Like Countable?

Install the App
TRY NOW

senate Bill S. 16281

Graham-Cassidy: Repealing Obamacare and Giving States Block Grants to Help People Buy Health Insurance

Argument in favor

This bill would take money and power out of Washington and give it back to patients and states by rolling back the more onerous parts of Obamacare — like the individual and employer mandates and the medical device tax — through block grants and Medicaid reforms.

09/21/2017
True health care reform will happen when care is redesigned around the patient, not the doctor or hospital; when the financial incentives reward better health outcomes rather than hospital beds filled; and when the consumer has access to information to make good choices. While parts of the ACA are clearly on the right track to address health care reform, other parts need to be significantly improved. The focus should be on improving the affordability of health care for ‘every’ American.
Like (218)
Follow
Share
William's Opinion
···
09/21/2017
I support this bill. The current system of the ACA is untenable. It will die by the sheer weight of its own volume. Healthcare is a product of human derived technology. It is not a human right. It is not guaranteed by the Constitution. It is acquired through hard work and the toil of your labor. Free healthcare is a communist ideal. It has not worked in any other country. It will not work in ours either. The massive expense will break our economy.
Like (70)
Follow
Share
Jake's Opinion
···
09/21/2017
Although it is not perfect, it is a step back from the tyrannical process Obamacare has inflicted on EVERYONE. By passing this, it will open the gates for more specialized healthcare insurance and thereby reduce the costs of healthcare insurance. It gives us the people more power to influence the free market.
Like (25)
Follow
Share

Argument opposed

Rather than trying to apply measured fixes to the flaws of Obamacare, this bill negatively transforms America’s healthcare system in a way that could cause people to pay more for their health insurance or reduce the benefits plans cover, making quality coverage hard to find.

Anne's Opinion
···
09/21/2017
It seems that Republicans are looking for a win no matter how this bill would effect Americans. To ram this bill through without the CBO score, with many health associations and foundations against it, and even Blue Cross Blue Shield against it is horrifying. States will lose many federal dollars and won't be able to make up the losses so those costs will be passed on to consumers. States will be able to lift protections for those with pre-existing conditions, and lifetime caps on coverage. I don't trust states to be able to run exchanges. If Japan, Germany, France, Sweden, Canada, and so many other countries have figured out how to do healthcare, why the hell can't we?
Like (840)
Follow
Share
Sarah's Opinion
···
09/21/2017
Certainly the ACA has its problems. Not the least because the Republicans have attempted to undermine and sabotage it at every turn. Regardless, pushing 32M vulnerable Americans off of their healthcare is atrocious. Unforgivable. Even Trump has called the GOP's plans mean. Vote no on Graham-Cassidy.
Like (470)
Follow
Share
Alice's Opinion
···
09/21/2017
Was I not clear the last time we were through this? Why is this travesty of a healthcare bill back on the floor? Please support Medicare for all- it is way past time for us to have universal healthcare the way Every other developed country has. I don't care how many healthcare corporations lose money. I'm more concerned with the people in this country losing their lives.
Like (249)
Follow
Share

bill Progress


  • Not enacted
    The President has not signed this bill
  • The house has not voted
  • The senate has not voted
    IntroducedSeptember 13th, 2017

What is Senate Bill S. 16281?

(Update: 9/24/2017) Amendments have been added to the original version of this legislation and can be found at the bottom of the summary. This bill page represents Senate Republicans’ proposed amendment to the House-passed American Health Care Act, commonly known as Graham-Cassidy. It would gradually repeal the structure of the Affordable Care Act (aka Obamacare) and replace it with a block grant given annually to states to help individuals pay for healthcare. The bill would repeal Obamacare’s individual and employer mandates along with the medical device tax, improve the ability of states to get waivers from Obamacare regulations, protect patients with pre-existing medical conditions, and equalize the treatment between Medicaid expansion and non-expansion states through the block grant system. Obamacare’s Medicaid expansion, cost-sharing reduction program, and premium tax credits would end on December 31, 2019.

Block Grants

Federal block grants would be provided annually to states to help individuals pay for healthcare, giving states significant discretion over how to best use those funds to provide for the needs of patients in each state. Grant funding would be run through the Children’s Health Insurance Program (CHIP) and would be subject to the appropriations process. The total federal grant funding would replace what’s currently being spent on Medicaid expansion, tax credits, and cost-sharing reduction subsidies.

States would be able to use the money from their block grant to:

  • Assist individuals in purchasing health insurance coverage with premium support (like tax credits, cost-sharing reduction (CSR) payments, etc.) including for plans that don't meet Obamacare's required benefits like maternity care, mental health coverage, and prescription drugs;

  • Enter into agreements with insurers, including managed care providers, to encourage market participation;

  • Pay healthcare providers;

  • Help with out-of-pocket costs, and potentially modify the federal cap on out-of-pocket costs;

  • High risk or reinsurance pools, or multiple risk pools;

  • Help the traditional Medicaid population with up to 20 percent of the funds.

