New York Magazine had an article explaining four things in health care that Graham-Cassidy will make worse if it passes. Graham-Cassidy shifts the burden of crafting a health care system onto the states, and makes them do it with far less money.
1. Cut Protections for People With Preexisting Conditions.
Under Graham-Cassidy, insurers could not refuse to cover someone because of a preexisting condition, but they would be able to make coverage so exorbitantly expensive that sick people couldn’t afford it.
First, insurance companies could charge people higher premiums based on their health status. The Center for American Progress estimates that annual premiums would be tens of thousands of dollars higher for a 40-year-old with various medical conditions than for a completely health person. Like previous GOP health plans, insurers would be allowed to charge older people five times as much as younger people, while the currently limit is three times as much.
The bill also allows states to waive Obamacare’s essential health benefits, which require insurance plans to cover basics like hospitalizations, maternity care, and laboratory tests.
2. Gut Federal Funding for Health Care
Graham-Cassidy would eliminate both the employer and the individual mandate which would make health insurance more expensive, and lead to millions fewer being covered. But Graham-Cassidy does something even more radical: eliminating federal funding for Obamacare marketplace subsidies and the Medicaid expansion, and replacing it with one block grant to the states.
As the Center on Budget and Policy Priorities explains, between 2020 and 2026, states would receive less money via block grants than they would under Obamacare, and that gap would get worse over time:
The block grant would equal $140 billion in 2020, which is $26 billion, or 16 percent, below projected federal spending for the Medicaid expansion and marketplace subsidies under current law. The block grant would increase annually by roughly 2 percent, to $158 billion in 2026. That wouldn’t even keep pace with general inflation, which the Congressional Budget Office (CBO) projects to equal 2.4 percent annually over that period, let alone with expected growth in per-beneficiary health care costs and enrollment. Thus, by 2026, block grant funding under the plan would be $83 billion, or 34 percent, below currently projected federal spending on the ACA’s major coverage expansions.
“I think this is a game,” said Senator Rand Paul, one of the few GOP senators openly opposing the bill. “I think this is a game of Republicans taking money from Democratic states. What happens if Democrats take power back?”
3. Cut Medicaid Even Further
Graham-Cassidy destroy Medicaid with a per capita cap on federal funding for Medicaid. While the federal government currently pays a percentage of a state’s Medicaid costs, starting in 2020 it would pay a fixed amount for each Medicaid enrollee, regardless of what it actually costs to cover them.
States would have a number of other options — such as instituting work requirements and receiving part of their traditional Medicaid funding as a block grant — that would likely result in reducing eligibility and benefits for the poorest Americans. According to previous CBO estimates, non-expansion Medicaid funding would see a reduction of $39 billion, or 8 percent, by 2026.
4. Leave Millions Uninsured
The GOP’s plan to ram Graham-Cassidy through the Senate before Sept. 30 will not allow time for the CBO to score the bill. The CBO previously estimated that a straight repeal of the Affordable Care Act would leave 32 million people uninsured and double premiums over the next decade. Graham-Cassidy gives states an even greater ability to cut preexisting-condition protections and tear apart Medicaid. So, presumably, the new projections will be even worse.