Five things to know about the new ObamaCare repeal bill

The new ObamaCare repeal bill under consideration in the Senate includes some controversial policies that have divided Republicans in the past.

Some senators haven’t taken a position on the bill from Sens. Lindsey GrahamLindsey Olin GrahamCongress punts fight over Dreamers to March Pence tours Rio Grande between US and Mexico GOP looks for Plan B after failure of immigration measures MORE (R-S.C.) and Bill CassidyWilliam (Bill) Morgan CassidyTo lower prescription drug prices, fix existing drug discount programs Kimmel writer tweets amount NRA has given lawmakers in response to shooting prayers Overnight Regulation: Trump unveils budget | Sharp cuts proposed for EPA, HHS | Trump aims to speed environmental reviews | Officials propose repealing most of methane leak rule MORE (R-La.), saying that they have yet to fully digest the bill and how it would work.

In short: The bill ends federal funds for ObamaCare’s Medicaid expansion and the subsidies that help people afford coverage. Instead, the money would be converted into block grants and given to the states.

Here are five things to know about the legislation.

It could lead to insurer rules being waived in some states.

The legislation includes controversial waivers that would allow states to opt out of certain ObamaCare regulations, pending approval from the government.

For instance, insurers in some states could charge sick people more money and opt out of covering a list of 10 categories of services, such as maternity and mental health care.

In early May, Cassidy said any legislation the Senate passes must meet what he dubbed the "Jimmy Kimmel test” — a reference to an impassioned speech the talk show host gave urging Congress to ensure those with pre-existing conditions had affordable health insurance.  

On Monday, Kimmel suggested the legislation failed Cassidy’s own test.

But Cassidy told reporters Friday that he believes the bill protects those with pre-existing conditions because states would have to show they are providing “affordable and adequate” coverage before a waiver could be granted.

It would change Medicaid funding dramatically.

Like the Senate’s previous repeal bills, Graham-Cassidy would eliminate funding for ObamaCare’s Medicaid expansion. Instead, starting in 2020, states would receive a block grant based on a formula meant to redistribute money from high-spending states to low-spending states.

The block grant would be capped per beneficiary, regardless of how much a state spends. The grant would not adjust based on changes in states’ funding needs, and it could be spent for virtually any health-care purpose.

The bill’s sponsors have said the formula is based on fairness. They say states that took the Medicaid expansion like Massachusetts, California and New York shouldn’t get more federal money than states like Texas or Alabama that rejected the expansion. 

Sen. Rand PaulRandal (Rand) Howard PaulDem wins Kentucky state House seat in district Trump won by 49 points GOP's tax reform bait-and-switch will widen inequality Pentagon budget euphoria could be short-lived MORE (R-Ky.), who said he opposes the plan, said it isn’t about fairness at all.

"This is a game of Republicans sticking it to Democrats," Paul said. “The formula is taken arbitrarily out of space mostly to take money from four Democratic states and redistribute it to Republican states.”

It defunds Planned Parenthood. 

The bill defunds Planned Parenthood for a year, a provision that’s been divisive among Republicans.

This measure is important to many senators, including the caucus’s most conservative members. But Sens. Lisa MurkowskiLisa Ann MurkowskiThe siren of Baton Rouge Interior plan to use drilling funds for new projects met with skepticism The 14 GOP senators who voted against Trump’s immigration framework MORE (R-Alaska) and Susan CollinsSusan Margaret CollinsOvernight Tech: Judge blocks AT&T request for DOJ communications | Facebook VP apologizes for tweets about Mueller probe | Tech wants Treasury to fight EU tax proposal Overnight Regulation: Trump to take steps to ban bump stocks | Trump eases rules on insurance sold outside of ObamaCare | FCC to officially rescind net neutrality Thursday | Obama EPA chief: Reg rollback won't stand FCC to officially rescind net neutrality rules on Thursday MORE (R-Maine) have objected to defunding Planned Parenthood in other bills, particularly GOP leadership’s ObamaCare repeal bill. 

“It makes absolutely no sense to eliminate federal funding for Planned Parenthood,” Collins said in late June.

“There are already longstanding restrictions on the use of federal funds for abortion, so this is not what this debate is about. And Planned Parenthood is an important provider of health-care services, including family planning and cancer screenings for millions of Americans, particularly women,” she told ABC’s George Stephanopoulos on “This Week.”

During the last floor debate on an ObamaCare repeal bill, Murkowski and Collins wanted a vote on an amendment to strip out the Planned Parenthood provision.

But ultimately the Senate never reached that amendment vote as the pair — along with Sen. John McCainJohn Sidney McCainLawmakers worry about rise of fake video technology Democrats put Dreamers and their party in danger by playing hardball Trump set a good defense budget, but here is how to make it better MORE (R-Ariz.) — opposed a scaled-down version of ObamaCare repeal, halting work on the bill.

It does not contain funding to fight the opioid crisis. 

The first version of the Senate GOP leadership’s ObamaCare repeal bill included $2 billion to help address the opioid epidemic.

Sens. Rob PortmanRobert (Rob) Jones PortmanCommittee chairman aims for House vote on opioid bills by Memorial Day Flake to try to force vote on DACA stopgap plan Congress punts fight over Dreamers to March MORE (R-Ohio) and Shelley Moore CapitoShelley Wellons Moore CapitoAt least Alzheimer’s research is bringing Washington together Overnight Tech: Intel chief says 'no doubt' Russia will meddle in midterms | Dems press FCC over net neutrality comments | Bill aims to bridge rural-urban digital divide | FCC to review rules on children's TV Senators offer bill to close rural-urban internet divide MORE (R-W.Va.) pushed for $45 billion more in funding, and leadership acquiesced.

But the new legislation from Cassidy and Graham doesn’t add any new money to fight the epidemic. 

Portman said the money was needed in previous iterations of ObamaCare repeal bill because it ended the Medicaid expansion. He said he wanted to provide a way for those receiving treatment to “land on their feet.”

The new bill is different, Portman said, “because it keeps Medicaid expansion in place if a governor chooses to do so, like my governor or any other governors.”

He added: “As you can imagine, I’m talking to them about the opioid issue because we’re studying, trying to figure out what the impact might be, and I’m hopeful there can be some help with regard to that particular issue.”

It would set up a huge fiscal cliff.

The legislation gives states a temporary block grant to replace ObamaCare’s Medicaid expansion and subsidies. But the block grant expires at the end of 2026, creating a massive funding cliff. 

Cassidy and Graham have said they think the cliff won’t matter, because Congress will reauthorize the program. But the mere presence of an expiration date for the funding is likely to cause anxiety for state governments.

According to an analysis by the Center on Budget and Policy Priorities, the sudden end to the block grants would result in a $299 billion cut to federal health spending across every state.  

Even if there were political support to approve hundreds of billions of dollars in increased government spending in 2026, the cost would likely need to be offset. Finding a way to do so could prove difficult.