Editor’s note: The following piece was originally published on Families USA’s blog on Sept. 19. For more information and analysis on the horrible ACA repeal bill that the Senate is expected to vote on as early as Sept. 27, see the resources listed at the end of this post. Please take action today: call your senators (202-224-3121), call kindred spirits in states with swing senators, and share information on social media. So much is at stake! 

The latest Republican repeal and replace plan may be the last, which is why the plan authored by Sens. Lindsey Graham and Bill Cassidy is picking up steam despite the threat it poses to state budgets and taxpayers.

Why would senators consider a plan that bond rating agencies say is “more disruptive” than previous repeal and replace plans? Because this might be their last chance to repeal the Affordable Care Act before time runs out to pass it with only 50 votes.

The Graham-Cassidy proposal will undermine state Medicaid programs and put taxpayers at risk for funding other state programs. Fitch Ratings issued a release stating, “Negative implications for entities that rely on state support, including school districts, cities, counties, and public higher education institutions could be more significant given their generally more constrained budgetary flexibility.”

The Fitch Ratings release is just one of the dozen facts you should know about this last-ditch effort to repeal the ACA. Here is the complete list.

1. MASSIVE STATE BY STATE FUNDING CUTS. The Center on Budget and Policy Priorities released a report showing in 2027, every state in the nation would see federal funding cuts under Graham-Cassidy, totaling nearly $300 billion.
2. NO FULL CBO SCORE. The Congressional Budget Office announced it would not be able to produce a complete analysis on Graham-Cassidy that includes the impact on deficits, how many will lose coverage or the increase in premiums by September 30. Senator Bill Cassidy admitted “I just don’t care about the coverage numbers.”
3. PRE-EXISTING CONDITION PREMIUM HIKES. The Center for American Progress released a report showing how much more people with pre-existing conditions would pay each year under Graham-Cassidy. For example, an individual with asthma would face a premium surcharge of $4,340. The surcharge for pregnancy would be $17,320 and $142,650 more for patients with metastatic cancer.
4. WORSE THAN BEFORE. Fitch Rating Agency found that this bill was “more disruptive for most states than prior Republican efforts.” The Washington Post found this bill is worse than previous health care repeal bills, writing: “The latest Obamacare overhaul bill gaining steam on Capitol Hill slashes health-care spending more deeply and would likely cover fewer people than a July bill that failed precisely because of such concerns.”
5. MORE UNINSURED VETS. Rand Corporation study showing Republican repeal efforts would increase the number of uninsured veterans. The report showed that the ACA’s Medicaid expansion had increased coverage for low-income veterans who lived further from VA facilities. The report found that the ACA was responsible for reducing the uninsured rate of veterans by about one-third, from 9.1% to 5.8%, in 2015.
6. MORE UNINSURED CHILDREN. The Center for American Progress released an analysis showing that children are at immediate risk of losing coverage in Arizona, California, Connecticut, Hawaii, Idaho, Mississippi, Nevada, Oregon, Pennsylvania and Utah with CHIP funding running out quickly.
7. KEY STAKEHOLDERS OPPOSE. The AARP, AMA, six leading physician groups,American Cancer Society Cancer Action Network and 15 more high-profile patient groups and Children’s Hospital Association are all unified in opposing the Republican repeal bill.
8. GOP GOVERNORS OPPOSE. Republican Governors from Alaska, Ohio, Massachusetts and New Hampshire have come out against the plan.
9. FAILS THE MCCAIN TEST. The New York Times’ David Leonhardt’s column, “John McCain Faces a New Test of His Principles.”
10. RAND PAUL IS A ‘NO.’ GOP Senator Rand Paul opposes Graham-Cassidy, writing in an op-ed, “In all ways, this bill is also ObamaCare Lite. In no way is it repeal the way we promised. I will oppose this bill as I did the other fake repeal bills, and I urge those who want repeal to do so, as well.“
11. INCLUDES THE AGE TAX. This repeal bill still lets insurance companies charge an unlimited amount more for people over 50, what AARP has dubbed an “Age Tax”.
12. NO GUARANTEE IN THE HOUSE. Because this repeal bill is worse than previous ones, The Washington Post reports, “Would the House pass Graham-Cassidy? It’s not a slam dunk.”

Additional resources:

From CHN: Head Smacker: They’re trying to repeal the ACA…again

From the Center on Budget and Policy Priorities: Like other ACA repeal bills, Cassidy-Graham plan would add millions to Uninsured, Destabilize Individual Market; Cassidy-Graham’s waiver authority would gut protections for people with pre-existing conditions; and more

From Families USA: Explainer of Graham-Cassidy bill, and Checklist comparing it to other repeal bills

From the Center for American Progress: Coverage losses by state under the Graham-Cassidy bill