U.S. Senate Republicans have 10 days left to repeal and replace Obamacare with the votes of 50 senators. It’s not enough time to get a comprehensive score on the Graham-Cassidy bill from the Congressional Budget Office, but that hasn’t stopped other groups from diving into the numbers to understand how the last last-ditch effort to repeal Obamacare would affect the country.
A new report out this morning by the progressive Center for American Progress estimates that 32 million fewer people would have health insurance coverage under the bill by 2027, when most of the funding put in place by Obamacare would fully expire. That translates to 41,000 people in Alaska through a combination of eliminated funding for Medicaid expansion and eliminated funding for tax credits that help people buy insurance on the individual marketplace, according to the group’s estimate.
The Graham-Cassidy repeal could also cut coverage even deeper, according to the Center for American Progress estimate, because it also makes fundamental changes to how the traditional Medicaid coverage is funded.
The leading repeal and replace effort contains many elements of the previous repeals that either died before reaching a vote or were voted down on the Senate floor, but the significant change contained in this round is a transition of federal funding to a block grant method.
The bill aims to pool most all the existing Obamacare funding, reduce it and then redistribute it on a per capita basis to the states. What’s been of particular concern is that it would also sweep up all of the Medicaid expansion money from the 31 states that chose to expand Medicaid (including Alaska) and distribute it to all 50 starting in 2020.
An estimated $844 million (or much more) lost
2027 is a cliff of a year for the Graham-Cassidy bill.
That’s when the redistribution of federal health care funding comes to a full stop and all funding for Medicaid expansion and insurance subsidies would disappear. The move is being done in the name of granting states more flexibility, but the concern is whether that flexibility will matter with significantly less funding.
The Center on Budget and Policy Priorities estimates that through 2027, Alaska will have lost $844 million in federal health care funding.
“According to the bill’s sponsors, this block grant would give states “flexibility,” allowing them to maintain the coverage available under the ACA if they wanted to do so while enabling other states to experiment with alternative approaches. But in reality, states wouldn’t be able to maintain their coverage gains under the ACA,” explains a report by a group of CBPP researchers. “Instead, Cassidy-Graham, like the earlier House and Senate repeal-and-replace bills, would cause many millions of people to lose coverage.”
Another study by the D.C.-based health care consulting firm Avalere Health estimates the cuts would be even greater for Alaska. It estimates the cumulative cuts through 2026 in Alaska would amount to $1 billion lost. That figure would jump by another $1 billion in 2027, according to the study.
Gov. Bill Walker has already come out in opposition to the bill, concerned about its impacts on Alaska.
“Alaskans pay more for health care than do most Americans,” Walker said in a statement Tuesday. “Before any changes to existing law are made, Alaska must have a clear understanding of how the proposed changes impact Alaskans.”
Walker signed onto a letter with nine other governors to oppose the Graham-Cassidy, urging Congress to return to a bipartisan effort to reform Obamacare. The Senate Committee on Health, Education, Labor and Pensions had been holding hearings on short-term fixes for the health care markets, but that was abruptly cut off by the emergence of Graham-Cassidy.
U.S. Sen. Lisa Murkowski has remained undecided on the bill, but statements given Tuesday would suggest she would have big problems with a bill that cuts funding too deeply.