Cassidy-Graham 2.0 came out last night. There are some major policy changes in it:
- No need for states to submit waivers
- States must submit a plan
- Plan does not define “Affordable” or “Adequate” or “pre-exisiting condition”
- No specification of consequences or recourse if the state plan that was submitted failed to meet its objectives
- States define their own Essential Health Benefits, out of pocket maximums and community rating
- Risk pools can be split
There are a bunch of political provisions. Several are aimed at shoveling money to Alaska, but those are not the important provisions. The policy matters more.
The bill sponsors also released their estimates of state effects. They use magical math.
1) They entirely ignore the cap to non-ACA Medicaid – which grows over time – a cut estimated at $1 trillion from '20-'36 for prior draft
— Jacob Leibenluft (@jleibenluft) September 25, 2017
Who cares about a trillion dollars among friends?
Transitioning Medicaid from a shared responsibility program to a program where the state bears the entire risk of crisis is the most basic element of the entire series of Republican bills. This is what will dive state governors crazy as their budgets can’t handle a counter-cyclical shock or a hurricane or an infectious disease outbreak without a federal backstop.
You know what to do; call the senate, call your governor and call your Rep.