The Senate is poised to consider another last-minute health care bill without the benefit of public hearings. Upon analysis, the bill makes significant changes to the Medicaid program, while giving states the option to waive existing federal requirement in the private market.

The Graham-Cassidy-Heller-Johnson proposal, named after the senators that introduced the bill, rolls up the federal dollars being spent on Medicaid expansion, tax credits, cost-sharing subsidies and basic health plans into a block grant, referred to as the Health Care Grant Program. This grant would be administered through the Children’s Health Insurance Program (CHIP).

The proposal makes significant changes to the Medicaid program, which includes:

  • Repealing enhanced match rates for states that expanded their Medicaid programs as of Jan. 1, 2020
  • Converting federal Medicaid spending to a per capita cap as of fiscal year 2020
  • Giving states the option to elected the Medicaid block grant instead of per capita cap for a period of five years beginning in FY 2020, referred to as Medicaid Flexibility Program
  • Creating state option to conduct eligibility redeterminations every six months (or more frequently) for expansion enrollees
  • Eliminating enrollment simplification and marketplace coordination requirements as of Jan. 1, 2020
  • Creating a state option to require work as a condition of Medicaid eligibility
  • Repealing essential health benefit requirements as of Dec. 31, 2019

Among the provisions impacting the private market, states would be allowed to opt-out of the Affordable Care Act’s (ACA) requirement to cover essential health benefits but would prohibit plans from denying people coverage based on pre-existing conditions. However, plans would be able to charge higher premiums based on health status and waive other ACA market rules/consumer protection as part of their block grant program. 
Kaiser Family Foundation offers an interactive tool that compares health reform bills against current law. 

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