The latest attempt by Republicans in Congress to repeal and replace the Affordable Care Act, spearheaded by Sens. Lindsay Graham (R-SC) and Bill Cassidy (R-LA), would reduce federal funding to states by $215 billion over ten years, ultimately decreasing funding for all states, according to an analysis released Wednesday.

The bill has the support of President Donald Trump, who has consistently pushed for Republicans to repeal and replace the ACA after repeated failures to do so in recent months.

“I hope Republican Senators will vote for Graham-Cassidy and fulfill their promise to Repeal & Replace ObamaCare. Money direct to States!” Trump tweeted Wednesday morning.

I hope Republican Senators will vote for Graham-Cassidy and fulfill their promise to Repeal & Replace ObamaCare. Money direct to States! — Donald J. Trump (@realDonaldTrump) September 20, 2017

Rand Paul is a friend of mine but he is such a negative force when it comes to fixing healthcare. Graham-Cassidy Bill is GREAT! Ends Ocare! — Donald J. Trump (@realDonaldTrump) September 20, 2017

“Graham-Cassidy Bill is GREAT,” Trump said. “Ends Ocare!”

While the bill would indeed fulfill the GOP’s years-long unfulfilled promise of repealing and replacing Obamacare, the new analysis, conducted by nonpartisan health consulting firm Avalere (a favorite of the National Governors Association), paints a different picture.


The Graham-Cassidy bill, which is also supported by Sens. Dean Heller (R-NV) and Ron Johnson (R-WI), requires that the funding to states be re-appropriated after 2026, but that re-appropriation is far from certain. The “funding cliff” created by the uncertain re-appropriation means that not only does Avalere estimate a loss of $215 billion over 10 years, but also finds that states would lose an estimated $4 trillion over by 2036.

While Graham and Cassidy have often said the bill would benefit smaller, more rural states, Avalere found that every state would ultimately suffer under the law.

By 2036, all states would see a decrease in fed $ relative to current law, ranging from $4B in SD to $800B in CA https://t.co/HrGVucimIw pic.twitter.com/yKVqzSEkiO — Avalere Health (@avalerehealth) September 20, 2017

The report also notes that two states that would be among those hit the hardest include Alaska and Arizona, losing 33 and 34 percent of their funding by 2036, respectively.

Avalere: Alaska and Arizona are among the hardest hit states under #GrahamCassidy. pic.twitter.com/VGrUZQEAaU — Topher Spiro (@TopherSpiro) September 20, 2017

Two of the senators from those states — Sens. John McCain (R-AZ) and Lisa Murkowski (R-AK) — are among a small handful of key swing votes that could determine the fate of the bill. Sen. Rand Paul (R-KY) has consistently said he will vote against the bill and Sen. Susan Collins (R-ME) has suggested she may also vote no, which means Republicans can lose just one more vote.


Graham-Cassidy would also gut Medicaid, ultimately repealing the Medicaid expansion offered under the ACA and shifting to a block grant system.

“The Graham-Cassidy bill would significantly reduce funding to states over the long term, particularly for states that have already expanded Medicaid,” Caroline Pearson, senior vice president at Avalere, said in a statement. “States would have broad flexibility to shape their markets but would have less funding to subsidize coverage for low- and middle-income individuals.”

Avalere’s Wednesday assessment of the bill is particularly valuable because there is very little information available about the bill’s potential impact as lawmakers rush to move it forward.

Senate Republicans are attempting to pass the last-ditch effort to repeal and replace Obamacare through reconciliation. Passing the bill through the reconciliation process would allow the bill to pass with just 51 votes — but reconciliation ends September 30, meaning the Congressional Budget Office will only be able to provide a “preliminary assessment” of the Graham-Cassidy bill before the Senate votes on the bill.

If it has the votes, Senate Majority Leader Mitch McConnell is expected to bring the bill to the floor without data from the CBO about how the bill will affect the deficit, coverage, or premiums.