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PolitiFact Florida: How would Florida fare in Graham-Cassidy health care bill?

 
Sen. Bill Cassidy, R-La.
Sen. Bill Cassidy, R-La.
Published Sept. 25, 2017

Following a sharp rebuke by late-night talk show host Jimmy Kimmel, Sen. Bill Cassidy, R-La., hit the airwaves to defend his bill that would undo much of the Affordable Care Act.

The bill, which Cassidy proposed with Sen. Lindsey Graham, R-S.C., was approaching Senate floor consideration when Kimmel took aim at the bill's impact on some Americans' ability to secure health insurance.

Cassidy on CNN's New Day defended the bill, saying certain states, including Florida, would have a lot to gain.

"States like Maine, Virginia, Florida, Missouri, there will be billions more dollars to provide health insurance coverage for those in those states who have been passed by Obamacare," Cassidy said.

According to the best available analysis, Cassidy is not fully accurate about the funding increase.

The bill would establish a new "block grant" program for states, taking the place of funding currently provided under the Affordable Care Act. The current funding under the ACA is primarily in the form of subsidies for people who purchase plans on the ACA's online marketplace, as well as an expansion of access to Medicaid.

Because the bill would enshrine complex formulas to determine the size of each state's block grant, individual states would see differently sized block grants.

Generally speaking, the formula is more generous to states that chose not to expand Medicaid under the Affordable Care Act (most of which are Republican-leaning). By contrast, the states that did expand Medicaid (many of them Democratic-leaning) would tend to do less well under Graham-Cassidy, based on various analyses. And if nothing is done to extend funding beyond 2026, all states would feel the pinch.

We would ordinarily turn to the independent Congressional Budget Office to assess Cassidy's statement, but the CBO has said that, given the Republican leadership's rush to get the Graham-Cassidy bill to the floor, it will be unable to do a full analysis of the bill before the planned vote. (Senate Republicans' ability to pass the measure with just 51 votes expires at the end of September, which is widely considered the reason for the rush.)

However, on Wednesday, an outside consulting group, Avalere Health, released an analysis it had conducted of the bill's potential impact on the 50 states.

Overall, the report concluded that the Graham-Cassidy bill "would significantly reduce funding to states over the long term, particularly for states that have already expanded Medicaid," wrote Caroline Pearson, Avalere's senior vice president. It did find that in 16 states, funding would increase, at least as long as the block grants were funded.

The four states Cassidy mentioned don't fare that well in Avalere's analysis, even though all four decided against accepting the Medicaid expansion, which should have been an indicator of a relatively benign funding outcome under the law. (In Florida's case, signups on the law's online marketplace have been widespread even as efforts to accept the Medicaid expansion have foundered.)

According to Avalere, Florida and Maine would both suffer declines in the billions of dollars during all three periods studied. For Florida, the decline during the block-granting period of 2020 to 2026 alone would be $4 billion, and billions more through 2036, by Avalere's projection. (A day after Cassidy made his comments, the Kaiser Family Foundation also found that Florida would lose funds — more than $7 billion through 2026.)

Virginia and Missouri, for their part, would either gain or hold steady through 2027, but would then see roughly 20 percent declines through 2036, according to Avalere.

If these projections are to be believed, then the four states Cassidy cited would not necessarily see "billions more dollars to provide health insurance coverage" under the Graham-Cassidy bill over the long term. And Florida and Maine in particular would see only decreases.

Now for Cassidy's statement that Obamacare "passed by" these states. Some viewers will take this comment as simply explaining the reality that Obamacare isn't reaching enough people in those places. Others will note this reality has more to do with GOP opposition in the states than with the law itself.

The Affordable Care Act did in fact provide insurance marketplaces to residents of all 50 states through its federal website — almost 2.5 million people in Cassidy's four states alone.

In addition, the Affordable Care Act as passed would have expanded Medicaid in every state. When the Supreme Court ruled that states could opt out of the expansion, many states, most of them with a Republican governor or legislature, decided to opt out of the expansion. The four states Cassidy cited were among those to reject an expansion.

So, if Cassidy is trying to say that Obamacare is at fault for having "passed by" these states, he has it backward.

"Those states were not passed by" by the law itself, said Linda Blumberg, a health policy specialist at the Urban Institute.

On the whole, we rate Cassidy's statement Mostly False.