#obamcare

Sarah Kliff at Vox:

I have spent the bulk of 2017 writing about the different Republican plans to repeal the Affordable Care Act.

Graham-Cassidy, in my view, is the most radical of them all.

While other Republican plans essentially create a poorly funded version of the Affordable Care Act, Graham-Cassidy blows it up. The bill offered by Republican Sens. Lindsey Graham and Bill Cassidy takes money from states that did a good job getting residents covered under Obamacare and gives it to states that did not. It eliminates an expansion of the Medicaid program that covers millions of Americans in favor of block grants. States aren’t required to use the money to get people covered or to help subsidize low- and middle-income earners, as Obamacare does now.

Plus, the bill includes other drastic changes that appeared in some previous bills. Insurers in the private marketplace would be allowed to discriminate against people with preexisting conditions, for example. And it would eliminate the individual mandate as other bills would have, but this time there is no replacement. Most analysts agree that would inject chaos into the individual market.

[...]

The Graham-Cassidy bill has, so far, received far less attention than the last bill the Senate considered in July or one the House took up in May. But the reality is that this quiet bill would be far more disruptive.

Other GOP bills shrank Obamacare programs. Graham-Cassidy eliminates them entirely.

Other key Republican health plans introduced this year actually have kept a good deal of the Affordable Care Act intact, except with dramatically less funding.

Take, for example, the Better Care Reconciliation Act, which the House passed in May. That bill certainly included deep cuts to the health law’s coverage programs, which is why the Congressional Budget Office estimated it would cause 22 million Americans to lose coverage.

But it also kept some key Obamacare programs. It envisioned a future for the marketplaces, where some Americans receive subsidies to purchase health coverage. Granted, those subsidies were much smaller than those that exist in current law, and they would only cover skimpier health plans. But they still existed under the BCRA, in a nod to how entrenched that program has become in the American health care system.

The BCRA also sharply reduced funding for the Medicaid expansion. Right now, the federal government covers 90 percent of the cost of this program. BCRA would have reduced that funding down to a lower match (each state would have a different match rate, and they vary between 50 to 70 percent).

The future that Graham-Cassidy envisions is much, much different. This bill would not give states the option to continue the Medicaid expansion at a lower match rate. It would not mandate that middle-income Americans receive financial help to purchase insurance coverage. Those programs would end in 2020.

Instead, Graham-Cassidy would lump together all the money spent on these two programs across the country — about $1.8 trillion according to the Congressional Budget Office. It would dial back that spending significantly, like other plans: cutting it by $239 billion between 2020 and 2026.

Then, going much further than other Republican plans, it would use a new and complex formula to redistribute money from states that expanded Medicaid to those that do not participate in the program. States would be able to use this new lump sum for all sorts of things.

“A state could say, I’m going to take all this money to pay doctors for uncompensated care and not provide any health coverage,” Park says. “You can spend the money on a whole host of other services that have nothing to do with expanding insurance coverage.”

The list of the options, which begins on page 8, says states can use the money to:

Establish a program to “help high risk individuals in the purchase of health benefits coverage”

“Stabilizing premiums and promoting state health insurance market participation”

Pay health providers for “the provision of health care services”

Create a fund to cover “out-of-pocket costs such as co-payments, coinsurance, and deductibles of individuals enrolled in the individual market”

Create programs “to help individuals purchase health benefits coverage”