Understanding Graham-Cassidy

by Kim Eldridge

The Republicans are trying once again to repeal the Affordable Care Act/ Obamacare. It is important to be aware of what is actually in each bill that they try to pass. Here I am going to explain what is in the recent Graham-Cassidy bill before the Senate.

Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana last week released a bill that would eliminate or overhaul major sections of the ACA. Republicans have about two weeks left to use their 2017 budget reconciliation bill as a way to dismantle Obamacare with a simple majority in the Senate. They have tried to push the bill through with great urgency even before the Congressional Budget Office has been able to score it.

Here is what I can tell you about the bill:

  • It would repeal Obamacare individual and employer mandates. Obamacare imposes penalties on most Americans who don’t have health insurance and larger employers who don’t provide affordable coverage for their workers. This bill would eliminate the penalty, retroactive to 2016.
  • It repeals Obamacare subsidies and ends Medicaid expansion funding and the legislation would eliminate Obamacare subsidies that lower premiums, deductibles and co-pays in 2020. It would also do away with federal funding for Medicaid expansion. 31 states use this funding to provide coverage for residents with incomes up to about $16,200. The state of Indiana expanded their Medicaid coverage under the Healthy Indiana Plan or “HIP”. That expansion would end.
  • This legislation would turn the federal funding for Medicaid expansion and the subsidies into a block grant program. States would be given a lump sum of money and would have a lot of leeway over how to spend it. But many consumer advocates say that many states, especially those that expanded Medicaid, would lose a lot of federal funding, making it harder for them to provide coverage or assistance to their residents. But because the block grant is only authorized through 2026, it would jeopardize the continuation of funding after that.
  • It defunds Planned Parenthood. The legislation prohibits federal funding for Planned Parenthood. But the restriction is only for a year, beginning when the bill is enacted. This would cripple Planned Parenthood in most states.
  • It loosens regulations for pre-existing conditions. This bill would also let states waive several key Obamacare protections for those with pre-existing conditions. While it would still require insurers to provide coverage to everyone, states could allow carriers to charge enrollees more based on their medical history. Younger, healthier people could see their premiums go down, but sicker Americans could find themselves totally priced out of policies.
  • The legislation also would let states eliminate Obamacare’s essential health benefits provision that mandates insurers cover a list of services, including hospitalization, maternity care, prescription drugs, mental health and substance abuse services. This would make it harder for people to buy comprehensive policies so those with pre-existing conditions may not be able to find coverage that meets their health care needs.
  • It revamps funding for Medicaid overall. The legislation would send the states a fixed amount of money per Medicaid enrollee, known as a per-capita cap, starting in 2020.
    States could also opt to receive federal Medicaid funding as a block grant for the non-disabled adults and children in their program. Under a block grant, states would get a fixed amount of federal funding each year, regardless of how many participants are in the program. This could definitely result in people being denied care.
  • Graham-Cassidy would also shrink the program even more over time by pegging the annual growth rate of funding for children and non-disabled adults to standard inflation after 2024, rather than the more generous medical inflation. The block grants would limit federal responsibility, and shift that burden to the states. But since states don’t have the money to make up the difference, they would likely either reduce eligibility, cut benefits or cut provider payments.
  • It permits everyone in the individual market to buy catastrophic plans. Obamacare only allows those under age 30 to buy catastrophic policies, which usually have higher deductibles and fewer benefits. This legislation would allow anyone to buy these plans starting in 2019. Catastrophic plans don’t provide much in the way of general healthcare.
  • It repeals several taxes. The bill would repeal the tax on over-the-counter medicine, health savings accounts and medical devices, a levy unpopular on both sides of the aisle. But it keeps in place Obamacare’s taxes on the wealthy, health insurers and others.
  • It allows states to have work requirements for Medicaid. States would now be able to require adult Medicaid recipients to work. The disabled, elderly and pregnant women would be exempt.

I believe Republicans, as in the past, are counting on people being uninformed. They are hoping to get this passed without CBO scores and without debate. I pass along this information so that you can understand what is in the bill and hopefully to talk to your friends and neighbors and educate them. Call, email and text your elected officials to voice your opposition! Unfortunately, several companies have pulled out of the marketplace in Indiana due to the total uncertainty of what the ACA could look like next year. There will only be two Insurance companies left; Ambetter and Caresource. If the Marketplace was made stable we could possibly see companies come back and offer plans once again.