By TAYLOR STUCK
The Herald-Dispatch
HUNTINGTON, W.Va. — New legislation that supporters say would allow states to create better healthcare systems for their populations would actually leave millions in West Virginia without health insurance coverage as federal funding to the state is cut by $2 billion, according to experts with the Centers for Budget Policy and Priorities.
The latest Republican-sponsored legislation to repeal and replace the Affordable Care Act is sponsored by senators Bill Cassidy, R-La., and Lindsey Graham, R-S.C.. It would replace much of the Affordable Care Act with block grants to states, giving them wide leeway on spending the money, and would cut and reshape Medicaid. It would let states set their own coverage requirements, allow insurers to boost premiums on people with serious medical conditions and end the mandates that most Americans buy insurance and that companies offer coverage to workers.
Senate Majority Leader Mitch McConnell on Tuesday praised the revived Republican effort to uproot former President Barack Obama’s health care law. McConnell, R-Ky., said the bill would let states “implement better health care ideas by taking more decision-making power out of Washington” and letting local officials decide what “works better in their own particular states.”
The CBPP, a nonpartisan research and policy institution, says the plan would significantly cut federal funding for health coverage over the next decade. The cuts would grow in 2027, when the bill’s temporary block grant (which would replace the ACA’s Medicaid expansion and marketplace subsidies) would expire and its Medicaid per capita cap cuts would become increasingly lower. The CBPP estimates that in 2027 alone, the bill would cut federal health care funding by $299 billion relative to current law, with the cuts affecting all states.
It’s estimated West Virginia would lose more than $2 billion by 2027 after cuts to Medicaid and redistribution of funds through the block grants.
Though there is no official analysis from the Congressional Budget Office, and there won’t be one before the Sept. 30 deadline to pass a bill under reconciliation, CBPP experts used the CBO’s estimates of the several previous bills Congress has failed to pass over the last three months to make their conclusions.
In a call with regional press Tuesday, CBPP Vice President for Health Policy Edwin Park said he believes the Cassidy-Graham bill would be more devastating than repeal without replace, which the CBO estimated would leave 32 million more people uninsured.
“Cassidy-Graham would presumably result in even deeper coverage losses than that in the second decade as the cuts due to the Medicaid per capita cap continue to deepen,” Park said.
The Cassidy-Graham bill would convert the Medicaid expansion and marketplace subsidies to smaller block grants ending in 2026. The block grant would provide $239 billion less between 2020 and 2026 than projected federal spending for the Medicaid expansion and marketplace subsidies under current law. In 2026, block grant funding would be at least $41 billion (17 percent) below projected levels under the ACA.
The CBPP says the bill would also punish states like West Virginia that have been successful in Medicaid expansion, by redistributing the reduced federal funding across states, based on their share of low-income residents rather than their actual spending needs.
About 525,000 West Virginians are enrolled in Medicaid, with almost 175,000 joining under the expansion.
No vote is currently scheduled, but the pressure is on to have a vote by Sept. 30, when the special procedures protecting the GOP bill from filibusters — which take 60 votes to block — expire.
The Associated Press contributed to this report.
Who wins? Who loses?
Here’s a look at some winners and losers under the most recent Republican-sponsored bill in the U.S. Senate aimed at repealing the Affordable Care Act:
Winners – People who don’t believe the government should require individuals to purchase a costly private service like health insurance. The bill would repeal “Obamacare’s” unpopular requirements for individuals to have coverage and for larger employers to offer coverage. The trade-off is that without such a legal requirement, more people are likely to be uninsured. And an accident or unexpected illness can make that a costly decision.
Losers – People with health problems or with pre-existing medical conditions could be charged more if the state they live in obtains a waiver from current requirements that forbid insurers from charging higher premiums based on health status. States could also seek waivers from the current requirement that insurers cover 10 basic kinds of services, such as maternity and childbirth, or mental health and substance abuse treatment.
Winners – Medical device manufacturers. The bill would repeal an ACA tax on the industry. But it would leave in place Obama’s tax increases on upper-income individuals, a feature that may cause problems among some conservatives.
Losers – States that expanded Medicaid, including 17 with Republican governors. The more generous federal match for the expansion would be phased out, and some of the money would be redistributed to states that did not expand their programs.
Winners – People who use tax-sheltered health savings accounts for health care expenses. Contribution limits would be raised and consumers could use their accounts to pay insurance premiums, not just out-of-pocket costs such as copays and deductibles.
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