Health Care

TrumpCare By Another Name: “Graham-Cassidy”


Trump and the Senate Republicans have been put on a tight deadline if they have any hope of passing TrumpCare. They are making one last push on TrumpCare—a bill known as “Graham-Cassidy”—and it should be taken seriously to make sure we defeat TrumpCare for good. Here’s what you need to know.

Republicans only have until Sept. 30 to get this done

Back in early September, that seemed like a tough deadline to meet, given Congress’s packed September agenda. The packed agenda worked in our favor—with so many deadlines to meet, Republicans would have had a hard time pivoting back to health care or moving on to the Trump tax scam. The Senate had also committed to a bipartisan process with hearings—based on your work—and this process is expected to produce a bipartisan bill to improve and stabilize the ACA marketplaces. It did not seem like there was room for TrumpCare.

Republicans are as close as they've ever been to passing TrumpCare. Despite the tight timeline, Senate Republicans are not willing to give up on a 7-year goal—and they’re very close to succeeding. It would have still been difficult for Republicans to get this through, if not for the bad deal that Chuck Schumer and Nancy cut with Donald Trump. The deal took the most contentious must-pass September bills off the table, clearing the calendar for Republicans to push forward on TrumpCare.

Senator John McCain, who opposed TrumpCare in July, said that he would support the Graham-Cassidy bill, under certain conditions. If all other Republicans hold, that would give Mitch McConnell the 50 votes plus Vice President Pence’s tiebreaker that he needs to jam TrumpCare through the Senate.

What we know about Graham-Cassidy

Graham-Cassidy is strikingly similar to earlier TrumpCare bills. For starters, it destroys Medicaid as we know it by fundamentally and permanently transforming the funding for the program into a capped system.

Graham-Cassidy contains deep cuts to Medicaid. Remember, limiting how much federal money states have to spend on Medicaid limits coverage, access, and states’ options when more people need coverage. For example, if we had a per-capita cap system now and Hurricane Harvey hit, Texas might be out of federal Medicaid money for the year. And they’d be out of luck if more people need Medicaid because of the hurricane damages.

Graham-Cassidy eliminates protections for people with pre-existing conditions. The bill undermines protections for people with pre-existing conditions and people who need treatment for opioid abuse by allowing states to waive essential health benefits. Why? Because states would have incredibly broad discretion in how they use the vague waivers in the proposal. Another example: insurers could decide to raise anyone’s premiums any time.

Graham-Cassidy provides a giant tax break for those who don’t need it. This bill also includes a special new tax break for the well-off, allowing Health Savings Accounts to be used for health insurance premiums. This may also incentivize employers to just put tax-free money into these HSAs and stop offering their staff health insurance all-together.

Graham-Cassidy attacks women’s health. To top it all off, Graham-Cassidy enacts a total prohibition on any covered insurance plans from offering abortion coverage.

How does Graham-Cassidy cut funding?

  1. Block Grants and Cuts the Federal Money Given to States 

    The proposal would take all of the money going out the door to help people afford and access insurance and bundle it into one “block grant” given to states. This “block grant” includes money for the Medicaid expansion and marketplace subsidies while also deeply cutting the total amount of money. Then, it only allows the block grants to grow at 2%, a far slower growth rate than medical costs grow.And amazingly, all the funding ends in 2027. Starting that year, states would receive exactly zero dollars in their already slim block grants.. Either 29 million more Americans would suddenly be thrown off health insurance or Congress would need to give the states new money. And, as we’ve seen, Congress does not deal with deadlines well.

     

  2. Redistributes this block grant to favor red states that did not expand access and coverage for their residents by punishing states that did:

    This provision is about politics, not policy. Senator Cassidy himself said: “Let a blue state do a blue thing and a red state such as mine take a different, conservative approach.” This is not what would happen under his bill. Graham-Cassidy literally takes money from states that expanded Medicaid and gives it to states that did not. There are other factors in the Graham-Cassidy formula that then tilt the limited funds toward red states (such as distributing some of the block grant based on population density) in order to try to appease states like West Virginia whose Senators are key swing votes. 

    Make sure your Senators know you are paying attention and that TrumpCare 3.0 is not acceptable. Tell them you oppose Graham-Cassidy and that you want them to commit to following “regular order” and working through the committee process as some Senators have started to do. And find out how much your state will lose in federal funding here.

SAMPLE CALL SCRIPT

Caller: Hello! My name is [ ] and I’m calling from [part of state]. Can you tell me how Senator [ ] will vote on the Graham-Cassidy health care bill if it comes up for a vote?

Staffer: The Senator hasn’t reviewed the text of the bill yet and hasn’t taken a position on it. There is no vote scheduled on that bill though.

Caller: I want Senator [ ] to oppose Graham-Cassidy. The bill is just like other TrumpCare bills in that it destroys Medicaid as we know it by turning Medicaid into a capped system. This hurts children with disabilities, seniors, and even victims of natural disasters like Harvey and Irma. It also takes away funding to help people afford health insurance through the marketplace, and it hurts states that have expanded Medicaid.

Staffer: Obamacare is a failure. The Senator believes we must stabilize the market and lower premiums.

Caller: If that’s what the Senator wants to do, then supporting the bipartisan, transparent process that Senators Alexander and Murray are leading through regular order would be a better option than supporting the Graham-Cassidy bill. I expect Senator [ ] to respect regular order and reject the Graham-Cassidy bill if it comes to a vote.

Staffer: I’ll let the Senator know your thoughts.

Caller: Yes, please do. I will be watching this vote closely and I expect Senator [ ] to oppose. Please take down my contact information so you can let me know what Senator [ ] decides to do.