What you need to know about the GOP’s Graham-Cassidy health care bill

Republican’s long-fraught effort to repeal the ACA has regained momentum in the Senate just as a critical deadline looms for the GOP. The new health care bill, sponsored by Sen. Lindsey Graham and Sen. Bill Cassidy, would bring sweeping changes to the current system. Lisa Desjardins and Sarah Kliff of Vox join John Yang to explain the policy and politics behind the bill.

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    A few weeks ago, Republicans' long-fraught efforts to repeal and replace the Affordable Care Act looked all but dead on Capitol Hill. But just in the past few days, a new proposal is gaining sudden momentum in the Senate, as a critical deadline looms for the GOP.

    This afternoon, President Trump told reporters that he believes the bill has a very good chance of passing the Senate.

    John Yang has more.


    Judy, the new health care bill is sponsored by four Republican senators, Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada, and Ron Johnson of Wisconsin.

    It would bring sweeping changes to the current health care system, including ending the individual mandate that everyone have insurance or pay a penalty, eliminating the Medicaid expansion in states, and instead give states lump sums so they can spend as they choose, eliminating federal tax credits to help offset health care costs, and removing protections so that insurers cannot charge more for preexisting conditions.

    Majority Leader Mitch McConnell said he intends to have a vote in the Senate next week, before the chamber loses its chance to pass a health care bill with just 50 votes, instead of 60 to overcome a filibuster.

    One of the bill's original sponsors, Lindsey Graham, defended the push:


    You can have different opinions about the quality of this bill. At the end of the day, this is the only process left available to stop a march towards socialism.

    We have between now and the end of the month to have a vote and a debate about whether this is better than the status quo. My friends on the other side are never going to agree to a bipartisan proposal that does anything other than prop up Obamacare.


    Today, former President Barack Obama, at a Bill and Melinda Gates Foundation — in New York City ripped into the bill.


    When I see people trying to undo that hard-won progress for the 50th or 60th time, it is aggravating.

    And all of this being done without any demonstrable economic or actuarial or plain commonsense rationale, it — it frustrates.


    Here to help us understand the policy and the politics behind all of it, Sarah Kliff, who covers health policy for Vox, and our own Lisa Desjardins, who covers Capitol Hill.

    Lisa, a lot of changes not only to the current system, but also to the previous bills, repeal bills. One is how the federal money is going to be distributed.

    What are those changes?


    This is a massive change in health care spending. It would shift money to the states.

    Let's look at it specifically. So, right now, under the Affordable Care Act, the federal government pays tax credits for premiums. These are for lower- and middle-income people. Also pays cost-sharing subsidies to help with deductibles. And, in addition to that, there's the Medicaid expansion.

    That's a lot of money. The Graham-Cassidy bill would shift all of that money and all of those things and shift it all to states, $1.4 trillion worth. Now, Republicans say that gives states many more options. But without the limits, there is also no guidance, there's no plan right now for what to do with that money.


    Sarah, this morning, you wrote that of the four repeal bills that Congress has considered so far, that this is the most radical of them all.

    Explain that in terms of the protections, the benefits and coverage that this bill would afford.


    Yes, I think part of it has to do with what Lisa was saying, that there is really no requirement that this money go to health insurance.

    It could be sent to hospitals. It could be put into high-risk pools. There's very few guardrails around how this money gets spent. And one of the other things you see going on is a return of preexisting conditions.

    Health insurance plans could once again charge people higher premiums because they have a cancer diagnosis or something like asthma if a state applies for a waiver to let its insurance companies do that.

    So it really goes beyond the other Republican repeal plans. Those ones, I kind of saw as poorly funded versions of Obamacare. The tax credits go down, Medicaid expansion gets less money, but the framework is there.

    Like Lisa was saying, this gets rid of the framework entirely. It makes this lump of money. It distributes it in a very, very different way. It really disadvantages any state that has embraced Obamacare. It would be very, very disruptive if it were to become law.


    And, Lisa, what are the timelines for this? When would these changes take effect? When would the programs end, the current programs end?


    That is another big difference.

    The Medicaid expansion in other bills was phased out in different ways. But in this bill, it would have a hard end in 2020. And there also would be some changes that would affect — be in effect immediately in 2018. And it's not clear how insurers would deal with those right away.


    Now let's turn to the politics of all of this.

    This is now being opposed by a slew of patient groups, of provider groups, the American Medical Association, the American Heart Association, the AARP, some hospital groups, late-night talk show Jimmy Kimmel, who became a voice on all of this debate in May when he talked about his son, who was born with a congenital heart defect.

    Last night, he joined the criticism.

    JIMMY KIMMEL, Host, "Jimmy Kimmel Live!": If the bill passes, individual states can let insurance companies charge you more if you have a preexisting condition.

    You will find that little loophole later in the document, after it says they can't. They can, and they will.

    But will it lower premiums? Well, in fact, for lots of people, the bill will result in higher premiums. And as far as no lifetime caps go, the states can decide on that, too, which means there will be lifetime caps in many states.

    So, not only did Bill Cassidy fail the Jimmy Kimmel test. He failed the Bill Cassidy test. He failed his own test.


    Lisa, you have got governors coming out against this. You have got all these groups.

    What are the chances of this passing?


    We should point out, there are also some governors who came out in favor of it, Republican governors.

    I think the chances are still long, because it comes down to four key Republicans. We already know that the Senate Republicans can only lose two of their members on this vote. Rand Paul is already a no. Then you get the three Republicans who voted no the last time, Susan Collins, Lisa Murkowski, and John McCain.

    They need two of those three. And that's going to be hard to do. John McCain said just today to reporters that he still wants regular order, he doesn't want this to be rushed through.

    But they have got this September 30 deadline, and McConnell seems to want to meet it.


    And, Sarah, why are some people so enthusiastic about this?


    I think Obamacare repeal has been such a goal for Republicans.

    If you talk to senators on Capitol Hill, as my colleagues at Vox have been doing, a lot of them will say, this is our last chance. We have promised this in elections. We have said we need to deliver.

    Pat Roberts of Kansas told one of my colleagues, this is the last car leaving, and we want to get in it.

    So, it seems very much it is less about the actual policy. It's more about this being last plan left standing and the last option to move forward with 50 votes this year.


    And the leaders have made this the last option in a certain way. There was an attempt at bipartisan — to fix the problems with Obamacare. But what's happened to that?


    That's right.

    Democrat Patty Murray has been working with Lamar Alexander of Tennessee, Republican, to try and craft a bipartisan compromise. Different versions on that. The Republicans say they just couldn't get there. The Democrats say they came a long way.

    It's hard to say, but I think one other answer to what Republicans like about this, they do want more options for state. They want more power to states. And some specific states win in this deal, red states.

    The states that lost the most are states like California and New York. States that gain the most seem to be states like Kansas, Alabama, Mississippi. Those are Republican red states and it's a significant shift in resources.


    And, Sarah, what would this do for insurers? If states — every state could write is own rules, what do insurance companies think about this?


    They are very nervous.

    They have generally come out against this bill. If you remember, when healthcare.gov launched in 2013, it was a big mess. It didn't work. And that was with four years to build one system for the entire country.

    Graham-Cassidy asks all 50 states to build their own health insurance system, some new framework in just two years. So I think insurance companies, they have just gotten used to the Affordable Care Act. The marketplaces, they're finding their legs there. They are not enthusiastic about the idea of having 50 new systems that they would have to learn to navigate in just two years from now.


    Sarah Kliff, Lisa Desjardins, we have an interesting week-and-a-half ahead. So, thank you very much.



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