Articles on GOP Medicaid Spending 3/3/17

Published Mar. 8, 2017

Articles on GOP Medicaid Spending 3/3/17

House GOP Medicaid Provisions Would Cut Federal Medicaid Spending by $560 Billion Over Next Decade

March 3, 2017 at 5:15 PM

The House Republican health plan would shift an estimated $560 billion in Medicaid costs to states over the next ten years, effectively ending the Affordable Care Act’s (ACA) Medicaid expansion and harming tens of millions of additional seniors, people with disabilities who rely on Medicaid today — based on new details that the Wall Street Journal reported today as well as the leaked bill draft from last week. 
The legislation, which the House Energy and Commerce Committee is expected to consider next week, would:
End the Medicaid expansion.  Starting in 2020, states would receive only the regular federal Medicaid matching rate — on average, 57 percent of Medicaid costs, with state covering the other 43 percent — for any new enrollees under the expansion instead of the ACA’s matching rate of 90 percent.  This means that expansion states would have to pay 2.8 to 5 times more in terms of their own costs.
While states could continue to get the expansion matching rate for beneficiaries who were enrolled before the end of 2019 and stayed enrolled without a break in coverage, the large majority of beneficiaries now on Medicaid under the expansion would likely fall off the program after two years, with further continued declines after that.  That’s because the income of low-income people tends to fluctuate, so they’re no longer eligible because their income is too high.
Thus, the overwhelming share of Medicaid expansion spending would eventually be subject to the regular matching rate.  To maintain the expansion as it’s now operating in the expansion states, we estimate that these states would have to increase their share of costs by about $280 billion over ten years. (This figure includes the added effect of applying a per capita cap — as described below — to the Medicaid expansion.)
In seven states, expansion coverage would automatically end because those states have passed laws that require their expansion to end if the federal Medicaid matching rate falls or require the state to take steps to prevent their state’s Medicaid costs from rising.  As a practical matter, most or all of the other 25 expansion states (including the District of Columbia) also would have to end their expansions, or close them to new enrollees (if the House Republican legislation allows it).  As a result, the 11 million adults in 32 states who gained coverage through the expansion would lose it and become uninsured.
Convert the Medicaid program to a per capita cap.  The proposal would cap federal funding on a per-beneficiary basis for virtually the entire Medicaid program (including the Medicaid expansion) starting in 2019.  The caps would be based on states’ historical per-beneficiary spending in fiscal year 2016, increased annually by the chained Consumer Price Index plus 1 percentage point.  (The chained CPI is about 0.25 percentage points lower than general inflation, even though Medicaid costs rise faster than general inflation.)
Because Medicaid costs per beneficiary are now expected to rise by about 0.9 percentage points faster than states’ capped amounts each year, this means that states will get less federal funding than under current law, with the cuts growing larger each year.  Based on our preliminary estimate, that would cut federal spending for the Medicaid program by an additional $280 billion over the next decade (on top of the $280 billion in cuts to the Medicaid expansion as described above).
Moreover, because states would be responsible for 100 percent of all costs in excess of the per capita cap, state costs could be even higher due to unanticipated health care cost growth or to demographic changes like population aging that a per capita cap wouldn’t account for.  For example, states would be responsible for all costs due to an epidemic or a new treatment as well as higher costs as seniors on Medicaid move from young-old age to old-old age and have much greater medical and long-term care needs and costs.
In response, states would have to contribute much more of their own funding or, far likelier, make deep cuts to eligibility, benefits, and provider payments, with those cuts growing more severe each year.  Along with those who’ve gained coverage under the Medicaid expansion who would lose it, the remaining 63 million children and families, seniors, and people with disabilities who rely on Medicaid today would face the significant risk of ending up uninsured or losing access to needed care in coming years.


New GOP bill to replace Obamacare is leaked

By Harris Meyer  | March 3, 2017

In the latest leaked draft of their healthcare plan, House Republicans propose to cut off premium tax credits for wealthier Americans. But they haven't decided on the details.

A leaked draft, dated Feb. 10, 2017, emerged last week. It would offer refundable premium tax credits starting in 2020 based on age, unlike the Affordable Care Act's income-based credits. People under 30 would receive $2,000, while people over 60 would get $4,000. Both lower-income and higher-income people would get the same amount.

The slightly revised draft, obtained by Politico and dated Feb. 24, 2017, would set some type of higher-end cutoff of the tax credits. It still would phase out the ACA's Medicaid expansion to low-income adults. And it would convert Medicaid from an open-ended entitlement to a program of capped federal payments to the states.

Healthcare providers are deeply worried about this proposed Medicaid restructuring and how it would affect their ability to care for low-income and disabled patients.

Both versions of the bill would repeal all the ACA taxes that finance the law's premium subsidies, Medicaid expansion and Medicare benefit enhancements. In their place, the bill would establish a new tax on employees for the value of generous employer health benefits. It would hit plans at and above the 90th percentile of current premiums. That idea is deeply unpopular with business groups and labor unions.

The slight changes in the new draft are unlikely to significantly lessen criticism from both Republicans and Democrats. The most conservative congressional Republicans oppose any type of refundable tax credit that exceeds what people have paid in income tax, which they denounce as a new entitlement. Still, the higher-end cutoff may ease their concerns about tax subsidies going to very wealthy people who don't need them.

House Speaker Paul Ryan wants House committees to mark up and pass an ACA repeal bill as early as next week. He wants Congress to pass it through the expedited budget reconciliation process on a straight party-line vote before the Easter recess in early April.

But Democrats, healthcare industry groups, and the general public have not yet gotten a chance to see the latest House GOP bill. Critics note that Republicans repeatedly have promised to pass an ACA repeal-and-replace bill through an open and inclusive process offering everyone plenty of time for input, unlike what Republicans claim was the backroom process by which Democrats passed the ACA.

It took the Democrats dozens of committee hearings and nearly 14 months to pass the law, which included many Republican amendments.

On Thursday, House Republicans refused to allow Republican Sen. Rand Paul or House Democrats to see their latest bill.

According to Politico, the latest House GOp bill draft eliminates a provision that would have allowed “grandmothered” health plans to remain in the insurance market indefinitely.

That contrasts with the Trump administration's move last week to allow insurers and consumers to extend for an additional year individual and small-group health plans that do not comply with the Affordable Care Act's coverage rules.

It's estimated that fewer than one million people currently remain in grandmothered individual-market plans in the three dozen or so states that still allow them. The rest of the states, including California and New York, already halted the sale of non-ACA compliant plans to strengthen their ACA-regulated markets.

The Obama administration's original decision to allow grandmothering of plans was blamed by many for some of the individual market's problems. That decision was driven by widespread criticism of President Barack Obama for failing to live up to his famous promise that if people liked their health plan they could keep it. Under his administration's last extension, grandmothered plans would have ended Dec. 31, 2017.