To get the federal block grants, states would have to certify that funds would only be used on allowed activities and that none were used for prohibited activities. States would have to describe how they will regulate plans using funds in the block grant, including how they'll maintain access to adequate and affordable coverage for individuals with pre-existing conditions.

The distribution of funding would start at a level dependent on the amount received in 2017 through the Medicaid expansion, ACA tax credits, and CSR payments before eventually converging to a base rate in 2026 at which each state will receive the same amount of money for each beneficiary between 50 and 138 percent of the federal poverty level (FPL). To ease the transition, the incremental increase in total national funding available is distributed evenly each year between 2020 and 2026.

Starting in 2021, the total number of eligible beneficiaries between 50 and 138 percent of the FPL in the U.S. would be calculated each year. Then, the percentage of those in each state is calculated and the total amount of federal money is multiplied by the state’s percentage to determine the amount of the state’s funding for the year.

Also beginning in 2021, a risk adjustment formula would be applied to block grant amounts which accounts for factors like disease burden, age, regional cost of living, and gender. It could adjust the per-beneficiary amount that’s the basis for the block grant by 10 percent over and below the mean for all states. The Centers for Medicare and Medicaid Services (CMS) would be responsible for developing the formula over the next three years and it’d be based on information in the Transformed Medicaid Statistical Information System.

The following amounts would be appropriated for block grants:

  • Fiscal year 2020: $136 billion;

  • Fiscal year 2021: $146 billion;

  • Fiscal year 2022: $157 billion;

  • Fiscal year 2023: $168 billion;

  • Fiscal year 2024: $179 billion;

  • Fiscal year 2025: $190 billion;

  • Fiscal year 2026: $200 billion.

Medicaid

The Obamacare Medicaid expansion would end on December 31, 2019 and no state would be allowed to expand after September 1, 2017. States that expanded pre-Obamacare would get a match rate of 90 percent in 2018 and 2019, after which point the match rate would go to 0 percent.

Starting in fiscal year 2020, federal Medicaid funding would be reformed to a per capita model based on enrollees (currently the federal government matches state spending dollar-for-dollar). States would have targeted spending amounts that increase annually by an inflation factor which varies based on enrollee category, and if states exceed their targeted amount they would receive reduced block grants the following fiscal year.

Starting October 1, 2017 states would be allowed to require non-disabled, non-elderly, non-pregnant individuals to satisfy a work requirement as a condition of receiving Medicaid medical assistance. Individuals would be exempt if they’re pregnant (and 60 or fewer days postpartum), under age 19, the sole parent or caretaker of a disabled child under age 6, under age 20 and enrolled in secondary school or employment-related education, in drug or alcohol rehabilitation, or a full-time student at an institution of higher education.

Taxes

The following tax provisions would be affected by this legislation:

  • The 2.3 percent excise tax on medical devices -- which is currently delayed through December 31, 2017 -- would be repealed.

  • Business-expense deductions for retiree prescription drug costs would be reinstated without reduction by the amount of any federal subsidy.

  • Small business health insurance tax credits would be repealed as of January 1, 2020, and in the meantime would only be available to purchase health plans that don’t cover abortions except for those necessary to save the mother’s life or for pregnancies resulting from rape or incest.

  • Premium tax credits would be repealed as of January 1, 2020, and in the meantime would only be available to purchase health plans that don’t cover abortions except for those necessary to save the mother’s life or for pregnancies resulting from rape or incest.

Health Savings Accounts

The following provisions would apply to health savings accounts:

  • Taxes on Archer Medical Savings Accounts and Health Savings Accounts would be lowered to 15 percent and 10 percent taxes, respectively. The lower rates would apply to distributions made after December 31, 2016.

  • The requirement that only prescription drugs be be considered qualified expenses from tax-advantaged health accounts would be eliminated, allowing individuals to use health savings accounts to purchase over-the-counter medications.

  • Limits on contributions to health savings accounts would be increased to $6,650 and $13,300 for individuals and families, respectively. Funds from such accounts could be spent on health insurance premiums, including catastrophic plans.

Other provisions of this bill include:

  • Abortion providers such that perform abortion in cases that don’t meet the Hyde Amendment’s exception for federal payment (cases of rape, incest, to save the mother’s life), such as Planned Parenthood, wouldn’t receive federal funding for one year.

  • All individuals would be allowed to enroll in a low-premium catastrophic health insurance plan beginning on or after January 1, 2019.

  • An additional $422 million for fiscal year 2017 would be provided to the Community Health Center Fund.

