Our main webpage on AHCA of 2017 Trumpcare HR 1628
Modernize and strengthen Medicaid by transitioning to a “per capita allotment” so states can better serve the patients most in need.
Are you repealing Obamacare’s Medicaid expansion?
Medicaid is a critical program, but it has its flaws—including fewer choices and less access to quality care. Obamacare’s expansion made those flaws worse.
Our proposal strengthens Medicaid and targets the program’s limited resources to the patients most in need.
We will provide a stable transition and help ensure low-income Americans have access quality, affordable options through a new, competitive, state-based private insurance marketplace.
How are you going to cover the millions of Americans who gained coverage
through Obamacare’s Medicaid expansion?
(100% vs 138% of Federal Poverty Level and no asset test)
Our proposal provides Americans who do not receive insurance through work or a government program with an advanceable, refundable tax credit so they can access a plan that’s right for them—not one that’s dictated by Washington.
What happens next?
The Committees move their pieces of the legislation through regular order. [Overview of the legislative process 9 video’s & transcript] There will be Committee markups on Wednesday [March 8, 2017] so our Members can consider the policies, offer amendments, and vote on a final product.
Then we send our final products over to the Budget Committee to put together and send to the floor for a House vote. https://housegop.leadpages.co/healthcare/
- The plan maintains the Medicaid expansion — for now. The Affordable Care Act expanded Medicaid to cover millions of low-income Americans. And, in a big shift from previous drafts of the legislation, which ended Medicaid expansion immediately, this bill would continue to that coverage expansion through January 1, 2020. At that point, enrollment would “freeze,” and legislators expect enrollees would drop out of the program as their incomes change.
AHCA would end Medicaid expansion in 2020
One of the main ways that Obamacare increased insurance coverage was by expanding the Medicaid program to cover millions more low-income Americans. Prior to the health law, the entitlement was restricted to specific groups of low-income Americans (pregnant women, for example, and the blind and disabled).
Obamacare opened the program up to anyone below 138 percent of the poverty line (about $15,000 for an individual) in the 31 states that opted to participate.
Initial GOP plans would have ended this coverage expansion outright — but in a big reversal, the replacement bill will allow Medicaid expansion to continue through January 1, 2020. States will be able to continue to enroll people in the program. States that haven’t expanded yet but are considering the option could join the Medicaid expansion, and enroll people over the same time period as well.
In 2020, enrollment in the Medicaid expansion will “freeze” and states with no longer be able to sign new enrollees up for the program. Legislators expect that enrollment would slowly decline, as enrollees’ incomes change and they shift off the program.
This change is near certainly due to intense pressure from the 15 Republican governors who run states that have expanded Medicaid, and have lobbied aggressively in favor of the keeping the program alive. It could encourage some states eyeing Medicaid expansion like Kansas and Maine to move forward before the enrollment freeze.
There are significant changes to Medicaid in the American Health Care Act outside of the expansion, too. This bill would convert Medicaid to a “per capita cap” system, where states would get a lump sum from the federal government for each enrollee.
This is different from current Medicaid funding. Right now, the federal government has an open-ended commitment to paying all of a Medicaid enrollee’s bills, regardless of how high they go.
Previous analyses of different version of this proposal suggest it could lead to very deep cuts to Medicaid. It’s unclear, at this point, how much this new version of the policy would reduce Medicaid spending. Vox 3.6.2017
The federal government picks up between half and 70 percent of Medicaid costs. The percentage varies based on the relative wealth of the state.
Under the GOP plan, federal funding would be based on what the government spent in the fiscal year that ended Sept. 30. Those amounts would be adjusted annually based on a state’s enrollment and medical inflation.
Currently, federal payments to states also take into account how generous the state’s benefits are and what rate it uses to pay providers. That means states like New York and Vermont get higher funding than states like Nevada and New Hampshire and those differences would be locked in for future years.
Republicans have pushed to cap federal funding to states in return for giving them more control in running the program.
The legislation also affects the health law’s expansion of Medicaid, in which the federal government provided enhanced funding to states to widen eligibility. The bill would also end that extra funding for anyone enrolling under the expansion guidelines starting in 2020. But the legislation would let states keep the extra funding Obamacare provided for individuals already in the expansion program who stay enrolled.
How it works now: For decades, being a poor adult in America often meant not having health insurance.
That’s because Medicaid, the 50-year-old government safety net health plan, historically limited coverage to select groups of low-income Americans. These included children, pregnant women, the disabled and the elderly.
Poor adults without children were barred from Medicaid coverage in most states.
Obamacare tried to change that by offering states billions of dollars to expand Medicaid to childless adults. Thirty-one states have done so.
That has helped millions of low-income Americans get health coverage over the last several years.
How it would change: The House GOP plan would make two big changes to the Medicaid program.
First, starting in 2020, it would phase out the additional federal money that has helped states expand their Medicaid programs.
The legislation would then eliminate the decades-old system that linked federal aid to states to how much medical care Medicaid enrollees used.
The GOP plan would instead cap how much aid the federal government provides states for Medicaid under a system called a “per capita cap.”
That means the federal government would give each state a fixed amount of money every year for every person who qualifies for Medicaid. That amount then would increase annually by an amount linked to the medical inflation rate.
Many advocates and medical groups fear that over time that change would force states to scale back coverage for poor people and limit medical services. LA Times 3.8.2017
Resources & Links
Congressional Budget Office – Medicaid Overview
Child & Sibling Pages
- American Health Care Act – Medi-Cal Qualification & Benefits
- Block Grants – Capping
- Prior to ACA – How Medi-Cal use to work
- Supreme Court Expansion Decesion
Even with AHCA no longer on the table – Medi-Cal might have problems – Sacramento Bee 3.28.2017