Graham/Cassidy Version of Healthcare – Set To Be Voted On Next Week In Senate

IS it good enough as a healthcare replacement bill?

A Closer Look

September 21, 2017

On July 13, 2017, Senators Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) released a proposal to modify the Affordable Care Act (ACA), also known as Obamacare.

The plan was also introduced as an amendment to the Better Care Reconciliation Act during the Republican effort to repeal the ACA in July 2017. The proposal is a reconciliation bill, which would only impact the budgetary and fiscal provisions of the ACA.

The bill does not contain a provision to repeal the law in its entirety.

Instead, the bill would keep in place most of the ACA’s taxes and fees and send that money to the states for them to make changes to health insurance and healthcare at the state level.
On September 20, 2017, a spokeswoman for Senate Majority Leader Mitch McConnell (R-Ky.) said, “It is the Leader’s intention to consider Graham/Cassidy on the floor next week.”

HIGHLIGHTS of HR 1628 (to provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017) :

The proposal would repeal the federal premium tax credits and the cost-sharing reductions provided to individuals under the ACA. States could create their own system of tax credits and subsidies if they chose.
The federal rrequirements for individuals to obtain health insurance and for employers to offer it would be effectively eliminated by reducing the penalty to $0. States could establish their own requirements, if they chose.
The plan would appropriate $1.18 trillion between 2020 and 2026 for a healthcare grant program for states that could be used to establish programs or policies to help cover high-risk individuals, stabilize premiums, and reduce out-of-pocket costs.

Healthcare grants

In place of federal tax credits, cost-sharing reductions, and the Medicaid expansion, the proposal would fund a grant program for states to design their own systems for health insurance and healthcare.

The funds could be used to establish programs or policies to help cover high-risk individuals, stabilize premiums, and reduce out-of-pocket costs. The proposal would appropriate $1.18 trillion between 2020 and 2026 for the grant program. Funding would be allocated using a formula based on the amount of ACA-related federal funding provided to a state for the Medicaid expansion, tax credits, and cost-sharing reductions and the number of low-income individuals in a state. A more detailed outline of the formula can be found here.

In applying for the grants, states could request waivers from the following ACA provisions:

  1. The provision that restricts the extent to which insurers may vary premiums based on age or other factors, except restrictions on variations based on sex or other protected classes of individuals
  2. The provision the prohibits health insurers from varying premiums based on preexisting conditions
  3. The provision that requires insurers to cover a standard set of health benefits
  4. The provision that requires insurers to provide rebates to consumers if they do not spend a minimum percentage of premium revenue on medical services

Insurance market rules and funding

Many of the ACA’s iinsurance market rules would remain in effect.

  • Insurers would still be prohibited from denying coverage for pre-existing conditions.
  • Insurers would also still be required to allow dependents to remain on their parents’ insurance coverage until age 26.
  • Under the proposal, any individual could purchase a catastrophic health plan; under the ACA, this was restricted to individuals under 30 or those who meet a hardship exemption.

The proposal would establish a fund of $25 billion to pay out to insurers to mitigate disruptions to health insurance coverage and address urgent health care needs. The funds would be paid out in 2019 and 2020. The bill would not fund cost-sharing reduction reimbursements and would end the program in 2020.


The Affordable Care Act allowed states to expand eligibility for their Medicaid programs to childless adults earning incomes below 138 percent of the poverty level. The Graham-Cassidy plan would end this Medicaid expansion and all federal funding for it on January 1, 2020.

Beginning in 2020, the bill would also convert Medicaid financing from an open-ended entitlement to a per-capita (i.e. per-member) amount. This amount would be adjusted based on the number of individuals in four distinct groups:

  1. elderly individuals
  2. blind and disabled individuals
  3. children
  4. other adults

The law would set a target spending amount for states based on spending during a past two-year period that the state chose. Until 2025, the amount allotted to a state would increase each year by the medical component of the consumer price index (CPI) for urban consumers; for elderly individuals and blind individuals, it would increase by medical CPI plus 1 percentage point. After 2025, the amount would increase by the CPI each year. Beginning in 2020, states that spent more than the targeted amount on their Medicaid programs in any given year would receive a reduced amount of funding the following year.