  • Obamacare’s Prevention and Public Health Fund would be repealed.


Amendments
A total of $500 million would be available to states that set up 1332 waiver systems under Obamacare, with Alaska and Hawaii being the only states to have done so. States that recently expanded Medicaid would have $750 million available to them in each fiscal year from 2023-2026.

Impact

Consumers of health insurance and healthcare services; healthcare providers and insurers; states; and the federal government.

Cost of Senate Bill S. 16281

The CBO estimates that enacting this bill would reduce budget deficits by at least $133 billion over the 2017-2026 period.

More Information

In-DepthSponsoring Sen. Lindsey Graham (R-SC) introduced this bill to reform the healthcare system by repealing Obamacare and replacing it with an annual block grant to states that’d be used to help people obtain health insurance:

“Instead of a Washington-knows-best approach like Obamacare, our legislation empowers those closest to the health care needs of their communities to provide solutions. Our bill takes money and power out of Washington and gives it back to patients and states. It takes us off the path to single payer health care — which would be a disaster — and puts us on a path toward local control. Our approach will have better health care outcomes, transparency, and sustainability than Obamacare. This bill fundamentally transforms health care in the United States.”

Senate Minority Leader Chuck Schumer (D-NY) called the potential consideration of this bill a “red siren moment” for the country and is more dangerous than previous Republican healthcare reform proposals:

“After a few weeks of lying dormant, Trumpcare is back and it’s meaner than ever. While this latest version of Trumpcare may live under a new name… no matter how many ways Republicans try to dress it up, this bill is even more dangerous than its predecessors.”

Aside from Sen. Graham, three other Republicans helped draft this legislation — Sens. Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI). Some Senate Republicans have held back on publicly backing this proposal yet, so it’s not clear whether it will have the support it needs to pass. Assuming all senators are present at the time of a vote, only two Republicans can oppose the bill and allow it to be approved on a tie-breaking vote by Vice President Mike Pence. So far, Sens. Rand Paul (R-KY), John McCain (R-AZ), and Susan Collins (R-ME) have said they would vote against it, while Sens. Lisa Murkowski (R-AK), Ted Cruz (R-TX), and Mike Lee (R-TX) have withheld their support and are undecided.

Given the role of states in this proposal, it’s worth noting that 15 governors have written letters in support of the bill, while another 10 have been opposed.

The CBO hasn't had time to conduct a full analysis of this legislation and won't for weeks, but it did do a preliminary analysis which found:

The number of people with comprehensive health insurance that covers high-cost medical events would be reduced by millions compared with the baseline projections for each year during the decade, CBO and JCT estimate. That number could vary widely depending on how states implemented the legislation, although the direction of the effect is clear. The reduction in the number of insured people relative to the number under current law would result from three main causes. First, enrollment in Medicaid would be substantially lower because of large reductions in federal funding for that program. Second, enrollment in nongroup coverage would be lower because of reductions in subsidies for it. Third, enrollment in all types of health insurance would be lower because penalties for not having insurance would be repealed. Those losses in coverage would be partly offset by enrollment in new programs established by states using the block grants and by somewhat higher enrollment in employment-based insurance. Many of the new programs would probably cover people with characteristics similar to those of people made eligible for Medicaid by the ACA.


Media:

Summary by Eric Revell

(Photo Credit: FatCamera / iStock)

