant women, seniors, people with disabilities) who had little to no savings or assets. Parents of children and childless adults were often excluded from Medicaid or only the lowest income individuals in these categories were eligible. For example, the Medicaid expansion greatly expanded coverage for LGBTQ individuals who previously did not fit into a traditional Medicaid eligibility category and for working people struggling in jobs that do not offer health insurance and pay at or near the minimum wage. Yet the Graham-Cassidy proposal repeals Medicaid expansion and cuts billions from Medicaid itself which will force states to cut eligibility and services.

We do not yet have a full CBO score that tells us how many people would have Medicaid or marketplace coverage taken away from them under the Graham-Cassidy bill, and we will not have that estimate before legislation may come up on the Senate floor. But the analysis that is already available provides a stark picture, one in which Graham-Cassidy would decimate the Medicaid program as we know it, end the Medicaid expansion, defund Planned Parenthood health centers, and rescind tax credits and cost-sharing reductions currently available to low-income individuals to purchase private coverage.

The Graham-Cassidy bill makes fundamental changes to both the Medicaid expansion and the traditional Medicaid program, as well as dismantling ACA’s reforms to the individual market. Graham-Cassidy destroys the Medicaid program, ending the federal-state partnership and dramatically altering the structure of the program by implementing a per capita cap. The bill would cut billions of dollars of funding to states, limiting the federal contribution to states based on a state’s historical expenditures, which would be inflated at a rate that is projected to be less than the annual growth of Medicaid costs. Any costs above the per capita caps would be the sole responsibility of states, regardless of the cost of care. As a result, per capita caps will cause deep cuts in care for people with disabilities, seniors, women, and people of color who qualify for Medicaid. Women, who comprise the majority of Medicaid adult enrollees, would be particularly harmed, with women of color disproportionately impacted. Thirty percent of African-American women and 24 percent of Hispanic women aged 15-44 are enrolled in Medicaid. The move to per capita caps would also disproportionately harm people with disabilities, with home- and community-based services likely targeted for cuts by many states. The move to per capita caps may also give states the option to turn the entire Medicaid program into a block grant.

With regard to the Medicaid expansion, under the Graham-Cassidy plan, ACA tax credits and Medicaid expansion funding would be converted into block grants to states. The Medicaid expansion would effectively end at the beginning of 2020, and the block grants would end entirely in 2026. Graham-Cassidy would cut funding for the expansion under the new block grant system, with funding for the block grants set at 17 percent less than current funding, providing insufficient funds to maintain ACA coverage levels. Beginning in 2021, Graham-Cassidy would also redistribute this reduced federal funding stream across states based on their share of low-income residents instead of their actual spending needs, punishing states that have enrolled more low-income people. Furthermore, and deeply troubling, the legislative language describing what purposes the block grants could be used for is very broad, with no requirement that block grant funds even be used to aid low or moderate-income people.

As the Center on Budget and Policy Priorities has noted, once the block grant funding stops in 2026, Graham-Cassidy would effectively repeal the ACA’s major coverage provisions without a replacement. CBO has previously estimated that this approach would result in 32 million more people being uninsured. Graham-Cassidy is even more harmful than prior repeal approaches however, in part because states could not continue to cover Medicaid expansion enrollees in Medicaid with less federal funding.

Furthermore, we are very concerned that Graham-Cassidy gives states the option to impose a work requirement as a condition of eligibility under the Medicaid program. Such a requirement not only fails to further the purpose of providing health care but also undermines this objective. Among adults with Medicaid coverage, nearly 8 in 10 live in working families and a majority are working themselves. This work requirement would include penalizing any woman who does not meet work requirements just 60 days after the end of her pregnancy.

In addition, Graham-Cassidy would single out Planned Parenthood by blocking federal Medicaid funds for care at its health centers. The “defunding” of Planned Parenthood would prevent more than half of its patients from getting affordable preventive care, including birth control, testing and treatment for sexually transmitted diseases, breast and cervical cancer screenings, and well-women exams at Planned Parenthood health centers, often the only care option in their area. This loss of funds will have a disproportionate effect on low income families and people of color who make up 40 percent of Planned Parenthood patients. Seventy-five percent of Planned Parenthood patients are at or below 150 percent of the federal poverty level and half of their health centers are in rural or underserved areas. One in five women in the United States have relied on Planned Parenthood for healthcare in her lifetime.

