Amid crumbling support for the Senate GOP’s last-ditch bill to repeal the Affordable Care Act, the authors of the Graham-Cassidy repeal bill dropped revised text late Sunday night in an attempt to woo dissenting Republicans back into the fold.
The changes attempt to offer something for everyone: more insurance deregulation and the weakening of protections for people with pre-existing conditions for far-right skeptics like Sens. Rand Paul (R-KY) and Ted Cruz (R-TX), re-jiggered state numbers to soothe the fears of moderates Susan Collins (R-ME) and Lisa Murkowski (R-AK), and an extra sweetener for the home state of bill author Bill Cassidy (R-LA).
Waiving the waivers
Like the first version of the bill unveiled last week, the legislation would repeal Obamacare’s employer and individual mandates and federal tax credits, and convert Medicaid funding into block grants that shrink over time.
But in the new bill, which may not even get a partial Congressional Budget Office review before a potential vote this week, states would have even fewer hoops to jump through in order to waive insurance regulations set up to protect people with pre-existing conditions.
Instead of having to apply for a waiver in order to, say, allow insurers to offer plans that don’t cover mental health or to charge sick people higher rates, states would merely have to describe their system to the federal government in order to receive a block grant.
The new bill also allows states to segregate healthy and sick people into separate risk pools, which combined with the steep cuts in federal funding for most states could send premiums sky-high for people with serious health needs.
Fuzzy math for Alaska
With Murkowski still publicly undecided on the bill and the time running out for Republicans to pass the bill with a simple majority, the new legislative text contains several major sweeteners for Alaska in a naked bid to win her vote.
One new provision would allow Native Alaskans enrolled in Alaska’s Medicaid expansion to be protected from the national gutting of the expansion that would begin in 2020.
Other additions to the bill would direct billions more dollars to states with low-density populations, states with high poverty rates, and states that have already set up reinsurance programs through a federal waiver—all of which significantly benefit Alaska.
Because of the rollback of the Medicaid expansion and the caps on traditional Medicaid spending, Alaska would still see a $100 million cut in federal funding over 10 years under the revised bill, even with the added sweeteners. Senate Republicans are arguing that funding for the state would actually increase by 3 percent, though they arrive at that calculation in part by assuming that Alaska would no longer fund its portion of the Medicaid expansion.
A Louisiana purchase
Finally, Graham-Cassidy includes a special sweetener directed at Cassidy’s home state.
The bill now allocates $750 million every year from 2023 to 2026—about $3 billion total—to states that decided to expand Medicaid after December 2015. Louisiana expanded in early 2016 after electing a Democratic governor, and would be the one of just two states to qualify for the provision, along with Montana. Cassidy’s state would get tens of millions more than Montana because it has a larger population.
Read the bill summary from Cassidy’s office below: