The Republicans are going to try again to repeal and replace Obamacare with a new “compromise” bill that might have a chance of passing. But like the earlier incarnations of the bill, it’s terrible and would result in millions of people losing their healthcare while destabilizing the exchanges.
- Eliminate the ACA’s marketplace subsidies and enhanced matching rate for the Medicaid expansion and replace them with an inadequate block grant. Block grant funding would be well below current law federal funding for coverage, would not adjust based on need, would disappear altogether after 2026, and could be spent on virtually any health care purpose, with no requirement to offer low- and moderate-income people coverage or financial assistance.
- Convert Medicaid’s current federal-state financial partnership to a per capita cap, which would cap and cut federal Medicaid per-beneficiary funding for seniors, people with disabilities, and families with children.
- Eliminate or weaken protections for people with pre-existing conditions by allowing states to waive the ACA’s prohibition against charging higher premiums based on health status and the requirement that insurers cover essential health benefits including mental health, substance abuse treatment, and maternity care.
- Destabilize the individual insurance market in the short run — by eliminating the ACA’s federal subsidies to purchase individual market coverage and eliminating the ACA’s individual mandate to have insurance or pay a penalty —and risk collapse of the individual market in the long run.
- Eventually result in larger coverage losses than under proposals to repeal ACA’s major coverage provisions without replacement. The Congressional Budget Office (CBO) has previously estimated that repeal-without-replace would cause 32 million people to lose coverage. The Cassidy-Graham bill would likely lead to greater numbers of uninsured after 2026, however, because it would not only entirely eliminate its block grant funding — effectively repealing the ACA’s major coverage expansions — but also make increasingly severe federal funding cuts to the rest of the Medicaid program (outside of the expansion) under its per capita cap.
The passage of this bill in the Senate will again hinge on a small handful of legislators — Murkowski, Collins and McCain. And the Huffington Post reports that they’re wavering on whether they’ll vote against the new bill. The only real difference is that it pushes some of the worst cuts off for long enough that they would fall outside the timeframe of the usual review by the Congressional Budget Office.