When Republicans in the U.S. Senate fell one poll short in July, it looked like their seven-year bid to undo the Affordable Care Act, aka Obamacare, had failed. Now there’s an effort to see if a different repeal bill, known as Graham-Cassidy, can make it through the Senate before a Sept. 30 deadline. Supporters say it would throw reshaping health insurance in the hands of the states. Its detractors call it the same old steep cuts in coverage in a new wrapper.
1. What would Graham-Cassidy do?
The proposal by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana would supplant Obamacare’s insurance subsidies with lump-sum “block grants” to governments, which would decide for themselves how to help people get health coverage. The bill, if signed into law, would spell an purpose to the Obamacare requirements that individuals obtain health insurance, that most employers render it to their workers, and that insurers can’t deny coverage or accuse more to people with pre-existing medical conditions. The proposal would terminate the Obamacare tax on medical machines while keeping others intact, including taxes on the wealthy, to fund the block grants. Those grants would expire in 2026.
2. How is it differently constituted previous repeal tries?
The Graham-Cassidy bill leaves to the states many questions that other Republican proposals would have had the federal government departments manage, like setting the size of insurance subsidies. It also strives to equalize Medicaid spending between states, and would cut the program in the mostly Democratic states that expanded it under the ACA, while mailing billions to the mostly red states that didn’t.
3. How is it like previous repeal strives?
In addition to ending Obamacare mandates, it would cap spending on Medicaid, the huge federal program for the poor and disabled.
4. Why does the bill face a deadline?
Republicans comprise 52 seats in the 100 -member Senate. They want to use a procedure, budget reconciliation, that allows legislation to pass with a simple majority rather than the 60 -vote supermajority required to move most bills to a final vote. The Senate’s parliamentarian has ruled that the ability to use reconciliation under the current budget resolve ends when the coming fiscal year expire on Sept. 30.
5. What has to happen between now and Sept. 30?
Graham-Cassidy was formally introduced last week. Major bills typically aren’t voted on without a score from the Congressional Budget Office, which will assess whether Graham-Cassidy gratifies the standards for a simple-majority reconciliation measurement. The CBO said Monday it will give a partial assessment of the measure early next week but won’t have estimates of its effects on the deficit, health insurance coverage or premiums for at least several weeks.The parliamentarian also has to rule on whether any of its provisions aren’t eligible for reconciliation, which is supposed to be limited to tax and spending provisions.
6. What are its possibilities?
Uncertain. Since Democrat have unanimously resisted efforts to repeal the ACA, Republicans necessity the support of at the least 50 of their 52 members.( Vice President Mike Pence, in his role as president of the Senate, would cast the tie-breaking 51 st referendum .) Senator Rand Paul of Kentucky says he’ll resist Graham-Cassidy because even it retains too many elements of Obamacare. So much depends on the three Republican who caused the overcome of the last Obamacare repeal bill — Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona.
7. What would happen in the House?
If the Senate passes Graham-Cassidy, the Republican-controlled House would have a chance to adopt it — but merely word-for-word, unchanged. If the House demands changes, they would need the support of 60 senators, which is a near-impossibility. House Speaker Paul Ryan has spoken positively about the bill, as has Republican Representative Mark Meadows, president of the conservative House Freedom Caucus. But a significant number of House Republicans come from states that could lose billions in Medicaid money under Graham-Cassidy.
8. Who’s for the bill?
President Donald Trump says he supportings it, though he has yet to do any active lobbying. Republican seem pressure from their base for failing in so far to repeal Obamacare — a failure Trump has excoriated them for.
9. Who’s against it?
Along with Democrat, several Republican governors in is to say that expanded Medicaid. Credit ratings bureau Fitch Ratings said Friday that because Medicaid spending represents one-third on the part of states budgets, the bill would pose big challenges for them, particularly those that took advantage of Obamacare’s Medicaid expansion.
10. What happens if it fails?
Democrats and Republicans on the Senate’s health committee are working together to see if they can write a narrow bill to address some of Obamacare’s flaws that threaten to lead to fewer selections and higher premiums for some people who buy individual insurance policies.
The Reference Shelf
An analysis by the liberal Center on Budget and Policy Priorities.
A comparison of Graham-Cassidy and previous repeal bills.