Graham-Cassidy: HOW THE GOP’S LAST DITCH REPEAL BILL WOULD HURT WISCONSINITES
Senate Republicans are once again trying to repeal our health care through the same secretive, partisan approach they tried
before. The bill introduced by Senators Graham, Cassidy, Heller and Johnson (Graham-Cassidy) would radically change 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 also convert traditional Medicaid into a per capita cap program permanently.
This bill would slash coverage, raise costs, eliminate protections for millions of people across America and gut Medicaid. In fact,
it is the worst of the repeal bills that we have seen to date.
Analysts Agree: Every State Loses Under Graham-Cassidy Affecting People’s Care. Multiple independent analyses agree
that the Graham-Cassidy repeal bill would cut federal funding to states. Over time, every state loses because Graham-Cassidy
zeroes out its block grants and ratchets down its spending on the Medicaid per capita cap. This means 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, Including $29 Billion Cut To Wisconsinites. 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. Wisconsin would see a $29 billion cut over 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 Cut Coverage
32 Million Would Lose Health Coverage, Including 414,000 Wisconsinites. As a result of zeroing out block grants for
Marketplace tax credits and Medicaid expansion and additional cuts to Medicaid, the Graham-Cassidy bill is essentially
repealing the Affordable Care Act without replacing it, and at least 414,000 Wisconsinites would lose coverage by 2027.
1,190,163 Wisconsinites with Traditional Medicaid Coverage, Including Seniors, People with Disabilities, and Children,
Would Be At Risk. The Graham-Cassidy bill would turn traditional Medicaid into a per capita cap, meaning the 1,190,163
Wisconsinites who are enrolled on Medicaid would have 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 cut funding for
people with disabilities by 15-percent and 31-percent for children by 2036.
490,939 Wisconsinite Children’s Care At Risk. 490,939 Wisconsinite children are currently enrolled in Medicaid and CHIP,
whose care could be at risk because of the funding cuts in Graham-Cassidy.
No Explicit Funding to Combat Substance Use Disorder. The Graham-Cassidy bill would not include the inadequate $45
billion fund in the last Senate bill to try to compensate for cuts in treatment. Even if the Senate bill’s fund for treating opioid use
disorders were increased, it would still be only a fraction of the $21 million cost of comprehensive coverage for all people treated
for opioid use disorders in Wisconsin in 2026.
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 Raise Costs, Reduce Access to Care And Eliminate Protections for Pre-Existing Conditions
Premiums Will Increase 20 Percent in the First Year. According to the Congressional Budget Office, Graham-Cassidy
includes provisions that would raise premiums up to 20 percent in the first year.
179,211 Wisconsinites Who Receive Marketplace Tax Credits Could Pay More. Because the Graham-Cassidy bill eliminates block grant funding in 2027 with no guarantee of any other funding to take its place, that means there would be no funding Marketplace tax credits that help people pay for their premiums, which currently benefits 179,211 Wisconsinites.
Graham-Cassidy Would Raise Costs For People With Pre-Existing Conditions. Graham-Cassidy would allow states to let
insurance companies once again charge people with pre-existing conditions more, which could raise costs for up to 2,435,700
Wisconsinites 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.
555,000 Wisconsinites Could See Lifetime And Annual Limits Again. Allowing states to opt out of the Essential Health
Benefits coverage means 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. Up to 555,000 Wisconsinites with employer-sponsored
coverage would lose these protections.
Graham-Cassidy Could Lead to An Age Tax, Meaning A 60 Year Old Wisconsinites Could Pay Up To $14,927 More. The
Graham-Cassidy bill would allow states to let insurers charge people over 50 high premiums without limits. The 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 Wisconsinites could pay as much as a $14,927 more in higher
premiums and out-of-pocket costs in 2020.
Millions of Women Could Face Higher Costs or Lose Access to Care. Graham-Cassidy would end Medicaid expansion,
which has 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 slashes 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 Pay More For The Same Comprehensive Coverage. According to the Brookings Institution, if a state waived
the Essential Health Benefits, 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
before. The bill introduced by Senators Graham, Cassidy, Heller and Johnson (Graham-Cassidy) would radically change 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 also convert traditional Medicaid into a per capita cap program permanently.
This bill would slash coverage, raise costs, eliminate protections for millions of people across America and gut Medicaid. In fact,
it is the worst of the repeal bills that we have seen to date.
Analysts Agree: Every State Loses Under Graham-Cassidy Affecting People’s Care. Multiple independent analyses agree
that the Graham-Cassidy repeal bill would cut federal funding to states. Over time, every state loses because Graham-Cassidy
zeroes out its block grants and ratchets down its spending on the Medicaid per capita cap. This means 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, Including $29 Billion Cut To Wisconsinites. 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. Wisconsin would see a $29 billion cut over 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 Cut Coverage
32 Million Would Lose Health Coverage, Including 414,000 Wisconsinites. As a result of zeroing out block grants for
Marketplace tax credits and Medicaid expansion and additional cuts to Medicaid, the Graham-Cassidy bill is essentially
repealing the Affordable Care Act without replacing it, and at least 414,000 Wisconsinites would lose coverage by 2027.
1,190,163 Wisconsinites with Traditional Medicaid Coverage, Including Seniors, People with Disabilities, and Children,
Would Be At Risk. The Graham-Cassidy bill would turn traditional Medicaid into a per capita cap, meaning the 1,190,163
Wisconsinites who are enrolled on Medicaid would have 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 cut funding for
people with disabilities by 15-percent and 31-percent for children by 2036.
490,939 Wisconsinite Children’s Care At Risk. 490,939 Wisconsinite children are currently enrolled in Medicaid and CHIP,
whose care could be at risk because of the funding cuts in Graham-Cassidy.
