In a new Republican effort to repeal the Affordable Care Act, Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana have released a plan that would essentially allow states to come up with their own health care plans using a federal block grant.

The grant money would replace federal dollars currently being spent on Medicaid expansion and on subsidies to help people afford insurance under the health law, also known as Obamacare. All of this funding would expire in 2027.

Like earlier Republican health care overhaul bills, the new bill would also make permanent, structural changes to the Medicaid program for beneficiaries who qualified before the expansion, converting it from an open-ended federal health care program to one that caps federal spending on each beneficiary.

How the bill would alter major parts of Obamacare

Repeal Change Keep Medicaid expansion Taxes created under Obamacare Dependent coverage until 26 Subsidies for out-of-pocket costs Essential health benefits Tax credits for premiums Prohibitions on annual and lifetime limits Individual mandate Pre-existing conditions policy Employer mandate Restrictions on charging more for older Americans Health savings account

Repeal Medicaid expansion Subsidies for out-of-pocket costs Tax credits for premiums Individual mandate Employer mandate Change Taxes created under Obamacare Essential health benefits Prohibitions on annual and lifetime limits Pre-existing conditions policy Restrictions on charging more for older Americans Health savings account Keep Dependent coverage until 26

Repeal

Medicaid expansion

OBAMACARE Changed Medicaid’s eligibility requirements to allow more people to enroll if a state chose to expand the program. The federal government pays at least 90 percent of the costs for newly eligible beneficiaries.

SENATE BILL The Cassidy-Graham bill would repeal Medicaid expansion. And instead it would create a big block of money for health coverage that states could use as they saw fit. The money would be used for residents who are currently eligible for the Medicaid expansion or the Affordable Care Act markets.

Money would be redistributed among states, using a complex formula, and the funding would expire entirely in 2027. Over all, states that expanded Medicaid would receive less money than they would under the Affordable Care Act.

Repeal

Subsidies for out-of-pocket costs

OBAMACARE Provides subsidies to help people with lower incomes pay for out-of-pocket costs like deductibles and co-payments.

SENATE BILL Would repeal the subsidies in 2020. States could use money from their block grants to lower cost-sharing for low-income beneficiaries, but they would not be required to do so.

Repeal

Tax credits for premiums

OBAMACARE Gives tax credits to middle-income Americans to offset the cost of premiums, based on their income and the cost of insurance in their area.

SENATE BILL Would repeal premium tax credits in 2020. But states could use the new block grant money to create their own subsidy programs.

Change

Taxes created under the Affordable Care Act

OBAMACARE Imposed new taxes to help pay for expanding coverage to more people. They include taxes on investment income, wages above $200,000, medical devices, prescription drugs and indoor tanning.

SENATE BILL The measure would repeal the tax on medical devices but leave most other Obamacare taxes in place.

Change

Essential health benefits

OBAMACARE Requires all insurers to offer 10 categories of essential health benefits, like maternity treatment and hospital care.

SENATE BILL States would be allowed to obtain waivers to eliminate the essential health benefits.

Change

Prohibitions on annual

and lifetime limits

OBAMACARE Bars insurers from setting a limit on how much they have to pay to cover someone.

SENATE BILLThe provision would not technically be repealed. But the caps would be less meaningful in states that pursued waivers and did not choose to guarantee coverage for essential health benefits. That’s because the annual and lifetime limits and essential health benefits are interrelated.

Change

Pre-existing conditions

OBAMACARE Requires insurers to cover people regardless of pre-existing medical conditions and bars them from setting prices based on a person’s health history.

SENATE BILL The requirement that insurers must cover people with pre-existing conditions would not be eliminated everywhere, but states would be able to obtain waivers to charge different premiums based on health status. Such waivers would effectively eliminate Obamacare’s protections, since people with prior health problems could be priced out of the market.

Change

Restrictions on charging more for older Americans

OBAMACARE Bans insurers that sell policies directly to individuals from charging their oldest customers more than three times what they charge their youngest ones.

SENATE BILL While it would not eliminate the restriction, the bill would allow states to obtain waivers that let insurers charge different premiums based on age.

Repeal

Individual mandate

OBAMACARE Requires all Americans to buy health insurance or pay a tax penalty, with exceptions for people who have experienced hardships.

SENATE BILL Would eliminate the penalties retroactive to 2016.

Repeal

Employer mandate

OBAMACARE Requires larger companies to provide affordable insurance to their employees, or face financial penalties.

SENATE BILL Eliminates the penalties retroactive to 2016.

Change

Health savings account

OBAMACARE In 2017, allows an individual to put $3,400 and a family to put $6,750 into a tax-free health savings account.

SENATE BILL The bill would increase the amounts people could put into their health savings accounts. It would also allow people to use health savings account money to pay insurance premiums, a change from current law.

Keep

Dependent coverage until 26

OBAMACARE Allows children to stay on their parents’ insurance policies until age 26.