What is the Graham-Cassidy Obamacare repeal bill — & why?

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Jeanine SkowronskiFormer Head of Content at PolicygeniusJeanine Skowronski is the former head of content at Policygenius in New York City. Her work has been featured in The Wall Street Journal, American Banker Magazine, Newsweek, Business Insider, Yahoo Finance, MSN, CNBC and more.

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So you might have missed this, given, you know, the four major hurricanes, one catastrophic earthquake, two minor ones and the President of the United States threatening to destroy North Korea to the tune of "Rocket Man" at the U.N. General Assembly, but Republicans are trying to cram yet another Obamacare repeal bill through the Senate.

And, yes, "cram through" is a totally fair assessment. Since last week, Senate Republicans have been quietly working to shore up support for their latest bill, sponsored by Lindsey Graham (R-SC) and Bill Cassidy (R-LA), so they can pass it before September 30. That's when a rule letting the Senate pass legislation with a simple majority (which the Republicans might have) as opposed a super majority (which Republicans don't have) expires.

That kind of turnaround also means the bill would miss out on a Congressional Budget Office (CBO) score — and conveniently spare Graham-Cassidy damning headlines like this one. And, yes, a CBO report would undoubtedly generate headlines like that. Because Graham-Cassidy is really just a (potentially more radical) version of all the other Obamacare repeal bills Republican have tried (and failed) to get through Congress already.

What is the Graham-Cassidy Obamacare repeal bill?

A Hail Mary effort to repeal President Barack Obama's signature legislation this year, Graham-Cassidy, which is available in full online:

  • Ends Obamacare's individual and employer mandate penalizing people and businesses that don't buy or offer health insurance (because, of course it does).

  • Replaces Obamacare premium subsidies with reduced funding for block grants that states can put toward health care stuff in general, at least until all funding expires in 2026.

  • Formally halts Medicaid expansion (not new) and caps Medicaid spending at up to 20% of a state's allocated block grants (new, but not improved).

  • Redistributes federal funding (i.e. those block grants) from Medicaid expansion states to non-expansion states (more on this in a sec).

  • Cuts federal funding for Planned Parenthood for a year (should sound familiar).

  • Repeals the Obamacare Medical Device Tax (another old favorite).

  • Keeps most of the other taxes on the wealthy (because, at this point, Republicans have conceded something needs to pay for whatever funding their repeal bills provide).

  • Technically (kind of, sort of, maaaaaybe) keeps insurers from outright refusing insurance to people with pre-existing conditions, but gives states a big out when it comes to charging more because of them, along with the right to waive other key Obamacare protections.

What does all that mean?

Nothing good.

Look, there's certainly a political argument for giving power back to the states, but that's not really what Graham-Cassidy does.

On his site, Cassidy is actually spinning "redistributes federal funding from Medicaid expansion states to non-expansion states" as "equalizing the treatment between Medicaid Expansion and Non-expansion States through an equitable block grant distribution." Sounds great (and vaguely socialist, BTW) on first read until you realize that "equalizing" is code for effectively penalizing the (the mostly blue) states that actually improved their health care coverage as the money they would otherwise use to fund their expanded programs would go to (the mostly red) states that, well, didn't.

But even without delving into all of the bill's nuances, it's pretty hard to argue this bill is going to be good for Americans. Why? Because, simply put, Graham-Cassidy reduces funding (to tune of $215 billion by 2026, per a new independent analysis from Avalere Health). Less funding means less coverage for fewer people. Or, put another way, less funding means more expensive and essentially unaffordable coverage for more people who don't have access to a solid employer-sponsored plan.

And that's before you remember the bill caps Medicaid spending (designed to cover low-income Americans) and lets states waive key Obamacare protections that protect older and/or sick people.

— & why?

The eleventh hour Obamacare repeal redux (re-three? re-four) is probably happening because Republicans are terrified of not delivering on their campaign promise to "repeal and replace" Obamacare. Actually that's not conjecture, given Sen. Pat Roberts (R-KS) told Vox's Jeff Stein as much, before dissolving into a bizarre "Thelma & Louise" metaphor that proves literally everyone else's point much better than his own. (Side note: If the only car around is a convertible two fugitives are about to drive into the Grand Canyon, you don't have to get into it. In fact, you shouldn't. Because death. Which, considering the millions of people this bill would leave without insurance, might not be such a nonsensical metaphor.)

Still, I would guess, at this point, even some top-tier establishment donors would rather Republicans stop demonstrating the definition of insanity and move on to tax reform. In other words, this last-ditch effort to repeal Obamacare is at least partially about saving face with (or sticking it to) Donald Trump, who picked a very public fight with Senate majority leader Mitch McConnell and his cohorts after the last Republican bill died a loud death.

Of course, no matter how you spin it, here is what Graham-Cassidy is not about: Actually making health care in America better.

What happens next?

No one knows. The bill is either super-close to passing, not going to pass, prone to stall tactics from Democrats or already hurting health care, depending on what news outlet you visit and what time of day it is. And the Senate is out of session until next week, so it's going to be "wait and see" pretty much until then.

But here's the thing: As of right now, Obamacare is still the law of the land. And even if the individual mandate were to go away on Monday, it's important to have coverage. Graham-Cassidy certainly hasn't helped stabilize the already shaky health care market, but with open enrollment kicking off Nov. 1 (and ending on Dec. 15, earlier than last year), this year's exchanges are close to set in stone. If you need insurance or are hoping to get a better plan, PolicyGenius has plenty of resources that can get you up to speed on how to shop the exchanges — and, in fact, we can help you compare health insurance plans once they're open. In the meantime, you can find answers to your big health insurance questions here.

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