Report: Medicaid-expansion states to lose $180 billion under Cassidy-Graham plan


A new analysis released Thursday morning buttresses a growing body of evidence that the Senate’s Cassidy-Graham health-care bill would slash federal spending on health coverage and cause most states to lose billions of dollars in such aid.

According to the report by the Kaiser Family Foundation, the Republican plan to dismantle much of the Affordable Care would cut federal spending on health insurance by an average of 11 percent between 2020 and 2026 in the 31 states, plus the District of Columbia, that have expanded their Medicaid programs under the law. The states that have not expanded Medicaid – all but one led by Republicans – would gain an average of 12 percent during that period.

As a result, states that kept their Medicaid programs small would receive an extra $73 billion, while the federal money to the Medicaid expansion states would be cut a total of $180 billion.

Overall, the analysis by Kaiser, a respected health-policy organization, predicts a slightly smaller decrease than other assessments of government spending. The pending bill – which is known by the names of its primary sponsors, Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina – would abolish key aspects of the ACA, replacing most of the law’s rules with block grants to states and ending the way Medicaid has worked for more than a half-century.

Using a different method of calculating the legislation’s effects, Kaiser forecasts an overall reduction of $160 billion between 2020, when most of the bill’s changes would begin, and 2026, when it would stop funding the block grants. That compares with $215 billion less in federal spending predicted in an analysis this week by Avalere Health, a consulting firm, and $243 billion in a report by a liberal think tank, the Center on Budget and Policy Priorities.

All three analyses show that, no matter whether Congress renewed spending for the block grants after 2026, federal aid for Medicaid would plummet across the country because the program’s entitlement funding would be replaced with a per-person cap. And over time, annual increases under that new method would tighten.

Such independent assessments are significant as the bill hurtles toward an expected vote next week, so quickly that the Congressional Budget Office is still working on even a rudimentary official forecast.

Some worried states – including those with senators whose support for the Cassidy-Graham plan will be crucial for its passage – are doing their own assessments of the legislation’s impact.

Alaska’s conclusions are expected to be completed on Thursday. That state is significant politically because its governor, Bill Walker, an independent, is one of 10 who signed a letter this week opposing the bill. Alaska Sen. Lisa Murkowski, a Republican, is widely considered a key swing vote on the measure.

In Colorado, an analysis already indicates that it would lose more than $1 billion annually in federal funding by 2025. In 2027, when the block grant money ends, this amount would increase to nearly $3 billion annually. At least 300,000 Coloradans would lose their Medicaid coverage starting in 2021 as a consequence, state officials expect. By 2026, the number would hit 350,000 and then keep climbing.

Kaiser had hoped to produce estimates of the plans’ effects on the number of Americans with insurance coverage, but president Drew Altman said that it proved too difficult to predict what health policies each state would adopt to use its block grant.



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