There’s a new version of the Graham-Cassidy bill out today and it shows a slight funding boost for Alaska, at least if you believe the numbers put out by its sponsors.
Just as with the numbers put out by progressive third-party groups, there’s some caveats to consider that make the numbers look a little less rosy.
The new analysis of the bill shows Alaska will get 3 percent more funding under Graham-Cassidy than the status quo. The revisions soften the blow to the home states of critical Republican votes like U.S. Sen. Lisa Murkowski and Maine Sen. Susan Collins (Maine would see a 43 percent increase in funding according to the revised projections).
But that’s because it counts cuts as new funding.
The new analysis argues Alaska will see an increase in funding because it will no longer be able to fund its share of Medicaid expansion (which Graham-Cassidy largely aims to gut). The Graham-Cassidy projection calls it “state savings.” That’s about $227 million according to the analysis reported by the Graham-Cassidy proposal’s sponsors. It’s not really additional money, but the sponsors include it in their projection.
Actual new funding for Alaska
That said, the new version of the bill does apparently soften some of the cuts made in the previous version of the bill. Under this, the block grant received by Alaska would be about $100 million smaller than current funding over the next decade. Other projections based on the original version of Graham-Cassidy, including one from the Alaska Department of Health and Social Services, showed Alaska would lose about $1 billion in federal health-care funding over the next decade.
Vox explains the new sweeteners for Alaska, as explained below.
The bill includes blatant funding boosts for some of the holdouts. Alaska is the target of several provisions:
- $500 million for states that have set up an Obamacare waiver program — a provision likely directed at Alaska, which set up a reinsurance program through the law’s waiver program.
- Additional federal Medicaid funding made available to certain high-poverty states, which also appears directed to Alaska.
- One-fourth of an $11 billion contingency fund, available in 2020 and 2021, is reserved for “low-density” states like Alaska.
The official analysis of Graham-Cassidy doesn’t, however, take into account the impact of Medicaid per capita caps and it still has no real answer for what happens when the Graham-Cassidy block grant funding all expires in 2027 (which has been the source of some of the deepest projections of the impacts of Graham-Cassidy).
The impact of that Medicaid per capita cap was explained in the Alaska DHSS analysis of Graham-Cassidy. It notes there are exemptions for low-density states from the per capita cap and Alaska would likely qualify for many of the years between now and 2026, but notes that things could change. The per capita cap exemptions also expire in 2026.
Preliminary CBO score due soon
The Congressional Budget Office plans to have a preliminary analysis of Graham-Cassidy out this afternoon. It will include estimates of its impact on budget deficits as compared to the House-passed American Health Care Act and not a whole lot more.
There’s simply not time for the CBO to produce a more exhaustive review of the Graham-Cassidy proposal before the deadline to pass the bill. Independent reviews have estimated the bill would cause a loss of coverage in Alaska that exceeds 40,000 people.