American Osteopathic Association

Advancing the distinctive philosophy and practice of osteopathic medicine

Comparison of Graham-Cassidy Bill Proposal to AOA Policy

Here's a comparison of how the proposed Graham-Cassidy Bill for health care reform compares with the provisions of the Affordable Care Act and AOA policy. Read the related news release from Sept. 25, 2017.


Individual Mandate

ACA: The individual mandate requires most Americans to have health coverage or pay a fine.

Graham-Cassidy Proposal: The individual mandate would be eliminated. There would be no replacement on the federal level, but states could make one, or even reinstate the mandate.

Employer Mandate

ACA: The employer mandate requires larger companies to offer affordable coverage to their employees.

Graham-Cassidy Proposal: The employer mandate would be eliminated.

Young Adults

ACA: Young adults could stay on their parents' health insurance plan until they're 26 years old.

Graham-Cassidy Proposal: This provision would be unchanged.

Subsidies

ACA: ACA subsidies are primarily based on income, age and geography, which benefits lower- and moderate-income people buying coverage through ACA marketplaces.

Graham-Cassidy Proposal: ACA subsidies would be eliminated. Instead, states could use money from their block grant to provide subsidies themselves.

AOA Policy:

H314-A/13 Health Care that Works for All Americans: The AOA has a priority goal to encourage the US Congress to pass legislation that addresses issues such as the ability of osteopathic physicians to provide quality, cost-efficient care, including the availability of affordable health insurance for all citizens.

H323-A/12 Regulation of Health Care: New regulations must demonstrate that access to care, or the quality of health care provided, will be improved, and done so at an acceptable cost to the public.

Cost-Sharing Subsidies

ACA: Cost-sharing subsidies were provided to insurers to help some of their ACA customers cover deductibles and co-payments.

Graham-Cassidy Proposal: Cost-sharing subsidies, along with premium subsidies, would end in 2020. But states could choose to use their block grant to fund cost-sharing subsidies.

AOA Policy:

H314-A/13 Health Care that Works for All Americans: The AOA has a priority goal to encourage the US Congress to pass legislation that addresses issues such as the ability of osteopathic physicians to provide quality, cost-efficient care, including the availability of affordable health insurance for all citizens.

H323-A/12 Regulation of Health Care: New regulations must demonstrate that access to care, or the quality of health care provided, will be improved, and done so at an acceptable cost to the public.

Pre-existing Conditions

ACA: Insurance companies are not allowed to increase someone's premiums or deny coverage based on preexisting conditions.

Graham-Cassidy Proposal: The ban is unchanged, but states could allow them to not cover costs associated with some conditions.

Age Rating

ACA: Insurers can charge older customers up to three times as much as they charge younger customers.

Graham-Cassidy Proposal: Insurers would be able to charge older customers up to five times as much as they charge younger customers. However, states could overrule this.

Health Savings Account

ACA: Individuals can contribute up to $3,400 and families up to $6,750 to pretax health savings accounts.

Graham-Cassidy Proposal: People can contribute more to their health savings accounts than under the ACA, among other changes making HSAs more attractive.

Risk Pool

ACA: The ACA did not create high-risk pools, because there were other protections for pre-existing conditions.

Graham-Cassidy Proposal: A temporary fund aimed at reimbursing insurers who take big losses would get $155 billion to use from 2018 to 2020.

Medicaid

ACA: Medicaid is an entitlement program with open-ended, matching federal funds for anyone who qualifies.

Graham-Cassidy Proposal: Medicaid would be funded by giving states a per capita amount beginning in 2020.

AOA Policy: 

H619-A/15 Medicaid Payment: The AOA supports the efforts in each state to uphold their obligation to reimburse physicians and hospitals at a fair and equitable rate for providing quality care to the state’s Medicaid recipients.

Medicaid Expansion

ACA: States can expand Medicaid to cover people making up to 138 percent of the poverty line, and the federal government would cover an outsize portion of their costs.

Graham-Cassidy Proposal: For states that expand Medicaid, the federal government would pay a smaller portion of the cost starting in 2020.

Essential Health Benefits

ACA: Insurers are required to cover certain categories of essential benefits, such as hospital visits and mental-health care.

Graham-Cassidy Proposal: States would be allowed to change what qualifies as an essential health benefit.

AOA Policy:

H633-A/16 Health Insurance Exchanges: The American Osteopathic Association adopts the following “Principles for State Health Insurance Exchanges” to assist states in the formation of health insurance exchanges and will communicate these principles to the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS), governors and state legislatures. 2011; reaffirmed as amended 2016

Planned Parenthood

ACA: Planned Parenthood is eligible for Medicaid reimbursements, but federal money cannot fund abortions.

Graham-Cassidy Proposal: Planned Parenthood would face a one-year Medicaid funding freeze.

Caps on Annual Coverage

ACA: Caps on annual or lifetime coverage are banned for essential health benefits. 

Graham-Cassidy Proposal: The ban would stay in place, but states would narrow what qualifies as an "essential health benefit."

AOA Policy:

H341-A/13 Uninsured – Access to Health Care: The AOA supports efforts to increase access to affordable health care coverage through expanded coverage to the uninsured and reforms to programs such as Medicaid, Medicare, and SCHIP to provide coverage to populations that would otherwise lack access to health care and ultimately, access to needed health care services.

H323-A/12 Regulation of Health Care: New regulations must demonstrate that access to care, or the quality of health care provided, will be improved, and done so at an acceptable cost to the public.