GOP revises health care measure to widen appeal

WASHINGTON — The revised Republican health care bill that senators plan to unveil Monday would partly even out wide gaps between states that would win and lose financially, providing more generous funding to states of some reluctant GOP lawmakers, but would give states less freedom to unwind health insurance rules.

The new version of the Cassidy-Graham legislation eliminates what had been one of the measure’s most controversial features, which would have enabled states to get federal permission to let insurers charge higher prices to customers with preexisting medical conditions. In addition, states now would not be able to allow health plans to impose annual or lifetime limits on coverage, as the original bill would have done.

While still giving states block grants for their programs and much more freedom to create their own rules than under the Affordable Care Act, this second draft of the plan would be less punitive financially than the first one for states that have most significantly expanded their residents’ access to insurance under the 2010 law.

The plan update emerged late Sunday after its chief sponsors, GOP Sens. Bill Cassidy, La., and Lindsey Graham, S.C., worked through the weekend on changes designed to both bolster support on the right and win over a handful of centrists who have been balking.

The latest version would steer more money to states with key senators in a few ways.

One provision would direct $500 million in funding to states like Alaska that have been granted waivers under the ACA’s Section 1332. That section aims to give states more flexibility in implementing the law, in order to set up a reinsurance program to help lower premiums on a state’s individual insurance market. With this provision included, Alaska will get to keep the federal funds it has been slated to receive.

Another part of the revised bill would give one-fourth of a $6 billion contingency fund to states with the lowest-density population — Alaska among them.

Separately, the law provides $750 million for states that expanded Medicaid after Dec. 31, 2015. That language means additional financial assistance for Montana and Cassidy’s home state of Louisiana.

Another addition to the plan, perhaps intended to appeal to another skeptical Republican, Maine Sen. Susan Collins, would require states to demonstrate that their health care rules meet several federal standards, including parity for mental health care, reconstructive surgery after mastectomies and minimal hospital states for newborns, among others.

To even out the checkerboards of winners and losers among states, the bill’s new version substantially revises the formula that would determine the allotment of money through block grants starting in 2020. Among other changes, the revision would spread the change over a decade, rather than the original halfdozen years.