WASHINGTON — Senate Republicans are pinning their final hopes for an Obamacare overhaul on legislation introduced by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., and co-sponsored by Sens. Dean Heller, R-Nev., and Ron Johnson, R-Wis.
The Graham-Cassidy bill would keep much of the Obamacare tax structure in place, but it would give the money back to the states in the form of block grants and would allow states to design their own health care systems.
The block grants would replace federal money currently being spent on Medicaid expansion and on subsidies to help people pay for insurance. A report published Tuesday by The New York Times said under the bill, 36 states would face spending cuts for health care by 2026.
The bill shifts money from states that expanded Medicaid under the Affordable Care act to those that did not. This means most of the 31 states that chose to expand Medicaid, including Oregon, will face cuts. In fact, Oregon stands to lose the most federal funding per person in the country, with a negative impact of more than $2,500 per person, according to The New York Times.
The Times reports that the five states facing the largest spending cuts would be Oregon, Vermont, Massachussetts, New York and Delaware. The five states that would receive the largest spending increases are Mississippi, Alabama, Kansas, South Dakota and Texas.
The Times calculated the funding impact per person by totaling the number of people receiving Medicaid benefits, those who purchased insurance through the Affordable Care Act marketplaces and those who are uninsured in each state. They used estimates from the Center on Budget and Policy Priorities, a left-leaning think tank.
Aided by the support of the White House and GOP leadership, Senate Republicans are searching for the last few votes to bring them to the required 50 to pass the bill. Democrats will all vote "no." Cassidy believes they are close — “we’ve probably got 48, 49,” he said last week.
Senate Majority Leader Mitch McConnell, R-Ky., praised the legislation in a floor speech Tuesday by saying it would allow “states and governors to actually implement better health care ideas by taking more decision-making power out of Washington.”
Many Democrats say the bill is similar to previous repeal attempts by Republicans. Senate Minority Leader Chuck Schumer, D-N.Y., said Tuesday on the Senate floor that the bill “is worse in many ways than the previous versions of Trumpcare.” The House passed repeal-and-replace legislation in May, and the Senate failed to pass a watered-down repeal bill of their own in July.
Much of what Graham-Cassidy does will depend on what state you live in, because states will receive different amounts of money and will use the block grants differently. But the bill has some major changes that will affect everyone:
Will you have to buy insurance?
The Affordable Care Act put in place a mandate to buy insurance, with a tax penalty if you are uninsured. Graham-Cassidy would get rid of that mandate and the penalty. The mandate was created to ensure that young and healthy people would buy insurance, offsetting the costs of insuring older and sicker people. Health insurers have said another mechanism is needed to keep insurance markets stable if the mandate is eliminated.
Are employers required to provide health care?
The bill would repeal the penalties for large employers that fail to offer affordable insurance to workers.
Do insurers have to sell coverage if you have a pre-existing condition?
Insurance companies still won’t be able to deny coverage based on pre-existing conditions, but states can waive the provision that caps what they can charge. They can also waive certain mandated coverage under Obamacare, such as maternity care, mental health services and hospitalization.
What happens to private insurance subsidies?
The bill would end subsidies in 2020 for those who purchase insurance on their own rather than getting it through an employer or government program. Under Obamacare, people earning up to 400 percent of poverty get subsidies to reduce their premiums. Those earning up to 250 percent of poverty get a break on deductibles and other out-of-pocket expenses.
What happens to states that expanded Medicaid?
Thirty-one states and the District of Columbia expanded Medicaid under Obamacare to people earning up to 138 percent of poverty. The Graham-Cassidy legislation would immediately stop more states from expanding Medicaid and would end the existing expansions in 2020. Instead, states would receive, through 2026, a block grant to devise their own way of helping residents who had gotten Obamacare coverage either through Medicaid or with private insurance subsidies.
What happens to other federal Medicaid funding?
The legislation would change the way traditional Medicaid is funded. Instead of reimbursing states for most of the cost of caring for Medicaid recipients, the federal government would send states a per capita allotment with limited growth. States could also elect to have a Medicaid work requirement, though disabled or pregnant people would be exempt.
How would Medicaid funding be redistributed among states?
States that expanded Medicaid, or have more people receiving private insurance subsidies through the Obamacare marketplaces, would lose funding to other states. Those that didn't expand Medicaid, or have fewer people getting help through a marketplace, could initially see an increase in funding. But all states would lose money in the long run and during recessions or other times of increased need, according to the left-leaning Center on Budget and Policy Priorities.
Would young people still be able to stay on their parents' plans?
The plan would leave in place the provision that allows people under age 26 to stay on their parents' health care plans.
Would Planned Parenthood still be reimbursed for services?
It’s already illegal for the federal government to pay for abortion services. However, the government currently reimburses Planned Parenthood for non-abortion services that are covered by Medicaid. The Graham-Cassidy bill would end that practice for a period of one year. The bill would provide money for community health centers in an attempt to supplement the coverage that will be lost from Planned Parenthood.