Republican Sens. Lindsey Graham and Bill Cassidy on Monday were set to roll out a last ditch effort repeal and replace the Affordable Care Act in the near-term.
The Graham-Cassidy bill would maintain a significant portion of the structure of previous GOP attempts at a healthcare overhaul in the first half of the year. But it contains some notable differences in an attempt to appeal to more moderate members of the party.
The bill, however, faces an uphill battle and a short window in which it could be passed.
A ruling by the Senate parliamentarian earlier this month said Republicans can’t continue after September 30 to use the process of reconciliation, which allows bills to be passed with a simple majority in the Senate if they decrease the deficit.
That leaves a little under three weeks for Republicans to attempt to push the bill through Congress. President Donald Trump has reportedly urged a vote on the bill before the option for budget reconciliation runs out. But given the minuscule window and competing healthcare-related pushes, there is little hope for the effort on Capitol Hill.
With that in mind, here’s a breakdown of what’s expected in the plan:
- Shift Medicaid funding and insurance subsidies to a block-grant system: Instead of determining the federal government’s share of funding for Obamacare’s Medicaid expansion and individual insurance subsidies through a formula, states would receive large chunks of money up front — and then determine what to do with it. About $1.2 trillion would be allocated for this purpose from 2020 through 2026. Funding would be cut off by 2027.
- Eliminate the individual and employer mandate: People who do not sign up for insurance would not face a tax under the plan, and companies would not be compelled to offer coverage. States could pass their own mandates, however.
- State reinsurance fund: A certain amount will likely be allocated to insurers to offset greater losses from insuring a sicker pool of people.
- Adjust the essential health benefits: States could determine what qualifies as an essential health benefit. Currently, the federal government mandates that all plans sold on the Obamacare exchanges cover 10 basic types of care, including emergency-room visits and prescription drugs.
The legislation still needs to be evaluated by lawmakers and scored by the Congressional Budget Office, complicating the already tight window for potential passage.
Additionally, the Senate Health, Education, Labor, and Pensions (HELP) Committee has already been moving forward with hearings focused on bipartisan healthcare fixes that would be smaller in scope but possibly garner more support.
Sen. John McCain — who cast a deciding vote that killed the previous round of Obamacare repeal efforts — has indicated that he would possibly vote for the package.