States could also apply to receive their Medicaid funding in a block grant. The block grant would be capped based on the target per-member amount for the state multiplied by the number of enrollees and the percentage increase in the state’s population over the previous two years. The block grant amount would be increased in subsequent years by the CPI for urban consumers.

Under the proposal, state would be required to reevaluate the eligibility of Medicaid enrollees every six months. States would also be allowed to include a work requirement for non-disabled, non-elderly, non-pregnant adults enrolled in Medicaid. Under current law, states must obtain federal approval to include a work requirement.

Health savings accounts

The proposal would allow individuals with high-deductible health plans to use health savings accounts (HSAs) to pay premiums in excess of amounts that are already credited or deducted through the federal tax code.

The plan would also increase the limit on annual HSA contributions to the combined amount of the deductible and the limit on out-of-pocket spending. In 2017, high-deductible health plans had to have deductibles of at least $1,300 for an individual or $2,600 for a family. Out-of-pocket costs were limited to $6,550 for individuals and $13,100 for families. This means that under the plan, using 2017 figures, an individual could contribute $7,850 to a HSA each year and a family could contribute $15,700. By comparison, for 2016, these limits were capped at $3,350 for individuals and $6,750 for families.

Planned Parenthood

The bill would suspend federal funding to community health centers that provide family planning, reproductive health, and related medical services and that also provide abortions for reasons other than rape or incest or to save the life of the mother. This would include the nonprofit organization Planned Parenthood. The funding would be suspended for one year.

(not sure where this is in the bill.  Here is the exact wording:

Effective as if included in the enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (Public Law 114–10, 129 Stat. 87), paragraph (1) of section 221(a) of such Act is amended by inserting “, and an additional $422,000,000 for fiscal year 2017” after “2017”.)


The ACA tax on over-the-counter medications and 2.3 percent excise tax on medical devices would be repealed. The 40 percent excise tax on high cost employer-sponsored health coverage (known as the Cadillac tax) would not be repealed.

In addition, the tax penalty for withdrawals from health savings accounts for nonmedical expenses would be reduced from 20 percent to 10 percent.

Source  (ALL emphasis mine)


NPR – “Graham-Cassidy Health Bill Would Shift Funds From States That Expanded Medicaid”

CNBC – “These states would get hit hardest by latest GOP health care bill”

Real Clear Politics – “Sen. Rand Paul Responds To Trump On Cassidy-Graham Health Care Bill: “I Promised Repeal”

The Atlantic – “Doctors: No. Physicians rarely agree on anything as strongly as they do that the Graham-Cassidy health-care bill is harmful.”

Forbes – “Insurance Industry Comes Out Against Graham-Cassidy Trumpcare Bill”

US News – “Bipartisan Governors Oppose Graham-Cassidy”


I definitely would expect some kick back crying from Democrat states and big insurance lobbyists BUT I have my own objections.

First, there are already expanded Medicaid enrollments that would be adversely affected by the whims of this congress.

Second, why in the world remove community health center programs after 2017? Is there a better method separately that will help them. (No I don’t mean Planned Parenthood, they do NOT deserve a dime.)

Third, and most importantly, this is NOT what the American citizens voted for.  We want a complete REPEAL and a REPLACE with more succinct, clearly defined information that will stand up to public scrutiny, not just congressional malarkey. TRANSPARENCY not subterfuge.

As usual congress has decided to weasel out. Apparently they have NOT learned their lesson. REPEAL then REPLACE is what the public has demanded.

We all know from experience that a major fubar mistake needs to be restarted FROM THE BEGINNING. It is all well and good to want to be lazy and not repeat the exact wording or steps. However, that is NOT anything but time-consuming, wasteful spending, and inevitably leads to misunderstanding and compounds errors.

I again point to the fact that IF A BILL IS WORTH SUBMITTING then it is worth submitting in TOTAL not in “replace X with Y or dumm-te-dumm”. If one is correcting “syntax errors” then fine do the “replace” bit but otherwise say repeal Law NML and replace it with Law ARGK.

