When Sen. John McCain, R-Ariz., announced his opposition to the Graham-Cassidy bill Friday, it appeared the proposal might be dead before it was ever brought to a vote. However, the bill's authors leaked a revised version of the legislation Sunday night to the media, according to The Washington Post.
Here are the five biggest changes to the Graham-Cassidy 2.0 bill, which were made as Senate Republicans face a Sept. 30 deadline to pass the measure.
1. Though the amount of funding given to states through block grants remains the same, tweaks to different formulas have resulted in Maine, Arizona, Alaska and Kentucky receiving boosts in federal funding from 2020 through 2026. Sen. Susan Collins, R-Maine, Sen. Lisa Murkowski, R-Alaska, and Mr. McCain were the only three Republicans to vote against GOP healthcare reform efforts in July. Sen. Sen. Rand Paul, R-Ky., has previously voiced his opposition to the legislation as initially drafted.
2. Under the new version of Graham-Cassidy, Maine would see a 43 percent increase in federal funding, with Arizona seeing 15 percent, Kentucky 4 percent and Alaska 3 percent. Arizona, Kentucky and Alaska each would have seen declines in funding under the previous version of the bill, according to Politico. The bill combines subsidies for private coverage and Medicaid expansion and redistributes it to states in the form of block grants.
3. Analysis of the bill has been criticized by independent analysts because it does not account for cuts to Medicaid spending and per capita caps instituted by the proposal. Caps on Medicaid effectively slash future Medicaid funding, and if these cuts were considered in the new funding algorithm, pundits say several states, such as Alaska, would still lose funding.
4. According to analysis by the HHS, which supports Graham-Cassidy, the new formulas would lower the funding disparities of past versions of the bill. Under the new version, South Dakota would see the largest funding increase of 88 percent while Oregon would experience the greatest loss at 17 percent. Previous calculations performed by CMS, which took into account Medicaid caps, estimated that Mississippi stood to increase funding 347 percent while Maryland's funding would decrease by 51 percent
5. The revised bill contains a series of carveouts for Alaska, according to a summary of the new legislation obtained by an industry lobbyist and reported by NBC News. The legislations would grandfather Native Alaskans into Medicaid so they would retain coverage after the expanded Medicaid program is rolled back in 2020. The update would also carve out a special provision for states with low population densities so 5 percent of federal funds would be guaranteed for rural states, including Alaska.
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