The bill introduced by Senators Graham, Cassidy, Heller and Johnson (Graham-Cassidy) would have radically changed our health care system – ending the Affordable Care Act tax credits and Medicaid expansion and changing them into block grants with dramatically less funding for states. It would have also converted traditional Medicaid into a per capita cap program permanently. This bill aimed to slash coverage, raise costs, eliminate protections for millions of people across America and gut Medicaid. In fact, it was the worst of the repeal bills that we have seen to date. 

Graham-Cassidy Was Worse for States Than Other GOP Repeal Bills 

Analysts Agree: Every State Loses Under Graham-Cassidy Affecting People’s Care. Multiple independent analyses agreed that the Graham-Cassidy repeal bill would have cut federal funding to states. Over time, every state would lose because Graham-Cassidy proposed to zero out its block grants and ratchet down its spending on the Medicaid per capita cap. This meant people would not have access to the financial assistance to help lower their health care bills, and federal Medicaid funding would no longer adjust for public health emergencies, prescription drug or other cost spikes, or other unexpected increases in need. 

Avalere: $4 Trillion Cut To States Over Next Two Decades. Independent analysts at Avalere estimated that states collectively would lose $215 billion from 2020 to 2026 from the plans block grants and Medicaid cap, another $283 billion in 2027 when the block grant funding disappears altogether and $4 trillion over the next two decades

Fitch Ratings: Graham-Cassidy “More Disruptive.” Fitch Rating Agency found that the Graham-Cassidy bill was “more disruptive for most states than prior Republican efforts.”

Graham-Cassidy Would Have Cut Coverage 

32 Million Would Lose Health Coverage. As a result of zeroing out block grants for Marketplace tax credits and Medicaid expansion and additional cuts to Medicaid, the Graham-Cassidy bill essentially repealed the Affordable Care Act without replacing it

Millions Enrolled Through Medicaid Expansion Would Be Put At Risk. The Graham-Cassidy bill would have eliminated Medicaid expansion, which has helped more than 15 million Americans receive quality, affordable coverage, and put part of its funding into inadequate block grants. The bill would have further punished states that expanded Medicaid by redistributing funds to states that did not expand Medicaid. 

More Than 70 Million Americans with Medicaid Coverage, Including Seniors, People with Disabilities, and Children, Would Be Put At Risk. The Graham-Cassidy bill would have turned traditional Medicaid into a per capita cap, meaning millions who are enrolled in Medicaid would have had their care jeopardized. Medicaid disproportionately helps children, seniors in nursing home care and people with disabilities. A study by Avalere found that Graham-Cassidy would have cut funding for people with disabilities by 15-percent and 31-percent for children by 2036. 

More Than 35 Million Children’s Care Would Be Put At Risk. Millions of children are enrolled in Medicaid and CHIP, whose care could be at risk because of the funding cuts in Graham-Cassidy. 

Veterans Across The Country Could Lose Coverage. The Rand Corp released a study showing Republican repeal efforts would increase the number of uninsured veterans. The report found that the ACA’s Medicaid expansion was responsible for reducing the uninsured rate of veterans by about one-third, from 9.1% to 5.8%, in 2015.

Graham-Cassidy Would Have Raised Costs, Reduced Access to Care And Eliminated Protections for Pre-Existing Conditions 

Premiums Would Have Increased 20 Percent in the First Year. According to the Congressional Budget Office, Graham-Cassidy included provisions that would have raised premiums up to 20 percent in the first year. 

Nine Million People In The Marketplaces Would Have Paid More For Coverage. Because the Graham-Cassidy bill would have eliminated block grant funding in 2027 with no guarantee of any other funding to take its place, that meant there would be no funding for Marketplace tax credits that help people pay for their premiums. 

Graham-Cassidy Would Have Raised Costs For People With Pre-Existing Conditions. Graham-Cassidy would have allowed states to let insurance companies once again charge people with pre-existing conditions more, which could have raised costs for more than 130 millions Americans that have a pre-existing condition. For example, an individual with asthma would face a premium surcharge of $4,340. The surcharge for pregnancy would be $17,320, while it would be $142,650 more for patients with metastatic cancer. 

109 Million Privately Insured Americans Could Have Seen Lifetime And Annual Limits Again. Allowing states to opt out of the Essential Health Benefits coverage meant that insurance companies could once again put lifetime and annual limits on the amount of care you receive, even impacting people with coverage from their employer. 

People Over The Age of 50 Would Have Faced An “Age Tax.” The Graham-Cassidy bill would have allowed states to let insurers charge people over 50 high premiums without limits. AARP said, “The Graham/Cassidy/Heller/Johnson bill would result in an age tax for older Americans who would see their health care costs increase under this bill.” AARP estimates that 60-year-old Americans could have paid as much as $16,174 more in higher premiums and out-of-pocket costs in 2020. 

Millions of Women Could Have Faced Higher Costs or Even Lost Access to Care. Graham-Cassidy would have ended Medicaid expansion, which allowed 3.9 million women to gain access to care. It would end provisions that helped lower premiums and out-of pocket costs for 9 million women. Graham-Cassidy would have slashed Medicaid, on which one in five women of reproductive age rely. The bill would defund Planned Parenthood and would allow states to let insurers forgo maternity coverage. 

People Could Have Paid More For The Same Comprehensive Coverage. According to the Brookings Institution, if a state waived the Essential Health Benefits (EHB), no one “would have access to comprehensive coverage. Insurers would likely sell separate policies for benefits not covered in their core plan offerings, but these supplemental policies would be subject to tremendous adverse selection, leading to very high premiums and enrollment almost exclusively by those with pre-existing conditions.” A woman who purchases a separate insurance rider for maternity care, for example, would have to pay $17,320 more. For states that no longer required substance use disorders or mental health to be covered, coverage for drug dependence treatment could cost an extra $20,450

Key Health Care Stakeholders Oppose Graham-Cassidy 

PHYSICIANS AND NURSES: American Medical Association; American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Osteopathic Association, American Psychiatric Association; American College Of Physicians; American Nurses Association

CONSUMER GROUPS: AARP; Consumers Union 

PATIENT GROUPS: ALS Association, American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Lung Association, Arthritis Foundation, Cystic Fibrosis Foundation, Family Voices, JDRF, Lutheran Services in America, March of Dimes, National Health Council, National Multiple Sclerosis Society, National Organization for Rare Diseases, Volunteers of America, WomenHeart; More Than 35 Cancer Organizations; 469 Mental Health And Substance Use Disorder Groups; The Arc 

HOSPITALS: American Hospital Association; Children’s Hospital Association; Federation of American Hospitals; America’s Essential Hospitals; Catholic Health Association; Kansas Hospital Association; Greater New York Hospital Association; Kaiser Permanente

INSURERS: America’s Health Insurance Plans; Blue Cross Blue Shield Association; Association Of Community Affiliated Plans