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Report
warns of
state
money
fallout
from
health
law
repeal
By BEN
NUCKOLS
and
RICARDO
ALONZO-ZALDIVAR
ap.org
WASHINGTON
- A
sobering
report
to
governors
about
the
potential
consequences
of
repealing
the
Obama-era
health
care law
warns
that
federal
spending
cuts
probably
would
create
funding
gaps for
states
and
threaten
many
people
with the
loss of
insurance
coverage.
The
Affordable
Care Act
has two
main
components
for
expanding
coverage:
subsidized
private
health
insurance
available
in all
50
states,
and an
optional
Medicaid
expansion
that has
been
accepted
by 31
states
and the
District
of
Columbia.
Those
two
components
of the
health
law
cover
more
than 20
million
people.
A report
by the
consulting
firms
Avalere
Health
and
McKinsey
&
Company
concluded
that the
changes
under
consideration
by the
GOP-led
House
would
reduce
significantly
federal
dollars
for
Medicaid
and
subsidized
private
insurance.
The
effect
on
Medicaid
would be
far-reaching.
The
federal-state
program
for
low-income
people
covers
more
than 70
million
Americans,
many of
whom
have
high
health
care
needs.
The
Associated
Press
obtained
a copy
of a
slide
presentation
made by
the
consultants
to
governors
meeting
this
weekend
in
Washington.
The
report
said the
combination
of
phasing
out
Medicaid
expansion
money
from the
U.S.
government,
plus
transforming
the
overall
program
from an
open-ended
federal
entitlement
to one
that
operates
under a
cap
would
likely
result
in state
funding
gaps.
States
that
expanded
Medicaid
would
face the
deepest
cuts.
States
would
get more
flexibility
to
design
their
programs,
but the
money
crunch
could
lead to
cuts in
eligibility,
benefits,
or
payments
to
hospitals
and
other
service
providers.
The
impact
of
federal
spending
reductions
would
compound
over
time.
Reduced
Medicaid
spending
could
also
hurt
states
with
dampened
economic
activity
and
fewer
jobs,
the
consultants
said.
Hospitals,
which
benefit
from
Medicaid
coverage,
are big
employers
in local
communities.
Costs of
care for
uninsured
patients
could
become
an
issue.
In
addition,
the
private
insurance
subsidies
provided
under
Obama's
law
would
also be
scaled
back,
according
to the
report.
Although
states
would
get some
additional
safety-net
funding,
reductions
in
federal
insurance
subsidies
would
expose
some
consumers
to new
costs
for
their
coverage.
That
would
probably
result
in fewer
people
covered,
as some
consumers
drop
their
plans.
According
to the
Kaiser
Family
Foundation,
Medicaid
consumed
an
average
19
percent
of state
budgets
in 2015,
the most
current
year
available,
ranging
from 7
percent
in Utah
to 41
percent
in New
Hampshire.
Gov.
John
Kasich,
R-Ohio,
said he
thinks
"there's
going to
be a
problem
in the
House of
getting
anything
out of
there
that
still
provides
coverage
to
people.
That's
why the
Republicans
have to
reach
out to
some of
the
Democrats.
I don't
know
whether
this is
going to
happen,"
he told
CBS'
"Face
the
Nation."
With
President
Donald
Trump
set to
give his
first
speech
to
Congress
on
Tuesday
night
and his
words on
health
care to
be
closely
watched,
a White
House
spokeswoman
said the
administration's
goal is
ensure
people
do not
lose
their
coverage
and that
costs
are
lowered.
"So
we're
looking
at every
possible
way to
do
exactly
that:
repeal a
terrible,
failed
system
and
replace
with
something
better,"
Sarah
Huckabee
Sanders
told
ABC's
"This
Week."
She
depicted
the
current
system
as
"collapsing
under
itself,"
a view
not
shared
by
independent
experts.
It is
widely
acknowledged
that
affordability
is a
serious
problem,
but the
system
is not
regarded
as
teetering
on the
edge.
Governors
on
Saturday
met
privately
with
Health
and
Human
Services
Secretary
Tom
Price,
who
according
to
several
of the
state
leaders
said the
Trump
administration
wanted
to work
with
states
to
overhaul
health
care,
but he
did not
provide
specifics.
A
Medicaid
proposal
by GOP
governors,
a draft
of which
was
obtained
by the
AP,
urges
Congress
to
change
Medicaid
from an
open-ended
federal
entitlement
to a
program
designed
by each
state
within a
financial
limit.
Some of
the
governors
behind
the
proposal,
including
Kasich,
opted to
expand
Medicaid
in their
states
despite
pressure
from
conservatives.
"I think
there
are some
very
conservative
Republicans
in the
House
who are
going to
say just
get rid
of the
whole
thing.
And
that's
not
acceptable,"
he said.
He
added:
"Republicans
can go
and do
what
they
want,
and I'm
going to
talk to
them.
But at
the end
of the
day I'm
going to
stand up
for the
people
that
wouldn't
have the
coverage
if they
don't
get this
thing
right.
And I
happen
to
believe
that the
best way
to get
this
right
over
time is
for
actually
both
parties
to work
together.
I know
that's
considered
an
impossibility
now, but
what's
at stake
is not
some
political
thing.
What's
at stake
here are
20
million
Americans."
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