Sponsors: Graham, former Army Lawyer; Cassidy, former MD (Liver Expert)
Impact of Graham-Cassidy Bill (Not Pretty for Millions)
(Same old GOP BS: Talk one way, Act another, Hurt the needy)
The bad keeps getting worse – details follow:
1. It would effectively strangle the efforts of states — predominantly Democratic — that have been most successful in extending coverage under the ACA’s Medicaid expansion, tax credits and cost-sharing reductions.
2. It would, conversely, lavish new funding on states — predominantly Republican — that have resisted the coverage expansion opportunities the ACA offered.
3. It would dramatically cut funding for states that have successfully extended coverage under the ACA in which California would effectively receive $28 billion and New York $19 billion less.
4. It would however dramatically expand funding for states that have largely ignored their uninsured and not expanded or gone alone with the ACA – i.e., Texas would increase by $8 billion over currently projected levels.
5. It would immediately — and retroactively — end the individual- and employer-mandate penalties, while offering nothing in return to encourage healthy enrollees to maintain coverage.
6. It would also do nothing to compensate insurers for the reductions they must make in deductibles and other cost-sharing for low-income enrollees, an issue that is currently driving up premiums.
7. It includes some funding that could be used to help stabilize insurance markets, but does not specify how the money would be used, and in any event, it provides too little money.
8. It would give additional funds and allow ACA-resistant states to do more to cover their uninsured, states would first have to establish programs to distribute the money. This would likely require state legislation, administrative rules and possibly the establishment of new agencies.
9. It would allow states to waive the ACA requirement that insurers must cover essential health benefits, such as prescription drugs or mental health and substance-use disorder services, as well as the ACA’s prohibition against insurers charging higher premiums to people with preexisting conditions.
10. States would have to describe how they intend “to maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions,” but it is unclear what “adequate and affordable” means and difficult to understand how coverage could meet this standard if services to treat preexisting conditions are not available or if individuals with preexisting conditions can be charged higher premiums. Moreover, the bill contains no mechanism for revoking funding to a state if it fails in fact to meet its commitments.
11. It would allow states to spend up to 15 percent of their grants on covering traditional Medicaid enrollees through private insurance.
States could simply replace their traditional Medicaid expenditures with Graham-Cassidy funding or use the funds to make up for Medicaid shortfalls as other provisions in the bill limit federal funding of traditional Medicaid. This would reduce the money available to cover the low- and moderate- income people that the ACA now covers.
The kicker as it were: The entire block-grant program depends on private insurer participation, but insurers would face 50 different state regulatory and financing systems, each of which could change from year to year. Many private insurers may decide this is just too risky a market to play in.