Senate Republicans continue to push forward on a plan to hold a vote sometime next week on legislation to repeal and replace the Affordable Care Act. The bill, which is sponsored by Sens. Lindsey Graham, R-South Carolina, and Bill Cassidy, R-Louisiana, still lacks the 50 votes it needs — although Graham this week expressed confidence that they would get there.
Everything is moving very quickly on the Graham-Cassidy bill — largely out of necessity. Due to Senate rules, any attempt to repeal and replace Obamacare will need 60 votes after the end of this month. That is an impossibility in the current Senate.
It’s a complex bill with lots and lots of moving political and policy parts. So below is our attempt to explain the stakes — and the chances — in four *relatively simple* maps and charts.
Got another chart that you think would help people understand Graham-Cassidy? Send it to cillizza@cnn.com and we’ll add the good ones to this post!
1. The 2018 Senate map
On its face, this map should have meant real opportunity for Republicans — and the Trump White House — on health care. After all, there are 25 Democrats — and independents who caucus with Democrats — up for reelection in 2018. More remarkably, 10 of those 25 represent states where Donald Trump won in 2016; five of them — Missouri, North Dakota, Montana, Indiana and West Virginia — he carried by double digits.
But from the start, Senate Majority Leader Mitch McConnell made clear that he had no plans to court Democrats because he didn’t believe they would ever come on board. We’ll never know now. But if the legislation does fail, the decision to not even make an effort to peel away a Democrat or two could be fateful.
2. States that gain/lose federal money under Graham-Cassidy
Big states are, not surprisingly, affected the most. Texas, which rejected Medicaid expansion under Obamacare, would see an increase of $35 billion in federal dollars headed its way. California and New York, two massive states whose governors accepted the Medicaid expansion, would see dips in funding of $78 billion and $45 billion, respectively.
Those are the extremes. It’s the other 47 states — or at least the 34 that would receive less federal dollars under Graham-Cassidy — that should worry Republican politicians. Among the states that would lose billions in federal funding: Pennsylvania ($6 billion), Ohio ($9 billion), Colorado ($6 billion) and Michigan ($8 billion). The states that carried Trump to victory in the Rust Belt are hit hard.
3. States with the most people with pre-existing conditions
Jimmy Kimmel’s disappointment that pre-existing conditions are not fully covered in the bill could also be shared by many of the Rust Belt voters who voted for Trump. Pennsylvania, Indiana, Ohio and Wisconsin have some of the highest numbers of individuals per capita with pre-existing conditions and who buy insurance on the individual market. There are no guarantees those individuals would be able to buy insurance under Graham-Cassidy.
The South, which has moved heavily toward Republicans at the federal level over the last few decades, would also see decent-sized chunks of its population potentially impacted by the flexibility in the law around pre-existing conditions.
In all, approximately 2.2 million people in the individual market, where Obamacare is purchased, have chronic pre-existing conditions according to health care analysts.
4. Medicaid Spending cuts
Under the Graham-Cassidy plan, the Medicaid extension funds in Obamacare — which were used to incentivize states to expand their health coverage to include people living within 138% of the poverty line — would be sunsetted by 2027. Instead, the states would be given block grants of money to spend on state-based health insurance. What would that mean for the states?
The Medicaid limits will hit poor children and adults the hardest. States will have the option to spend more to supplement those huge funding drops but it is not required that they do so or even clear which states would.
States like Arkansas and Kentucky, home to Republican Sens. Tom Cotton and Rand Paul, will see the steepest cuts. Those states, which expanded Medicaid, will not receive funding to match their expansions.
As a result of these and other provisions, the National Association of Medicaid Directors, a bipartisan group representing all 50 states, just came out against the bill.
