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All the tough decisions are kicked down to state capitals, usually with too little money to achieve the ends the block grant is supposed to realize.

"It's not the repeal of Obamacare that was promised", wrote FreedomWorks' legislative affairs vice president Jason Pye on Saturday. Republicans have just 52 Senate seats, and no Democrats or independents are expected to vote for the bill.

This proposal removes the decisions from Washington and gives states significant latitude over how the dollars are used to best take care of the unique health care needs of the patients in each state.

Senate leadership called on the Congressional Budget Office to rush scoring on legislation - released by Sens. Fifty Senators must commit to voting for Graham's legislation to repeal and replace the Affordable Care Act, and while outside backing can help build momentum, it's no guarantee of Senate success. After that, it will take 60 votes to pass the bill, because the Senate's filibuster rule will go into effect.

Should consideration extend beyond September, reconciliation authority would have to be renewed in a subsequent budget resolution. The Senate failed to come up with 50 Republicans votes for the measure this summer, and no Democrats supported it.

Strengthens the ability for states to waive Obamacare regulations. However we eventually arrive at universal coverage, which we must, it will be far easier to get there by building on the ACA.

It is fairly clear that, like other GOP repeal-and-replace plans, Cassidy-Graham would cut federal payments to Medicaid and drive up the number of uninsured. What happens then? The bottom line, said Jacob Leibenluft, a senior adviser at the center, is that Graham-Cassidy "punts all the problems to governors while giving them insufficient tools and resources to address them".

But look at the complaints from its critics, and you get a sense of why it's a step worth taking.

"Doing nothing is not an option", said Senator Bill Cassidy, who has worked with Senator Lindsey Graham to push the bill.

States would essentially have to create a new health program between now and 2020, when the marketplaces and Medicaid expansion would be disbanded. "The Cassidy-Graham bill would presumably result in even deeper coverage losses than that in the second decade".

Because the plan keeps most of Obamacare's taxes, the conservative group Heritage Action is urging Republicans to block it.

Bernie Sanders (I-Vt.) proposed last week, Republicans have been working on a plan that would make-good on their seven-year pledge to repeal President Barack Obama's signature healthcare law, also known as Obamacare. If they chose, states could abandon the ACA's regulations on insurers to provide certain "essential benefits" and charge the same premiums to people regardless of their health status. So if the bill comes up, it would likely hit the floor in the last week of this month.

"There is tremendous flexibility for states under Cassidy-Graham, but also tremendous responsibility".