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Graham-Cassidy bill GOP's last-ditch effort to repeal ACA

Cost-sharing reduction payments to insurers not addressed in plan, but work of Senate committee that is addressing CSRs complements bill.

Susan Morse, Senior Editor

Credit: C-SpanCredit: C-Span

Republican Senators unveiled the $1.2 trillion Graham-Cassidy bill on Wednesday, calling it the GOP's last chance bill to repeal and replace the Affordable Care Act through budget reconciliation.

The bill proposes to keep ACA taxes on the rich and distribute the funds in block grants to states. 

[Also: Navigator organizations wait in limbo for reduced funding to enroll consumers in the ACA exchanges]

It repeals the individual and employer mandates and gets rid of the medical device tax.

Starting in 2022, it would include a risk adjustment for states which have older and sicker consumers. States that enroll greater numbers would also get more funding.

[Also: Fitch: States will take the lead on Medicaid reform despite ACA repeal and replace failure]

It also incorporates Sen. Ted Cruz's amendment to expand the use of health savings accounts.

Under the bill, millions would be expected to lose their individual insurance coverage along with their ACA subsidies, which would impact hospitals' bottom lines. Medicaid funding to states would be capped, which could also affect uncompensated care.

Official numbers are not yet known because the Congressional Budget Office has yet to score the bill sponsored by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana and co-sponsored by Sens. Dean Heller of Nevada and Ron Johnson of Wisconsin. Former Sen. Rick Santorum of Pennsylvania joined the news conference to show his support for the bill.

Continued cost-sharing reduction payments are not addressed in the bill because CSRs cannot be approved through budget reconciliation. Graham said they're on a Sept. 30 deadline.

Sen. Lamar Alexander, chairman of the Senate Committee on Health, Education, Labor and Pensions, is addressing CSRs and other market stabilizers during four hearings being held with insurance commissioners, governors and stakeholders, including Kaiser Permanente CEO Bernie Tyson. Alexander and Democratic Senator Patty Murray are working on a bipartisan plan to keep insurance premiums affordable, and are working on a deadline of September 27, when rates are set to be published on

Some insurers are filing two sets of rates depending on whether CSRs continue and others could leave markets should the funding not be extended through 2018. Without CSRs, premiums are expected to rise by about 20 percent in the exchange market.

While the Graham-Cassidy bill does not fund CSRs, it complements the work of the HELP committee, Cassidy said.

Meanwhile the Trump administration is thwarting navigator organizations' ability to enroll ACA consumers by cutting funding by 43 percent, delaying contracts that were expected on September 2, and tying funding to 2017 enrollment performance.

The Graham-Cassidy bill has yet to gain full Republican support. Senate Majority Leader Mitch McConnell told Graham to line-up support and get a CBO score, Graham said.

Graham admonished President Trump to get behind the bill.

"To the president, I'm all in on your agenda, pick up the phone, call governors," Graham said. "Mr. President help us, because we're trying to help you."

The bill is the antithesis to single payer system proposed by Independent Vermont Senator Bernie Sanders, a plan that is gaining consumer support.

"Under this block grant approach you can actually complain to a statehouse representative," Graham said. "You can complain to a governor you can vote for. Under Berniecare, you can complain to a faceless bureaucrat."

The bill would end attempts at single payer, because once the money for healthcare is out of the hands of the federal government and given to states, governors won't be giving it back, the Senators said.

Under the ACA, four states - New York, California, Massachusetts and Maryland - get 40 percent of the money from the ACA, Graham said.

The Graham-Cassidy bill distributes the money more evenly based on population.

It slows the growth of Medicaid spending, which by 2027 will be over $650 billion in spending.

Twitter: @SusanJMorse
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