What would the Graham-Cassidy bill to repeal Obamacare do?

WASHINGTON — Senate Republicans are rushing to vote by the end of next week on a new bill to roll back the Affordable Care Act.

The latest bill — authored by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La. — has been put together so quickly that the independent Congressional Budget Office said it will not have time to fully evaluate its impact before a vote.

Here is a rundown of the main parts of the bill and its impact:

Q: How different is this from the previous Republican repeal bills?

A: The Graham-Cassidy proposal shares some features of earlier repeal legislation approved in the House and debated in the Senate, including scrapping the requirement that Americans have health coverage and placing new restrictions on federal funding for Planned Parenthood.

But the new repeal bill is substantially more sweeping and goes far beyond just repealing the 2010 health care law, often called Obamacare.

The Graham-Cassidy proposal would completely restructure how the federal government provides health care assistance to some 80 million Americans and create a new system for distributing hundreds of billions of dollars of government aid.

That would represent the largest change in the way health care is financed in the United States in more than half a century.

Q: How would that happen?

A: The bill would first do away with the government’s two main tools for providing health insurance coverage to low- and moderate-income Americans.

Graham-Cassidy would eliminate insurance subsidies provided through the Affordable Care Act to about 8 million consumers who earn too much to qualify for the Medicaid program. And it would eliminate the half-century-old system of federal Medicaid funding, which currently provides money to states to cover poor children, mothers, senior citizens and the disabled.

State Medicaid programs today insure more than 70 million Americans. That includes millions who have gained coverage since 2014 through the Affordable Care Act, which provided additional federal funds to states to make Medicaid available to poor, working age adults, a population not usually eligible for coverage.

In place of the current law’s insurance subsidies and the Medicaid funding, Graham-Cassidy would provide states with a set amount of federal money that they could use as they choose to provide health care assistance to their residents. This federal funding would then be capped.

That would effectively end the federal government’s promise to guarantee health insurance for all low-income Americans.

Q: So would people lose coverage?

A: Almost certainly.

The nonpartisan Congressional Budget Office has estimated that previous GOP repeal bills that gave states the ability to waive consumer protections would make it harder for sicker people to get health coverage.

That would, in turn, drive up the number of uninsured. Independent analyses of proposals to cap federal funding to states also estimate that would lead to an erosion in coverage as the cost of providing health care assistance over time grows more rapidly than the cap.

The arcane funding formula in the new GOP proposal would effectively shift money away from these states to more conservative states that have resisted coverage expansions.

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