Graham-Cassidy Explained

Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) are mounting one last effort to repeal and replace the Affordable Care Act. Their bill would make the following changes.

Medicaid Expansion allowed states to insure people earning up to 138 percent of the Federal Poverty Level ($16,642.80). For the states that chose to expand Medicaid, the federal government pays at least 90 percent of the cost. Thirty-one states and the District of Columbia expanded Medicaid.

Graham-Cassidy would eliminate specific federal funding for Medicaid expansion. Beginning in 2020, the money that would currently fund Medicaid expansion would be added to a lump sum block grant. The 19 states that didn’t expand Medicaid would be eligible for a piece of this funding. In 2027, the funding that would have gone to Medicaid expansion expires.

Cost sharing reduction payments made to insurers help offset the out-of-pocket cost for people purchasing insurance through the individual marketplace earning up to 250 percent of the Federal Poverty Level ($30,150).

In 2020, cost sharing reduction payments would be eliminated by Graham-Cassidy. States could choose to use a portion of their block grant to continue the payments.

People earning up to 400 percent of the Federal Poverty Level ($48,240) qualify for tax credits to help them purchase insurance.

In 2020, Graham-Cassidy eliminates the tax credits. States could use a portion of their block grant to fund the tax credits.

Graham-Cassidy eliminates the individual mandate that penalized those without insurance who didn’t obtain a waiver. The mandate that requires all employers of 50 or more to offer insurance is also gone.

Funding for traditional Medicaid is based on the cost of providing health care to those enrolled in traditional Medicaid.

In 2020, Graham-Cassidy would change traditional Medicaid’s funding to a system that gives each state the same amount of money for each person enrolled. In other words, payments would have nothing to do with expenses.

All insurance plans must cover so-called essential benefits. Maternity care, prescription drugs, hospitalization, and mental health are some of the services insurance must now cover.

Graham-Cassidy allows states to apply for waivers to change what constitutes an essential benefit. Changing essential benefits would allow insurers to deny coverage to people with preexisting conditions. It would also allow for the reinstitution of annual and lifetime caps on the amount of money insurers will pay to cover you.

Insurers are allowed to charge people 55 or older three times what they charge younger people.

Graham-Cassidy lets states apply for waivers that would enable them to set the rates that could be charged older Americans.

I went over my 300-word limit. This is important though. Don’t worry, I won’t make longer posts a trend.

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