No Explicit Funding to Combat Substance Use Disorder. The Graham-Cassidy bill would not include the inadequate $45
billion fund in the last Senate bill to try to compensate for cuts in treatment. Even if the Senate bill’s fund for treating opioid use
disorders were increased, it would still be only a fraction of the $21 million cost of comprehensive coverage for all people treated
for opioid use disorders in Wisconsin in 2026.
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 Raise Costs, Reduce Access to Care And Eliminate Protections for Pre-Existing Conditions
Premiums Will Increase 20 Percent in the First Year. According to the Congressional Budget Office, Graham-Cassidy
includes provisions that would raise premiums up to 20 percent in the first year.
179,211 Wisconsinites Who Receive Marketplace Tax Credits Could Pay More. Because the Graham-Cassidy bill eliminates block grant funding in 2027 with no guarantee of any other funding to take its place, that means there would be no funding Marketplace tax credits that help people pay for their premiums, which currently benefits 179,211 Wisconsinites.
Graham-Cassidy Would Raise Costs For People With Pre-Existing Conditions. Graham-Cassidy would allow states to let
insurance companies once again charge people with pre-existing conditions more, which could raise costs for up to 2,435,700
Wisconsinites 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.
555,000 Wisconsinites Could See Lifetime And Annual Limits Again. Allowing states to opt out of the Essential Health
Benefits coverage means 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. Up to 555,000 Wisconsinites with employer-sponsored
coverage would lose these protections.
Graham-Cassidy Could Lead to An Age Tax, Meaning A 60 Year Old Wisconsinites Could Pay Up To $14,927 More. The
Graham-Cassidy bill would allow states to let insurers charge people over 50 high premiums without limits. The 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 Wisconsinites could pay as much as a $14,927 more in higher
premiums and out-of-pocket costs in 2020.
Millions of Women Could Face Higher Costs or Lose Access to Care. Graham-Cassidy would end Medicaid expansion,
which has 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 slashes 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 Pay More For The Same Comprehensive Coverage. According to the Brookings Institution, if a state waived
the Essential Health Benefits, 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
How ACA Repeal and Possible Replacement Plans Will Impact Health Care in the U.S. and Wisconsin
A great interactive graphic from the Kaiser Family Foundation that allows you to compare the Affordable Care Act to proposed replacement plans.
A handy chart from the Center on Budget and Policy Priorities regarding how the proposed ACA replacement plans fail to provide the same access to care and same quality of care.
A Wisconsin-specific fact sheet from the Wisconsin Council on Children and Families on the harmful consequences of ACA repeal in Wisconsin.
A great interactive graphic from the Kaiser Family Foundation that allows you to compare the Affordable Care Act to proposed replacement plans.
A handy chart from the Center on Budget and Policy Priorities regarding how the proposed ACA replacement plans fail to provide the same access to care and same quality of care.
A Wisconsin-specific fact sheet from the Wisconsin Council on Children and Families on the harmful consequences of ACA repeal in Wisconsin.
Impact on Affordability
The Affordable Care Act (ACA) contains many provisions that have helped make health care coverage more affordable and accessible to millions of Americans. For more information about how the ACA had made health care more affordable and how the proposed ACA replacements would fall short on affordability, see the resources below.
According to this analysis from the Kaiser Family Foundation, proposed ACS replacement plans would reduce the average health insurance premium tax credit received by consumers in 2020 by at least 36 percent as compared to the ACA. This would particularly disadvantage “people who are lower income, older, or live in high premium areas.”
Center on Budget and Policy Priorities report on how proposed replacement plans do not provide the same access to affordable, comprehensive care as compared to the ACA.
Center on Budget and Policy Priorities report on the limited effectiveness Health Savings Accounts would have in providing access to care for low- and moderate-income Americans.
Kaiser Family Foundation issue brief comparing the tax credits available to people to help them afford health insurance under the ACA versus the tax credits that would be available under the replacement plans currently under consideration.
According to this analysis from the Kaiser Family Foundation, proposed ACS replacement plans would reduce the average health insurance premium tax credit received by consumers in 2020 by at least 36 percent as compared to the ACA. This would particularly disadvantage “people who are lower income, older, or live in high premium areas.”
Center on Budget and Policy Priorities report on how proposed replacement plans do not provide the same access to affordable, comprehensive care as compared to the ACA.
Center on Budget and Policy Priorities report on the limited effectiveness Health Savings Accounts would have in providing access to care for low- and moderate-income Americans.
Kaiser Family Foundation issue brief comparing the tax credits available to people to help them afford health insurance under the ACA versus the tax credits that would be available under the replacement plans currently under consideration.
Impact on Quality of Care
The Affordable Care Act (ACA) contains many consumer protections that help ensure that millions of American have access to higher quality and more comprehensive health care than they would have had access to before the passage of the ACA. For more information about how the ACA has improved the quality of health care to which Americans have access, please see the resources below.
Kaiser Health News Article about 10 Essential Health Benefits private insurance plans must provide under the ACA.
Kaiser Health News Article about 10 Essential Health Benefits private insurance plans must provide under the ACA.
Impact on the Economy
The Affordable Care Act has an enormous economic impact on the state of Wisconsin, from federal tax subsidies that allow Wisconsinites to afford insurance coverage to improved work productivity due to more people being able to access preventive services to significant reductions in uncompensated care provided by hospitals. To better understand what is as stake for Wisconsin's economic health should the ACA be repealed, please take a moment to read the resources below.
A Citizen Action of Wisconsin Report about the adverse economic impact on Wisconsin of repealing the ACA without a viable replacement.
A Citizen Action of Wisconsin Report about the adverse economic impact on Wisconsin of repealing the ACA without a viable replacement.
