12 Ways Cassidy-Graham Affects Obamacare

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Robert Donachie Capitol Hill and Health Care Reporter
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A group of four Republican senators has put forth legislation that enacts major changes to the framework of Obamacare, repealing many of the Affordable Care Act’s provisions while keeping its most popular feature.

Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin released legislation Wednesday to repeal and replace major portions of Obamacare with a system of block grants. Effectively, the legislation changes the funding mechanism for Obamacare and tries to promote state innovation in the implementation of health care.

Here is a layout of the repeals, changes and features of Obamacare that stay the same under the Graham-Cassidy bill:


  1. Obamacare’s Medicaid Expansion program
  2. Subsidies for private insurance companies (cost-sharing reductions) that lower the cost of obtaining health insurance for low-income consumers.
  3. Tax credits that help consumers cover the cost of insurance premiums.
  4. The individual mandate that forces consumers to either purchase health insurance or pay a penalty for forgoing coverage.
  5. The employer mandate that requires businesses of a certain size to offer employees affordable health insurance.


  1. The bill makes some changes to Obamacare taxes. For example, the Graham-Cassidy bill would repeal the 2.3 percent tax on medical devices, which the medical industry has lobbied against for years.
  2. The bill also amends what is considered an “essential health benefit (EHB)” under the current health care system. Graham-Cassidy would provide states with the opportunity to obtain waivers that would allow them to eliminate some EHBs.
  3. Obamacare legally prevented insurance companies from setting a cap on the amount of money they would pay out to cover an enrollee. Under the Graham-Cassidy bill, states that applied for EHB waivers could be granted some wiggle room in setting limits on how much they pay to cover someone. It wouldn’t be fully repealed, but, since EHBs and limits are entwined, it could provide states some flexibility.
  4. Pre-existing conditions could see some changes. If a state obtained an EHB waiver, it could possibly charge different premium rates based on health status.
  5. The bill could also provide insurance companies with the opportunity to charge different premium rates based on age.
  6. Graham-Cassidy would increase the amount of money people can invest in health savings accounts (HSAs). The bill would allow people with HSAs to use their accounts to help cover the cost of premiums.


  1. Graham-Cassidy keeps the most popular provision of Obamacare, that allows consumers under the age of 26 to stay on their parent’s health insurance.

The fate of the bill is still unknown. The three Republican senators that struck down the party’s seven-month push to repeal and replace Obamacare in July are threatening to once again thwart Republicans’ last-ditch effort to upend the American health care system.

Sens. John McCain of Arizona, Lisa Murkowski of Alaska and Susan Collins of Maine are all signaling that they might vote against their party’s latest proposal to repeal Obamacare.

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