Official Title

Graham-Cassidy Healthcare Reform Proposal

    True health care reform will happen when care is redesigned around the patient, not the doctor or hospital; when the financial incentives reward better health outcomes rather than hospital beds filled; and when the consumer has access to information to make good choices. While parts of the ACA are clearly on the right track to address health care reform, other parts need to be significantly improved. The focus should be on improving the affordability of health care for ‘every’ American.
    Like (218)
    Follow
    Share
    It seems that Republicans are looking for a win no matter how this bill would effect Americans. To ram this bill through without the CBO score, with many health associations and foundations against it, and even Blue Cross Blue Shield against it is horrifying. States will lose many federal dollars and won't be able to make up the losses so those costs will be passed on to consumers. States will be able to lift protections for those with pre-existing conditions, and lifetime caps on coverage. I don't trust states to be able to run exchanges. If Japan, Germany, France, Sweden, Canada, and so many other countries have figured out how to do healthcare, why the hell can't we?
    Like (840)
    Follow
    Share
    Certainly the ACA has its problems. Not the least because the Republicans have attempted to undermine and sabotage it at every turn. Regardless, pushing 32M vulnerable Americans off of their healthcare is atrocious. Unforgivable. Even Trump has called the GOP's plans mean. Vote no on Graham-Cassidy.
    Like (470)
    Follow
    Share
    Was I not clear the last time we were through this? Why is this travesty of a healthcare bill back on the floor? Please support Medicare for all- it is way past time for us to have universal healthcare the way Every other developed country has. I don't care how many healthcare corporations lose money. I'm more concerned with the people in this country losing their lives.
    Like (249)
    Follow
    Share
    We need more health insurance coverage, not less. As a healthy person I have no issue subsidizing someone who is sick.
    Like (160)
    Follow
    Share
    Repair the ACA - don’t repeal it!
    Like (137)
    Follow
    Share
    No. Do not support this bill! It's a terrible healthcare bill that shows the Rs distain for people in a lower pay grade than themselves. Support Medicare for all please. Thank you.
    Like (99)
    Follow
    Share
    G-C undermines the Senate HELP committee's existing bipartisan efforts to strengthen the ACA, and violates key protections for Americans with preexisting conditions.
    Like (74)
    Follow
    Share
    I support this bill. The current system of the ACA is untenable. It will die by the sheer weight of its own volume. Healthcare is a product of human derived technology. It is not a human right. It is not guaranteed by the Constitution. It is acquired through hard work and the toil of your labor. Free healthcare is a communist ideal. It has not worked in any other country. It will not work in ours either. The massive expense will break our economy.
    Like (70)
    Follow
    Share
    Please vote no! This is another way to get millions off health insurance that will hurt the poor and elderly and help the rich!
    Like (67)
    Follow
    Share
    G-C is an abomination and the supporters are charlatans and con men. They have no interest in the Healthcare of Americans. Their goal is tax cuts for the wealthy and Healthcare for all stands in the way of this. Healthcare is a basic human right and the idea of monetizing it should have been called out for what it is, profiteering on human suffering and completely out of line with American ideals. We are a nation that was built and is strong only because of our work toward equality and uplifting the many over the few. The steps we have taken forward have made us the strongest nation over the long term and these cutbacks and shortcuts only serve to slow us down long term. Stop chasing a quick buck America and invest in America. We have a con man after a quick buck in the WH but we can rise above that mistake.
    Like (64)
    Follow
    Share
    This is the absolute worst of the multiple awful and evil bills proposed by republicans to destroy health care. Please vote no.
    Like (60)
    Follow
    Share
    To both of my Utah senators, Hatch and Lee, I would send you a well-reasoned thoughtful opinion if I thought that either of you would listen to your constituents. Instead I am just wagging a finger at you and saying, Shame on you for following the party line no matter the collateral damage to the people you supposedly represent. Beware of karma!
    Like (54)
    Follow
    Share
    This is Trump Care 2 and even worse. Millions with no insurance, pre existing conditions back, on an on. Do not vote for this
    Like (48)
    Follow
    Share
    NO NO NO NO NO NO. This is a horrible heartless bill trying to be slipped under the wire and skirt legislative process. Everyone involved should be ashamed.
    Like (35)
    Follow
    Share
    As had been said by others this is a case of Republicans being comfortable with killing children, the disabled and elders while jetting around at the expense of the very public they are killing. We have become a fascist oligarchy that both Putin and Hitler would appreciate. Graham and Cassidy have shown us who they are – liars, thieves, Koch brothers minions, and selfish oligarchs. Shameless. This is vile and vicious.
    Like (32)
    Follow
    Share
    I am the guardian of my disabled older sister and many families in the disabled community are aware of the damage this will cause to our loved ones because Medicaid cuts/pre-existing conditions. They need our help and we should never turn away from the most vulnerable.
    Like (31)
    Follow
    Share
    More people are going to loose their ability to afford coverage if this passes! It's no better than Trumpcare! The coverages that the states will offer won't be adequate and will be overpriced! Anyone that thinks the state polititions will handle the funds better is nuts because they are all the same people! They have their insurance bought and paid for by us so they have no skin in the game! Tell them to vote no! They can do better for us than this!
    Like (27)
    Follow
    Share
    This health insurance bill would make things worse, not better. Block grants have proven to be more expensive in the long run, both for the government and the people. Something that affects so many people needs to be a bipartisan effort to truly make the best possible coverage available to the most people possible. While Obamacare certainly has its flaws this is not an adequate or reasonable answer.
    Like (26)
    Follow
    Share
    Absolutely do not pass or vote for this bill! This bill, along with all of the other attempts that the Republican Party have me to undo the ACA do nothing to help the American people! I support any bipartisan effort to seriously consider changes to the ACA for the introduction of a new bill to create or replace the ACA with a single-payer system or Medicare- for-all. I believe the Democrats deserve a chance to bring single-payer to the floor for consideration. I would even support a reasonable Bill sponsored by the Republican Party but I do not think they can provide one! Clearly their history thus far seems to indicate they are incapable of doing so.
    Like (26)
    Follow
    Share
    MORE