Will the ACA Get Repealed This Week?

Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) are spearheading efforts to repeal and replace substantial parts of the Affordable Care Act (ACA). The bill they’ve introduced is expected to go to vote later this week.  There are many changes that the so-called “Graham-Cassidy” bill would make to the ACA—here are three that stand out the most:

1. Block Grants to States: 
   The bill would end funding for Exchange subsidies and Medicaid expansion as it exists under the ACA today. Instead, states would be provided block grants from the federal government, and states would decide how those funds are used.  Each state could opt out of certain ACA provisions, such as those that apply to pre-existing conditions and essential health benefits. But only if there was first a program in place to provide adequate and affordable coverage to lower income and/or high risk individuals.
2. The End of Mandates: 
   The bill would make penalties under the Individual and Employer Mandates $0 retroactively to 2016. This is not a direct repeal of the mandates, but it essentially has the same effect as a repeal.
3. Enhancements to HSAs:
   Contribution limits for Health Savings Accounts (HSAs) would increase. They would be equal to the maximum out-of-pocket limit for an HSA-eligible health plan ($6,650/single, $13,300/family in 2018). In addition, there would be no more need to obtain a prescription to make over-the-counter drugs an eligible expense. Several other HSA enhancements were also included in the bill.

For a section-by-section summary of the Graham-Cassidy bill, please click here.    

The biggest controversy of the Graham-Cassidy bill is about the block grants to states. Federal funding for healthcare would be fixed and ultimately less than what it would otherwise be under the ACA. 

There is also a worry by Democrats and even some Republicans that this type of system does not provide enough protections for people with pre-existing conditions. 

The main underlying issues and concerns that have been debated in Washington D.C. throughout the year appear to be the same with the Graham-Cassidy bill.

It’s unclear if Senate Republicans will get the 51 votes they need to pass this legislation and move it onto the next phase. Keep in mind that even if they do get the 51 votes, the bill would have to go back to the House of Representatives and it’s unclear if it would pass in that Chamber again.