https://apnews.com/a533c012173f4d879bee565f6fe1eec2/Study:-Most-states-would-take-a-hit-from-GOP-health-bill

Most states would take a stiff budgetary hit if the latest Senate GOP health care bill becomes law, according to an analysis released Wednesday. That would likely result in more uninsured Americans.

The study by the consulting firm Avalere Health found that the Graham-Cassidy bill would lead to an overall $215 billion cut to states in federal funding for health insurance, through 2026. Reductions would grow over time.

“A reduction in federal subsidies for health insurance is likely to result in more people being uninsured,” said Caroline Pearson, a senior vice president at Avalere, which specializes in health industry research. The study itself did not make estimates of the impact on insurance coverage.

States that voted for President Donald Trump would not be immune from cuts, though deep-blue California and New York face the deepest reductions. West Virginia, a Trump bastion, would see a $1 billion cut from 2020-2026.

The Avalere analysis comes as Senate leaders are rushing a vote on the legislation by the end of the month, before the expiration of special budget rules that allow passage by a simple majority. The findings could take on added importance, because the nonpartisan Congressional Budget Office says it can’t complete a full analysis of the bill by the Sep. 30 vote deadline.

Named for Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, the bill would repeal much of the Obama-era Affordable Care Act and limit future federal funding for Medicaid. That federal-state health insurance program covers more than 70 million low-income people, ranging from newborns to elderly nursing home residents. Compared to current projected levels, Medicaid spending would be reduced by more than $1 trillion, or 12 percent, from 2020-2036, the study found.

The bill would also end Obama’s health insurance subsidies and put money into a big pot that would distributed among the states. Governors and legislatures would have broad leeway on how to spend the money, and could also seek waivers from ACA insurance requirements. Though insurers would still have to cover people with medical problems, in some states they may be able to charge them more.

The Avalere study also found that over 20 years cuts could potentially total more than $4 trillion, but that scenario appears unlikely. It’s based on a literal reading of the bill, under which legal authority for the big pot of money to subsidize coverage would expire after 2026. Typically, Congress renews expiring programs.

Still, the study found more losers than winners. Thirty-four states would see cuts by 2026, while 16 would see increases. Among the losers are several states that were key for President Donald Trump, including Florida, Pennsylvania, Michigan, and Ohio.

Arizona and Alaska would be losers, a detail that could be important. Sens. John McCain, R-Ariz., and Lisa Murkowski, R-Alaska, are seen as undecided on the legislation, and Republican leaders cannot afford many defections.

New Jersey Republican Gov. Chris Christie said Wednesday he is opposed to the Graham-Cassidy bill because of cuts to his state, estimated by Avalere at $10 billion from 2020-2026.

Texas would be the biggest winner, with a $35-billion funding increase by 2026. Georgia, Alabama, Tennessee and Virginia would also see funding gains, as would Wisconsin and Wyoming.

Within states, the analysis found that there could be winners and losers among people at different income levels. Because the GOP bill focuses on providing money to cover poor people and the near-poor, states may decide to reduce support for middle-class people who now receive subsidies under Obama’s law.

Funding for the Avalere report was provided by the Center for American Progress, a liberal think tank. Avalere said it maintained full control over the research and the think tank did not influence the findings.

GOP leaders and the White House are pushing for a vote next week.

http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta

New analysis from Avalere finds that the Graham-Cassidy-Heller-Johnson (GCHJ) bill to repeal and replace the Affordable Care Act (ACA) would lead to a reduction in federal funding to states by $215B through 2026 and more than $4T over a 20-year period.

The proposed legislation would repeal the ACA’s Medicaid expansion, premium tax credits, cost sharing reduction (CSR) payments, individual and employer mandates, and the Basic Health Program (BHP). Instead, the bill would provide states with block grants to fund health insurance coverage in their state. The bill would also change the financing structure for the traditional Medicaid population from an open-ended approach to a fixed per capita cap or block grant approach.

“The Graham-Cassidy bill would significantly reduce funding to states over the long term, particularly for states that have already expanded Medicaid,” said Caroline Pearson, senior vice president at Avalere. “States would have broad flexibility to shape their markets but would have less funding to subsidize coverage for low- and middle-income individuals.”

Avalere’s analysis projects the impact of the bill compared to current law and details the expected cumulative changes in federal funding for each state through 2026, 2027, and 2036.

