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Obamacare - One More Repeal Attempt

After several attempts at repealing Obamacare the Republicans are making one last effort this year.  This will likely be the last effort of the year because they can only use the budget reconciliation bill to pass the legislation until September 30th.  This would allow the bill to pass with a simple majority of 50 votes in the Senate (with Vice President Mike Pence breaking the tie presumably in favor of the Republican proposal).  If the legislation is not passed by this time it could not be part of budget reconciliation and would require 60 votes to avoid a filibuster. 

The latest effort is known as the Graham-Cassidy Amendment, referring to its primary authors Sen. Lindsey Graham and Sen. Bill Cassidy.   The Kaiser Family Foundation offers a comparison of the amendment against the current law and the most recent Senate attempt at repeal, the Better Care Reconciliation Act.

While there is still not uniform Republican support for this act, many believe this legislation has a chance to pass.  The Better Care Reconciliation Act fell just one vote short of passage in the Senate.  That deciding vote was cast by Sen. John McCain.  Sen. McCain is very close friends with Sen. Graham and has also commented that he was on the fence about the bill but might support it if his Governor was in favor of the bill.  McCain’s vote could get this legislation to pass.

The main points of the Graham-Cassidy Amendment:

  • Individual and employer mandates would be repealed
  • Premium and cost-sharing subsidies would be eliminated
  • Medicaid expansion rules would be nullified. Previously only children, pregnant women, elderly or disabled persons and in some cases parents of low-income families qualified for Medicaid, the expansion allowed anyone who makes below 138% of the federal poverty level to qualify. 
  • Medicaid would eventually be transitioned into a block grant program providing a certain amount of money per capita to states and then allow them to establish their own programs.
  • Private market health insurance rules would remain (pre-existing conditions, essential health benefits, medical-loss ratio requirements, etc.) but states would be allowed to apply for waivers to eliminate these rules if they wished to do so in their state.
  • The medical device tax would be repealed but other taxes established in Obamacare remain.
  • Health Savings Account contribution limits would be raised and the accounts will be allowed to pay health insurance premiums, not just cost sharing as they are now.
  • Additional funds would be allocated to community health centers.

These are the major points from the proposed legislation.  There are many other provisions in the details.  As stated, we should know whether this pass no later than September 30th.  We will update membership accordingly. 

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