Lastly, we are seriously concerned about the lack of transparency of the discussions leading to Graham-Cassidy, and the rush now to vote on the bill without adequate time for analysis, hearings, and a full CBO score, which would provide opportunity for both lawmakers and the public to understand the proposed legislation and participate in this discussion in which their very access to health care for themselves and their families is at stake. It is unconscionable to even contemplate dramatically altering one-sixth of the U.S. economy and taking away health care from millions of people without a full CBO score in hand, along with adequate time to review the CBO’s findings and debate the Graham-Cassidy bill with all the facts.

We urge you to oppose passage of the Graham-Cassidy bill and instead focus on moving forward with bipartisan efforts on market stabilization and other critical issues to improve access to affordable health care for all people in the United States. If you have any questions, please feel free to contact The Leadership Conference Health Care Task Force Co-chairs Katie Martin at the National Partnership for Women & Families (kmartin@nationalpartnership.org), Mara Youdelman at the National Health Law Program (youdelman@healthlaw.org), or Emily Chatterjee at The Leadership Conference (chatterjee@civilrights.org).

Sincerely,

The Leadership Conference on Civil and Human Rights

National Health Law Program (NHeLP)

National Partnership for Women & Families

ACCESS

Access Living

ADAP Advocacy Association (aaa+)

Advocates for Youth

AFL-CIO

African Coalition

AFSCME

AIDS Foundation of Chicago

American Academy of Nursing

American Association of Colleges of Pharmacy

American Association of People with Disabilities (AAPD)

American Association of University Women (AAUW)

American Atheists

American Civil Liberties Union

American Federation of Teachers

American Nurses Association

American Public Health Association

American-Arab Anti-Discrimination Committee

Amida Care

Amnesty International USA

APLA Health

APSE–Association of Persons Supporting Employment First

Asian & Pacific Islander American Health Forum

Asian & Pacific Islander Caucus for Public Health (APIC)

Asian American Drug Abuse Program, Inc.

Asian Americans Advancing Justice | AAJC

Asian Americans Advancing Justice-Los Angeles

Asian Law Alliance

Asian Pacific American Labor Alliance, AFL-CIO (APALA)

Asian Pacific Policy and Planning Council

Association of Asian Pacific Community Health Organizations (AAPCHO)

Association of Programs for Rural Independent Living

Association of Reproductive Health Professionals

Association of University Centers on Disabilities

Autistic Self Advocacy Network

Bazelon Center for Mental Health Law

Bend the Arc Jewish Action

Black Women’s Blueprint

Black Women’s Health Imperative

Black Women’s Roundtable

Black Womens Roundtable, National Coalition on Black Civic Participation

Black Youth Vote!

Breast Cancer Action

Cascade AIDS Project

Center for American Progress

Center for Community Change Action

Center for Law and Social Policy (CLASP)

Center for Medicare Advocacy

Center for Popular Democracy

Center for Reproductive Rights

Children’s Defense Fund

Children’s Health Fund

Chinatown Service Center

Coalition for Disability Health Equity

Coalition of Labor Union Women

Coalition on Human Needs

Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR)

Commission on the Public’s Health System

CommonHealth ACTION

Communications Workers of America (CWA)

Community Access National Network (CANN)

Council for Native Hawaiian Advancement

Council of Mexican Federations in North America (COFEM)

Crescent City Media Group

Disability Rights Education & Defense Fund

Drug Policy Alliance

EMILY’s List

Empowering Pacific Islander Communities

Equal Justice Society

Equal Rights Advocates

Equality California

Equality Federation

Families USA

Family Equality Council

Family Voices

Farmworker Justice

Feminist Majority

Friends of the Earth

GLMA: Health Professionals Advancing LGBT Equality

Global Justice Institute

Guam Communications Network

Health & Medicine Policy Research Group

Health Care for America Now (HCAN)

Health Justice Project

Healthy House Within A Match Coalition

Heartland Alliance for Human Needs & Human Rights

Hepatitis B Foundation and Hep B United

Hispanic Health Network

HIV Medicine Association

Human Rights Campaign

Human Rights Watch

Illinois Public Health Association

Indivisible

International Association of Official Human Rights Agencies

International Association of Women in Radio and Television, USA

International Institute of the Bay Area

Japanese American Citizens League

Jewish Council for Public Affairs

Jewish Women International

Justice in Aging

Korean Community Services of Metropolitan NY

La Cooperativa Campesina de California

Labor Council for Latin American Advancement (LCLAA)

Lambda Legal

Latino Commission on AIDS

Latinos in the Deep South

Lawyers’ Committee for Civil Rights Under Law

LBGT PA Caucus of the American Academy of Physician Assistants, Inc.

