What is Graham-Cassidy?
Graham-Cassidy is the shorthand title for a proposal introduced by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) to repeal and replace Obamacare.
Does this legislation “repeal and replace” Obamacare?
As with the previous three Republican proposals, the answer is yes and no (but overall, not really).
No, the Graham-Cassidy does not completely repeal Obamacare in toto and it merely replaces some aspects of the current law. But yes, it does repeal certain aspects of Obamacare and in some cases shifts the decision to the states. As Graham has said, “If you like Obamacare, you can re-impose the mandates at the state level. You can repair Obamacare if you think it needs to be repaired. You can replace it if you think it needs to be replaced. It’ll be up to the governors. They’ve got a better handle on it than any bureaucrat in Washington.”
What’s actually in the bill?
Here are some key changes that are included in the bill:
• Eliminates the fines for both the individual and employer mandate.
• Distributes some federal funding currently available under Obamacare directly to states in the form of block grants. This funding would expire in 2027.
• From 2020 to 2026, states would receive a set amount of federal funding to be used at their discretion for health care coverage.
• Cost-sharing subsidies the federal government pays to insurance companies to lower the cost of some plans on the individual insurance markets and money some states receives to expand their Medicaid rolls would expire in 2020.
• Changes Medicaid from an open ended entitlement to a capped program. Starting in 2020 Medicaid funding for states will be per capita.
• Repeals the medical device tax.
• Allows states to apply for waivers that could change what qualifies as an essential health benefit.
• Allows states to apply for waivers that let insurers charge different premiums based on age.
• Individuals and families would be eligible to contribute more to their Health Savings Accounts (HSAs). For 2018, that would be an annual increase from $3,400 to $6,650 for individuals and $6,750 to $13,300 for families.
• Would allow HSAs to be used to pay insurance premiums.
• Would create a $146 billion fund in 2020, financed by keeping in place some Obamacare taxes.
• Allows states to institute work requirements for Medicaid.
• Prohibits federal funding for Planned Parenthood for one year, beginning when the bill is enacted.
Who opposes the bill?
In Congress, all Democrats and Republican Senator Rand Paul. “This bill keeps 90 percent of the spending of Obamacare and reshuffles it,’’ says Sen. Paul. “Really, when you look at how it reshuffles it, it does it just to take money from the Democrat states and give it to Republican states.’’
A group of 10 governors sent a letter to Congress opposing the bill, and New Jersey Governor Chris Christie has also opposed it publicly.
Many insurance companies oppose the bill as does the AARP, the American Medical Association, the American Cancer Society Cancer Action Network, the American Diabetes Association, the American Heart Association, the American Lung Association, the Arthritis Foundation, the National Health Council and the March of Dimes.
Will the bill pass the Senate?
To pass, the legislation would need the support of 50 of the 52 Republican Senators. Sen. Paul has said he would vote no, and Susan Collins (R-ME), Lisa Murkowski (R-AK), Shelley Moore Capito, (R-WV), and Rob Portman (R-OH) have not indicated their support for the bill.
The Senate has until September 30 to make changes to Obamacare with a simple majority using budget reconciliation bill.
