The September 30 deadline for healthcare legislation to pass the Senate using a simple majority is looming. Legislation from Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) seems to be gaining speed and is expected to face a vote in the Senate next week. Known as Graham-Cassidy, the plan would cut federal funding for healthcare and while transitioning money to the states via a block-grant program. The legislation also would reduce Medicaid funding dramatically and remove the ACA’s coverage mandates. Federal funding would be redistributed with a complicated formula that favors states which did not expand Medicaid and those with more residents in or near poverty. The funding would expire in 2027 and face re-authorization by Congress, along with the cost offsetting problems that follow. According to a report by the consulting firm Avalere, the legislation would cut funding by $215 billion through 2026. Over the next two decades it is expected to reduce funding by more than $4 trillion. 

Governors from 10 states signed a letter opposing the legislation and endorsing a bipartisan approach to stabilizing the insurance marketplaces. The signatories include governors from states with Republican senators who are currently undecided on the legislation.  

Graham-Cassidy also may allow states to opt-out of mandates like covering people with pre-existing conditions if they make the case to the federal government they are able to provide “adequate and affordable insurance.” Experts say there is not clear guidance on what the threshold would be, and many believe it will be a judgment call by Health and Human Services Secretary. Graham-Cassidy would also waive the ACA essential health benefits which require coverage for a range of services including mental health and maternity care. 

It’s still unclear is the legislation can secure the necessary 50 votes. Senate Majority Leader Mitch McConnell (R-KY) said, “We’re in the process of discussing all of this. Everybody knows that the opportunity expires at the end of the month.”