2. Graham-Cassidy-Heller-Johnson (GCHJ)
Alex Brandon/AP
Replaces the Affordable Care Act coverage programs – Medicaid expansion, Marketplace subsidies, and the Basic Health Program – with a state grant program that would provide billions less in federal funding to states. The program lasts for seven years at which time all federal funding comes to an end.
Transitions the traditional Medicaid program to a per capita cap structure that would cut hundreds of billions of dollars out of the program.
© 2017 American Hospital Association – Not for Distribution

3. Overview of GCHJ’s Major Provisions
Coverage changes
Medicaid per capita cap
New block grant model
Taxes remain
Most ACA hospital reductions remain
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4. GCHJ: Coverage Changes
Eliminates the individual and employer coverage mandate penalties
Ends Medicaid expansion, the Basic Health Program, and the Health Insurance Marketplace subsidies in 2020 – using a portion of the funds to create a new state grant program
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5. GCHJ: Medicaid Per Capita Cap
Transitions the traditional Medicaid program to a per capita cap financing model in 2020.
Beginning in 2025, the federal funding inflation update would be tied to an update factor that grows at a slower rate than current Medicaid growth.
State Medicaid funding would be drastically cut.
Certain low population density states could temporarily “opt out” of per capita caps.
© 2017 American Hospital Association – Not for Distribution

6. GGHJ: New Block Grant Model
Uses a portion of the money from repealing Medicaid expansion, the Basic Health Program and the Health Insurance Marketplace subsidies to establish a $1.175 trillion grant program for states to create their own health care programs from 2020 to 2026.
States could use the funds to help individuals enroll in coverage or for other health-related purposes.
Allows states to waive essential health benefits and protections to maintain affordable coverage for those with pre-existing conditions.
Has no provision for federal funding or continuation of coverage after 2026.
Past experience with major health care programs suggests that a two-year planning and implementation timeframe will be insufficient and likely contribute to gaps in care.
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7. Market Stabilization Goals Not Met
Fails to fund the CSRs in the short-term (2018 and 2019), while providing a separate $25 billion fund for insurers to help stabilize the insurance markets in 2019 and 2020 (but not 2018).
CBO previously estimated that failure to fund the CSRs in 2018 would increase premium rates by 20 percent and increase the federal deficit by $6 billion that year as a result of the impact on the advance premium tax credits.

8. GCHJ: Most Taxes Remain
Keeps the Medicare tax on high earners
Keeps the “Cadillac” tax
Repeals the Medical Device tax
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9. GCHJ: Hospital Reductions Remain
The bill does NOT restore the hospital market basket reductions, Medicaid DSH cuts or Medicare DSH cuts used to help fund the ACA coverage expansions
Some states may be exempt from a portion of their Medicaid DSH cuts in instances where the state’s allotment for the grant program is determined to be “low”
© 2017 American Hospital Association – Not for Distribution

10. Detailed Summary of GCHJ
September 14, 2017
Republican Senators Unveil New ACA Repeal and Replace Legislation
Sens. Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV) and Ron Johnson (R-WI) Sept. 13 unveiled a health care reform bill that would repeal components of the Affordable Care Act (ACA), make significant changes to how the Medicaid program is financed, and create a new grant program allowing states flexibility to design their own system to provide health care coverage and access to care.
The Senate has until Sept. 30, 2017 to pass the bill with 51 votes under the reconciliation rules. After that point, the legislation would require at least 60 votes in the Senate to move forward. The bill has not yet been scored by the Congressional Budget Office.
Visit
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11. AHA Opposes GCHJ Proposal
AHA opposes the GCHJ proposal
Congress should protect patients, and find ways to maintain coverage for as many Americans as possible
AHA will continue to work with Congress and the Administration on ACA reform
AHA Top Priority: Maintain coverage for 20+ million people who gained coverage under ACA
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12. New Campaign from the Coalition to Protect America’s Health Care
Coalition Activities
New Campaign from the Coalition to Protect America’s Health Care
Mobilizing 1.5 million supporters to send s, tweets and calls to Senators
Digital and radio ads in key states
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13. Other Groups Reject GCHJ
“Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care…We sincerely urge the Senate to take short-term measures to stabilize the health insurance market by continuing to fund cost sharing reduction payments."
- September 19, 2017
“Overall, the Graham/Cassidy/Heller/ Johnson bill would increase health care costs for older Americans with an age tax, decrease coverage, and undermine preexisting condition protections. In addition, this bill would jeopardize the ability of older Americans and people with disabilities to stay in their own homes as they age and threaten coverage for individuals in nursing homes. Should this bill be brought to the Senate floor for a vote, we strongly urge all Senators to vote NO.” September 19, 2017
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14. Reconciliation: Legislative Process for GCHJ
Legislation to be considered under reconciliation
Only requires 51 votes in Senate, can’t be filibustered
Must meet certain criteria
Protections expire Sept. 30
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15. Potential Timetable for Action
MARCH 6
Repeal and replace bill introduced - Complete
MARCH 16
House Budget Committee approves bill - Complete
MAY 4
House passes AHCA
WEEK OF JULY 24
Senate attempts to pass BCRA, Straight repeal fail
SEPT 14
Graham-Cassidy-Heller-Johnson proposal introduced
WEEK OF SEPT 25
Potential target date for Senate vote
SEPT 30
Reconciliation instructions expire
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16. Senate GOP On GCHJ Sen. Susan Collins (R-ME) September 18, 2017
“I have a number of concerns with the Graham-Cassidy proposal, including the fundamental changes to the Medicaid program, the effect on premiums for older Americans, and the fact that the bill could allow insurers to charge higher premiums for people with pre-existing conditions.”
September 18, 2017
Sen. Rand Paul
(R-KY)
“This isn’t a repeal. This is keeping Obamacare and redistributing the proceeds …So, this is not a repeal bill, this is sort of, 'Hey, we’ll take Obamacare, replace it with Obamacare, but we’re going to let the states have a little more power in how we spend it.’”
September 18, 2017
Sen. Lisa Murkowski
(R-AK)
“I’m still looking for the data that walks me through how Alaska actually does …But I don’t have that right now. So those that have asked, ‘Where are you, where are you?’ – t’s not that I’m being evasive, it’s that I’m trying to be diligent.”
September 19, 2017
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17. White House Lends Support
“I hope Republican Senators will vote for Graham-Cassidy and fulfill their promise to Repeal & Replace ObamaCare. Money direct to States!”
- President Donald Trump
September 20, 2017
President Donald Trump
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18. Visit protecthealthcare.org
Make Your Voice Heard
Visit aha.org
Visit protecthealthcare.org
© 2017 American Hospital Association – Not for Distribution