The authors of the latest Republican effort to repeal and replace Obamacare have released a revised version of their health care legislation after spending the weekend finessing the numbers in their bill with the hope of winning over the last few Republican holdouts in the Senate.
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The newest draft from Sens. Bill Cassidy, R-La., Lindsey Graham, R-S.C., Dean Heller, R-Nev., and Ron Johnson, R-Wis., rejiggers how changes in federal funding provided to states for health care would be phased in over time.
As a result, there would likely be less of a gap between the states poised to get additional federal dollars from this bill and the states that would lose out on funding.
The concept of block granting federal funding remains the centerpieces of the legislation. Starting in 2020, the federal government would end stop providing additional money for states that specifically expanded their Medicaid programs under the Affordable Care Act. The bill would also end the cost-sharing subsidies the federal government currently pays to insurance companies to help keep premiums for lower-income Americans buying health insurance. Instead, the plan would designate some federal funds to be divided up to states based on their resident’s poverty levels and other factors that impact health care costs like population density.
The authors have argued it is unfair that under current law, some states receive more federal funding to help provide health insurance than others, though all states were offered the same opportunity and access to additional funds to expand their Medicaid rolls. Many Republican governors refused that available funding under current law.
The new Republican plan would essentially equalize federal funding between states that expanded Medicaid and states that did not, but the latest version makes those changes more gradually.
States that expanded Medicaid would still likely lose billions of dollars in federal funding, and the overall pot of total federal funding would still be approximately $160 billion less over the next 10 years as compared to current law, according to a study from the Kaiser Family Foundation.
The new draft would also appropriate $500 million specifically to states that set up waiver systems under Obamacare, which only includes Hawaii and Alaska. Alaska Sen. Lisa Murkowski still remains undecided on the Graham-Cassidy bill and her vote is vital to the bill’s passage.
The new draft also would allocate an additional $750 million a year to states that expanded Medicaid recently, while punishing states that expanded Medicaid when first given the option under the Affordable Care Act. The states that would most likely benefit the most from this include Montana and Cassidy's home state of Louisiana.
Before the revised bill was released, Sens. John McCain, R-Ariz., and Rand Paul, R-Ky., announced their opposition to the bill, putting Republicans' efforts to pass a repeal of Obamacare in the Senate at risk of failing once again. McCain said he could not "in good conscience" support the bill because it doesn't have bipartisan support and didn't go through the regular order, which includes committee markups, hearings and debates. Paul wants further cuts than Obamacare and wants block grants removed from the bill. With 52 Republicans in the Senate, the Graham-Cassidy bill cannot afford another "no" vote.
Over the weekend, two more senators appeared to be leaning against voting for the Graham-Cassidy bill unless changes to the legislation were made.
Sen. Ted Cruz, R-Texas, said Cassidy and Graham "don't have my vote" yet and Sen. Susan Collins, R-Maine, said it would "very difficult" to "envision a scenario" where she would vote for this bill.
Republicans are pushing the Graham-Cassidy bill quickly through the Senate in hopes of meeting the Sept. 30 deadline that allows them to pass health care on a party-line simple majority vote. After Sept. 30, Republicans will need 60 votes.
The Senate Finance Committee plans on holding the first hearing today on the bill. Congress is still waiting for the Congressional Budget Office to release its score of the bill, which would indicate how much the legislation will affect the government’s deficit.