League of United Latin American Citizens

League of Women Voters of the United States

LEAnet, a national coalition of local education agencies

LPAC

Main Street Alliance

Matthew Shepard Foundation

Medicare Rights Center

Metropolitan Community Churches

Mi Familia Vota

MomsRising

Movement Advancement Project

MoveOn.org Civic Action

NAACP

NAPAFASA

NARAL Pro-Choice America

NASTAD

NASW-NYC Committee on Health

National African American Drug Policy Coalition Inc.

National Asian Pacific American Women’s Forum (NAPAWF)

National Association of County and City Health Officials

National Association of County Behavioral Health and Developmental Disability Directors & National Association for Rural Mental Health

National Association of Human Rights Workers

National Association of Social Workers (NASW)

National Association of Social Workers New York City Chapter

National Black Justice Coalition

National CAPACD

National Center for Law and Economic Justice

National Center for Learning Disabilities

National Center for Lesbian Rights

National Center for Transgender Equality

National Coalition on Black Civic Participation

National Collaborative for Health Equity

National Congress of American Indians

National Council of Asian Pacific Americans (NCAPA)

National Council of Asian Pacific Islander Physicians

National Council of Churches

National Council of Jewish Women

National Council on Independent Living

National Disability Rights Network

National Domestic Workers Alliance

National Down Syndrome Congress

National Education Association

National Employment Law Project

National Fair Housing Alliance

National Family Planning & Reproductive Health Association

National Hispanic Media Coalition

National Hispanic Medical Association

National Immigrant Justice Center

National Immigration Law Center

National Institute for Reproductive Health

National Latina Institute for Reproductive Health

National LGBTQ Task Force Action Fund

National Low Income Housing Coalition

National Network for Arab American Communities (NNAAC)

National Network to End Domestic Violence

National Organization for Women

National Urban League

National Women’s Health Network

National Women’s Law Center

National Women’s Political Caucus

NETWORK Lobby for Catholic Social Justice

NICOS Chinese Health Coalition

NOBCO: National Organization of Black County Officials

OCA – Asian Pacific American Advocates

OneAmerica

Organizing for Action

Organizing for Action-Springfield

Out2Enroll

People for the American Way

PFLAG National

Philadelphia Unemployment Project

Planned Parenthood Federation of America

PolicyLink

Population Connection Action Fund

Population Institute

Positive Women’s Network – USA

Presbyterian Church (USA) member

Presbyterian Feminist Agenda Network

Presbyterians Affirming Reproductive Options (PARO)

Prevention Institute

Prism Health

Progressive Leadership Alliance of Nevada

Project Inform

Public Citizen

Raising Women’s Voices for the Health Care We Need

Resource Center

San Francisco AIDS Foundation

Service Employees International Union (SEIU)

Sexuality Information and Education Council of the U.S. (SIECUS)

SisterSong: National Women of Color Reproductive Justice Collective

SiX Action

Slow Roll Chicago

South Asian Bar Association of North America Health Law Section

South Asian Network (SAN)

Southeast Asia Resource Action Center

Southern Poverty Law Center

TASH

The AIDS Institute

The Alliance

The Arc of the United States

The National Campaign to Prevent Teen and Unplanned Pregnancy

The Trevor Project

The United Methodist Church — General Board of Church and Society

The Voter Participation Center

Trust for America’s Health

UCHAPS: Urban Coalition for HIV/AIDS Prevention Services

UMOS Inc

UnidosUS

Union for Reform Judaism

United Church of Christ, Justice and Witness Ministries

URGE: Unite for Reproductive & Gender Equity

US Women and Cuba Collaboration

Venas Abiertas

Voices for Progress

West Pinellas National Organization for Women (NOW-FL)

Wisconsin Alliance for Women’s Health

Women Employed

Women’s Action Movement

Women’s Intercultural Network (WIN)

Women’s Media Center

Women’s Missionary Society African Methodist Episcopal Church

Women’s Voices Women Vote Action Fund

Woodhull Freedom Foundation

Working America

Young Invincibles

YWCA USA

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