Beyond repealing many provisions of the ACA, the Graham-Cassidy plan, like the Better Care Reconciliation Act (BCRA) the Senate voted down in July, would convert the Medicaid program's open-ended federal funding to a capped per-enrollee allotment to most states going forward from 2020.
Based on his past partisan voting record, it is likely that Sen. It would permit states to opt out of ACA provisions that prevent health insurers from charging higher health insurance premiums to people who have been treated for cancer, diabetes, HIV, and other health conditions.
Jen Bersdale, executive director of the advocacy group Missouri Health Care for All, says, currently, for every dollar the state spends on Medicaid, the federal government pays a portion of those costs - whatever the need is.
The Graham-Cassidy Bill would keep the existing tax structures of the ACA but would repeal major parts of the legislation.
The ACA's Medicaid expansion has allowed some providors to do more for patients. "If you are a single parent in Texas, your income has to be under $6,000 per year to qualify for Medicaid", he said "If you have no children in your home, it does not matter how poor you are; unless you have a disability, you won't qualify for Medicaid". This legislation, if passed, will not reduce Medicaid fraud as the people who cheat on Medicaid and food stamps will find other ways around the law. It also would have reduced funding for subsidies that lower premiums for another 10 million people.
The Graham-Cassidy proposal would eliminate the expansion and the premiums subsidies in 2020 and instead give states a smaller amount of money they can use for lowering premiums, or any health-related goal they choose. "But if we can prove this type of program works in a state like California, especially-which has the resources of a nation-then we can do it federally".
It should be an idea attractive to Republicans who believe in less federal power.
New Mexico's Medicaid rolls have swollen since Gov. Susana Martinez expanded low- or no-cost health insurance in 2014 to cover adults with incomes slightly above the federal poverty level, up to about $16,600.
Grassley said the bill would deregulate a "Washington-knows-all attitude".
In the letter, ACS CAN also lauds the current bipartisan efforts underway in the Senate focused on stabilizing the health care markets and asks the Governor to urge his Senators "to support this important bipartisan effort, and to oppose the extreme repeal bill now being advanced by Senators Graham and Cassidy". According to the bill, funding redistribution would favor states who did not expand Medicaid under the ACA.
Avalere, an independent health policy consulting firm, estimated the bill would lower federal health care spending by $215 billion through 2026.
But "under most of these proposals", he said, "New Mexico loses". Avalere estimates that between 2020 and 2027, federal funding under the new block grants would be $489 billion less than under current health financing. The following year, the block grants would vanish altogether unless Congress acted to preserve them.
￼Some states, however, would receive additional funding.
According to the CBPP estimates, NY would lose $18 billion in 2026; MA, $5 billion; Kentucky, $3 billion; Pennsylvania, $850 million; West Virginia, $554 million; and in, $425 million.