September 21, 2017 Advocacy Alert

Senate Vote Planned Next Week for Graham-Cassidy
n4a Updates Grassroots Advocacy Tools to #SaveMedicaid 

As n4a’s September 19 Advocacy Alert detailed, there is a new—and very serious—threat to the Affordable Care Act (ACA) and Medicaid, which would have drastic implications for health care costs and coverage for older adults. The Graham-Cassidy proposal to repeal and replace the ACA and restructure Medicaid includes devastating cuts to critical health care services and programs.
Senate Republicans are attempting to push the Graham-Cassidy bill through both chambers in Congress in less than 12 legislative days—and without a complete analysis of cost and coverage implications from the non-partisan Congressional Budget Office (CBO). We understand that Senate Majority Leader Mitch McConnell (R-KY) intends to hold a vote on this measure as early as next Wednesday, and Congress has only until September 30 to pass this measure before the fast-track, privileged process expires.
Local Advocates MUST ACT NOW to reach out to your Senators if we are going to prevent significant threats to health care programs critical to older adults. n4a has updated our #SaveMedicaid tools and resources to assist your advocacy efforts! n4a will also hold a conference call for Aging Network Advocates TOMORROW, FRIDAY, September 22 at 1:00 p.m. ET to discuss advocacy next steps and strategies (CALL IN NUMBER: 1-866-809-4014, PASSWORD: 8720885).  

While we are opposed to many of the provisions in Graham-Cassidy, we are extremely concerned about the move to restructure Medicaid. To be clear, the Medicaid cuts and caps in Graham-Cassidy apply to ALL of Medicaid, not just the ACA Medicaid expansion population. This means that the in-home and nursing home care provided to millions of vulnerable older adults could be in jeopardy. We are now asking all AAA and Title VI aging programs around the country to reach out to your Senators this week and next to share your concerns about what Medicaid cuts would mean for older adults and caregivers that you serve.
In particular, we believe the Senate bill’s final provisions and passage hinge especially on the following Senators who have expressed previous concerns with Medicaid caps and cuts: Susan Collins (R-ME), Shelley Moore Capito (R-WV), Rob Portman (R-OH), Cory Gardner (R-CO), Jeff Flake and John McCain (R-AZ), Lisa Murkowski (R-AK), and Pat Roberts (R-KS) and Jerry Moran (R-KS). If you live in one of these states, your advocacy is especially critical. Additionally, we hope you will engage your local leadership, providers, other agency stakeholders, clients and grassroots—go big and go broad!
Advocacy Tools Available 
To support your advocacy efforts, n4a has UPDATED our suite of #SaveMedicaid tools and resources to address the threats posed by Graham-Cassidy ( Please use any/all of the following to assist your advocacy:

Also, join us for a conference call TOMORROW, Friday, September 22 at 1:00 p.m. ET to discuss advocacy strategy and answer local advocate’s questions. We encourage all members and your networks to join us for this conversation (CALL IN NUMBER: 1-866-809-4014, PASSWORD: 8720885).
How to Take Action:
Now is the time for broad action! We have less than one week to stop this bill and prevent major changes to Medicaid. We’re urging all n4a members to find a way to engage your Senators on this issue, and to ensure that your local networks reach out as well. We may not get another chance to prevent devastating Medicaid cuts!

  • Send a Letter to Your Senators
    You can use n4a’s template letter to fax or email a letter to your Senators. Send this letter to any state/Washington, DC staff that you know and/or you can find fax numbers and emails on senate websites at
  • Call your Senators
    Senators have said they aren’t hearing from their constituents about health care reform! Let’s change this—making a call is an easy way to be heard. Use n4a’s Talking Points to frame your message. You can find Senate DC office numbers on the Capitol Switchboard (202.224.3121), or look up your Senators’ district phone numbers on their websites.
  • Alert Your Grassroots
    Ask your grassroots to reach out to your Senators as well. n4a has put together a template alert that you can customize, as well as a social media toolkit with ready-made images and messages. As your agency is able to, please engage your provider networks, advisory boards and committees, and other stakeholders (including clients and caregivers!) to reach out.
  • Engage Your Local Media
    It is essential that lawmakers and the public understand what Medicaid cuts could mean for seniors. Consider submitting a letter to the editor or op-ed to your local paper. n4a has a template op-ed/letter to the editor that you can use to get started, but it is important to customize the messages to your community and states.

Again, advocacy NOW is critical. There is not much time to prevent devastating cuts to health and long-term care services for older adults. It is important to reach out no matter where you live, but it is essential if you live in Maine, West Virginia, Ohio, Colorado, Arizona, Alaska and Kansas.
Use n4a’s UPDATED advocacy tools and resources at ( to connect with your Senators and ask your local grassroots and stakeholders to do so as well!
Recap on Graham-Cassidy:
Graham-Cassidy would convert the ACA to a block grant structure—or capped amount given to states from the federal government—to provide insurance premium assistance (or other “health care services” up to the state discretion) to individuals previously on the Marketplace. The federal block grant, which would end after 2026, would also be subject to appropriations, which means it could be cut significantly by congressional appropriators. The block grant approach leaves it up to states to figure out how they want to provide health care services—premium support or otherwise—to individuals and who they want to target for coverage. 
Additionally, Graham-Cassidy would eliminate the individual and employer mandate; allow states to determine which health care services they deem protected as “essential benefits”; and allow insurers to charge older beneficiaries up to five times more than younger people for health coverage (or more, should states allow that). The bill would also effectively end Medicaid expansion to low-income adults, including a disproportionate share of adults between 55 and 64, as of 2019, which is earlier than any of the previous ACA repeal/replace proposals. The proposal would roll a portion of federal funding for Medicaid expansion into the overall block grant to states and force states to use commercial insurance options to cover individuals previously on Medicaid expansion, which would likely ultimately cost states more given Medicaid’s below average per-person costs.
As with the previous repeal attempts, Graham-Cassidy goes beyond ACA and would fundamentally restructure the Medicaid program by converting it to a per-capita cap under which states would receive a set amount of Medicaid funding per beneficiary that grows more slowly each year than anticipated Medicaid costs, thereby shifting costs to states. Additionally, in order to accommodate year-over-year costs growth, Graham-Cassidy explicitly gives states flexibility to cut services—such as eliminating optional services to provide long-term services and supports (LTSS) at home and in the community. Ultimately, Graham-Cassidy appears written to drive hundreds of billions in cuts to the federal Medicaid program, which would harm older adults and people with disabilities receiving Medicaid health care and LTSS.

If you have questions or concerns about this Advocacy Alert or n4a’s policy positions, please contact Autumn Campbell at and Amy Gotwals at