How frigging hard can it be to say:

  • Repeal ACA
  • Open state borders to insurance competitiveness
  • State decides its insurance needs and its methods so long as the basic parts are in sync with the coverage of : elderly, permanently disabled, indigent, workers under $.. income, and allows for proportional coverage based upon health savings accounts for which those in the above categories are covered through Medicaid grants to the states in addition to Health block grants.
  • States received $.. dollars based upon total CITIZENs from their census. (No illegal, refugee, or other would be involved but must fall under a different minimal coverage insurance system.) They would be responsible for making sure state payroll taxes were expanded and health savings accounts were maintained. If they didn’t then reduce ANY grants or federal aid to their state as a fine or reduce their block grant by whatever means necessary to achieve a better result.

Good heavens these people would make the very act of death itself into a major production that even the Grim Reaper would be rolling non-existent eyes at with their attempts to cover up, protect lobbyist interests, pander to, and kiss arse.


About Uriel

Retired educator and constitutionalist
Tagged , . Bookmark the permalink.

13 Responses to Graham/Cassidy Version of Healthcare – Set To Be Voted On Next Week In Senate

  1. I don’t understand why we need a “healthcare bill” in the first place. we didn’t have one in the 60’s or 70’s. Why the need for one now?
    Last I knew, pay as you play worked fine. This is just socialized medicine to benefit the insurance and pharmaceutical companies, only.

    • Uriel says:

      That it is. The only ones that should be covered in a healthcare bill are the four I mentioned. Everyone else would benefit better from health insurance savings accounts and deciding their OWN insurance carriers and what they want covered.

  2. Shar says:

    Hade…agree. Repeal and leave us alone. We can buy what we need ourself. Have an open market over state lines. How about tort reform? How about lowering the cost of drugs? Cassidy started with a bill co written with Collins. Probably couldn’t get past Planned Parenthood with Collins so he moved on to Graham.

    NY and CA will take the money and go to single payer. I don’t see how they can prevent that, unless I missed something.

    • Uriel says:

      Thanks for the added information Shar. I agree with both of you. Competition from excellent insurance companies would stop higher costs.

  3. GunnyG says:

    And who backstabs us AGAIN?

    Juan McShamnesty

  4. whitetop says:

    Show me where in the Constitution does it give the federal government authority over our healthcare? You will find it in the same place with government control over education. So write a one sentence bill that repeals Ocare in its entirety and then get to work on a budget.

    Meathead McCain is throwing his weight around again to stop it. I wouldn’t expect McConnell to let himself be embarrassed by letting a vote get defeated. Might be a reflection on his leadership.

    • Uriel says:

      My question too whitetop. The constitution saves all but minimal government to the STATES. But socialist Dems don’t want that.

  5. SafeSpace says:

    Thank you Uriel for the info here. This so-called plan still leaves the Feds in control of collecting and distributing billions of dollars. Why not just empower the states to do this themselves? Under the new “plan”, if California continues to give away medical care to every turd that floats ashore, their system will run enormous deficits Under the new “plan” I can see the feds taking OUR money to bail out the SJWs in California. This is not why I voted for Trump. Furthermore, if most physicians are opposed to this “plan”, so am I. Who knows better what works, and doesn’t work than the people on the front lines?

    • Uriel says:

      That’s why I included that post. I’m with you SafeSpace if they are against it then I am worried as well. Cassidy is from my state. I sure as heck didn’t vote for him. Graham is a weeble. He wobbles with every vibration.

  6. vonMesser says:

    Damn it. I do not much care. ACA should be 100% repealed. Otherwise, just about ANYTHING that reduces it should be accepted. If wee can’t gut the whole thing, then nibble away one paragraph at a time.

    • Uriel says:

      Laws were not meant to be set in stone. Repealing a law should be acceptable. When it is tangled in politics doubly so. The point is to define and guide. ACA should never have passed for that reason if no other. Addressing a need for a country should be okay but ACA was designed and deliberately worded to prevent reasonable understanding and gut our economy. It was a shyster’s slight-of-hand.