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 GrahamMSNBC's Joy Reid pans Manchin, Sinema as the 'no progress caucus' Overnight Defense: Biden proposes 3B defense budget | Criticism comes in from left and right | Pentagon moves toward new screening for extremists Biden defense budget criticized by Republicans, progressives alike MORE (R-S.C.) and Bill CassidyBill CassidyCalls grow for national paid family leave amid pandemic Senators urge Energy chief to prioritize cybersecurity amid growing threats Vivek Murthy confirmed as surgeon general 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 PaulCharles Booker launches exploratory committee to consider challenge to Rand Paul Rand Paul calls Fauci a 'petty tyrant' Biden picks vocal Trump critics to lead immigration agencies 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 MurkowskiNixed Interior nominee appointed to different department role  Against mounting odds, Biden seeks GOP support for infrastructure plan GOP Senate campaign arm awards Trump as he rails against McConnell MORE (R-Alaska) and Susan CollinsSusan Margaret CollinsAgainst mounting odds, Biden seeks GOP support for infrastructure plan Trump's early endorsements reveal GOP rift The Hill's Morning Report - Biden assails 'epidemic' of gun violence amid SC, Texas shootings 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 McCainSylvester Stallone reportedly joins Trump's Mar-a-Lago The Hill's 12:30 Report: Biden meets with bipartisan lawmakers for infrastructure negotiations Cindy McCain to be named Biden ambassador to UN program: report 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 PortmanHillicon Valley: Biden nominates former NSA deputy director to serve as cyber czar | Apple to send witness to Senate hearing after all | Biden pressed on semiconductor production amid shortage Bipartisan lawmakers signal support for Biden cybersecurity picks GOP Ohio Senate candidate asked to leave RNC retreat MORE (R-Ohio) and Shelley Moore CapitoShelley Wellons Moore CapitoBiden-GOP infrastructure talks off to rocky start Moderate GOP senators and Biden clash at start of infrastructure debate America's infrastructure: You get what you pay for 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.