Who Loses the Most? The Obamacare replacement bill now being considered in the Senate — and scheduled for a vote next week — would reduce federal funding to states for health care by $215 billion through 2026, and those cuts would shoot up to more than $4 trillion through 2036, according to a new analysis by consulting firm Avalere Health. What it means for states: The analysis found that the Graham-Cassidy bill’s approach to Medicaid financing, which would award block grants to states and implement a per capita cap, would reallocate federal money, creating near-term winners and losers. Thirty-four states and the District of Columbia would see funding reductions by 2026, with states that expanded Medicaid under Obamacare being hardest hit. Seven states would lose more than $10 billion each, with California losing $78 billion and New York funding dropping by $45 billion. The block grant funding in the bill expires in 2026, and Congress would have to re-appropriate money for the block grants to continue. “The ability of the Congress to appropriate additional funding is uncertain and could be constrained by the need to offset the cost,” the report says. Without that renewed funding, by 2036 all states would have their funding reduced compared with the current law.

Other winners and losers: “The bill creates a financial incentive for states to direct coverage to very low-income residents near or below the poverty line, potentially at the expense of lower-middle-income individuals who currently receive exchange subsidies,” Avalere’s Chris Sloan said. Separately, analysts at The Commonwealth Fund and the liberal Center for American Progress found that 32 million fewer people would have health coverage after 2026. Why it matters: The Avalere estimate may be the best available given that the non-partisan Congressional Budget Office said it would only be able to provide a partial assessment of the bill’s effects by early next week and would require at least several weeks to evaluate the legislation’s potential effects on the deficit, health insurance coverage levels and premiums. The figures are sure to ramp up criticism of the bill, which would repeal Obamacare’s subsidies for health coverage in the individual market and its expansion of Medicaid benefits for low-income Americans, among other things. Health care groups, a number of governors and even talk show host Jimmy Kimmel have come out against the bill as Senate Republicans have worked to round up the 50 votes required to pass it.

https://www.cbpp.org/research/health/like-other-aca-repeal-bills-cassidy-graham-plan-would-add-millions-to-uninsured

In releasing a revised version of their legislation to repeal and replace the Affordable Care Act (ACA), Senators Bill Cassidy and Lindsey Graham, along with co-sponsors Dean Heller and Ron Johnson, claimed that their bill isn’t a “partisan” approach and doesn’t include “draconian cuts.” In reality, however, the Cassidy-Graham bill would have the same harmful consequences as those prior bills. IT WOULD CAUSE MANY MILLIONS OF PEOPLE TO LOSE COVERAGE, RADICALLY RESTRUCTURE AND DEEPLY CUT MEDICAID, AND INCREASE OUT-OF-POCKET COSTS FOR INDIVIDUAL MARKET CONSUMERS. It would cause many millions of people to lose coverage, radically restructure and deeply cut Medicaid, eliminate or weaken protections for people with pre-existing conditions, and increase out-of-pocket costs for individual market consumers.

Cassidy-Graham would:

• Eliminate the ACA’s marketplace subsidies and enhanced matching rate for the Medicaid expansion and replace them with an inadequate block grant. Block grant funding would be well below current law federal funding for coverage, would not adjust based on need, would disappear altogether after 2026, and could be spent on virtually any health care purpose, with no requirement to offer low- and moderate-income people coverage or financial assistance.
• Convert Medicaid’s current federal-state financial partnership to a per capita cap, which would cap and cut federal Medicaid per-beneficiary funding for seniors, people with disabilities, and families with children.
• Eliminate or weaken protections for people with pre-existing conditions by allowing states to waive the ACA’s prohibition against charging higher premiums based on health status and the requirement that insurers cover essential health benefits including mental health, substance abuse treatment, and maternity care.
• Destabilize the individual insurance market in the short run — by eliminating the ACA’s federal subsidies to purchase individual market coverage and eliminating the ACA’s individual mandate to have insurance or pay a penalty —and risk collapse of the individual market in the long run.
• Eventually result in larger coverage losses than under proposals to repeal ACA’s major coverage provisions without replacement.  The Congressional Budget Office (CBO) has previously estimated that repeal-without-replace would cause 32 million people to lose coverage.  The Cassidy-Graham bill would likely lead to greater numbers of uninsured after 2026, however, because it would not only entirely eliminate its block grant funding — effectively repealing the ACA’s major coverage expansions — but also make increasingly severe federal funding cuts to the rest of the Medicaid program (outside of the expansion) under its per capita cap.

By attempting to push this bill forward now, Senators Cassidy and Graham are reverting to a damaging, partisan approach to repealing the ACA that would reverse the historic coverage gains under health reform and end Medicaid as we know it — even as other members of Congress, with the help of governors and insurance commissioners of both parties, are making progress in crafting bipartisan legislation to strengthen the individual market.