Reports are that many U.S. Senators will be voting on Graham-Cassidy without knowing what is in the bill. Following is a handy-dandy compendium of what is in the bill and what are some likely outcomes:
1.) A line in the G-C bill says that it "intends to maintain access to adequate and affordable health insurance for individuals with preexisting conditions." Healthcare analysts and industry groups contend that significant leeway is given to DHHS and states to determine the definition of "adequate and affordable." The Center for American Progress, using data that the Centers for Medicine and Medicaid Services (CMS) employs to calculate transfers between insurers based on enrollees' expected costs -- the risk adjustment program -- and applied to a 40-year-old, finds that asthma would draw a premium surcharge of $4,340; $5,600 for diabetes; $17,320 for pregnancy; $26,580 for rheumatoid arthritis; and $142,650 for metastatic cancer.
The waiver provision is similar to the so-called "MacArthur amendment" in the House-passed repeal bill, of which the CBO found that states accounting for 1/6th of the nation's population would choose to let insurers charge higher premiums based on health status; also, states accounting for half the nation's population would choose to let insurers exclude essential health benefits.
The Blue Cross Blue Shield Association has said of G-C: "The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions."
2.) The states would be allowed to let insurers exclude essential health benefits. According to the Kaiser Family Foundation, before the ACA introduced the requirement that all plans cover a defined set of basic services, 75% of individual market plans excluded maternity coverage; 45% excluded substance use treatment, and 38% excluded mental health care.
Allowing insurers to exclude basic service coverage should mean a significant rise in the millions now considered to be under-insured.
3.) States will be allowed to remove the protections that prevented insurance companies from putting lifetime caps on how much they spend on someone.
4.) The cap on federal Medicaid funding will cause states to cut back on traditional Medicaid funding.
5.)Insurers are not compensated for the reductions they must make in deductibles and other cost-sharing for low-income enrollees.
6.) There is no provision for revoking funding to a state if it fails to meet its commitments.
7.) The entire block-grant program depends on private insured participation. Insurers would face 50 different state regulatory and financing systems.
8.) Those states that have not accepted ACA funding and have not set up a system of exchanges, would be hard-pressed to put together a coverage program over the next two years. Medical organizations are saying that passage of G-C would destabilize the insurance markets.
9.) The elimination of the individual mandate removes the incentive for healthy people to purchase insurance, causing insurers to hike premiums and deductibles in order to survive economically.
10.) The fact that federal Medicaid funding goes only through 2026 under the G-C, means that a future Congress could fund Medicaid at a lower level or even end it.
11.) Limiting ourselves to the state of Georgia, the Georgia Budget and Policy Institute estimates that about 400,000 Georgians receive marketplace subsidies. Nearly 1.8 million Georgians, or 29% of the state's population, carry a preexisting condition. The consulting firm Avelere Health says Georgia will lose $48 billion in federal funding from 2020 to 2036 if G-C becomes law.
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