Millions may lose coverage in Affordable Care Act repeal, governors told

Policies supported by Republican congressional leaders to repeal and replace the Affordable Care Act could lead millions of people to lose their health coverage, according to a presentation given to state governors meeting Saturday in Washington.

The presentation, a copy of which was obtained by Bloomberg News, estimates that the number of people covered by Obamacare, another name for the ACA, through the individual insurance market could be slashed by as much as 51 percent in states that chose not to expand Medicaid coverage under Obamacare and by 30 percent in those that did expand the federal-state health program for the poor. The presentation was made by consulting firms Avalere Health and McKinsey & Co.

“Tens of thousands who would not be able to afford their coverage and would lose their coverage,” Democratic Governor Jay Inslee of Washington said after the closed-door meeting. “It was a pretty disturbing briefing.”

Republicans have campaigned for years on a promise to repeal the 2010 health law known as Obamacare, and Donald Trump’s election victory put that goal within reach. Now, though, they’re confronting the task of coming up with a replacement, mindful of the 20 million people who’ve gained health insurance under the law and the billions of dollars it sends each year to states.

In one hypothetical example presented, a state that didn’t expand Medicaid and had 235,000 enrollees in Obamacare through the individual market would see the number of participants fall to 115,000. In a hypothetical state that did expand Medicaid coverage and had 300,000 enrollees in the individual market, the number would drop to 210,000.

The expansion state could see further losses in Medicaid, where another 115,000 would probably lose eligibility, without being able to find an affordable replacement plan.

The presentation also revealed that a hypothetical state that expanded Medicaid could lose 24 percent of federal dollars spent on the program over five years, requiring $6.2 billion to make up the gap. The scenario would require Congress to repeal the expansion and implement a per-person funding mechanism. A hypothetical state that didn’t expand the program could lose 6 percent in federal spending.

The presentation is based on a plan by Republican leaders to eliminate income-based subsidies under Obamacare that help people afford insurance and replace them with age-based tax credits.

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Republican governors in states that expanded Medicaid have been telling their congressional delegations for months that repealing the health-care law without an adequate replacement would cost their budgets and hurt hospitals. While many say they support repealing Obamacare, they’ve advised a heavy dose of caution. Republican leaders in Washington are considering ending the Medicaid expansion, as well as setting per-person caps on federal funding of the program.

“Governors know about 50 times more about Medicaid than anyone in Congress,” said Haley Barbour, the former Republican governor of Mississippi. “The idea that we’re going to repeal, repair, replace, redundant, whatever — the idea that we’re going to do that in a matter of weeks just ignores the difficulty of doing it,” Barbour said.

Ohio Governor John Kasich has been among GOP leaders urging prudence, after expanding Medicaid in his state under the ACA. On Friday, Kasich called House Republicans’ initial plans to replace the health-care law “inadequate.” Kasich, a former Republican presidential candidate, didn’t go into details during brief remarks to reporters after a meeting Friday with President Donald Trump.

“To me, it’s not acceptable,” Kasich said. The governor, who opened Ohio’s Medicaid program to more low-income people under Obamacare, has advocated maintaining the Medicaid expansion. He has said the income limit for the program should be lower.

That option may be on the table. Connecticut Governor Dan Malloy, a Democrat, told reporters that Republican state leaders are considering a deal with the Trump administration that would lower the income limit for Medicaid to 100 percent of the poverty level from 138 percent. His remarks came after a meeting with Health and Human Services Secretary Tom Price. The arrangement would provide federal funding for Medicaid through block grants, Malloy said.

“It’s clear this administration has no desire to keep Medicaid expansion,” Malloy said.

Price, after meeting with governors on Saturday behind closed doors, declined to answer questions from reporters, saying only that he and the state leaders had a good discussion. His office later issued an e-mailed statement saying he met with the governors, listened to their concerns and discussed “real, positive solutions.”

Governors have been meeting with Trump as well. On Saturday, the president discussed the Affordable Care Act with Florida’s Rick Scott and Wisconsin’s Scott Walker, both Republicans. The topic was “how best to solve the problems of Obamacare, with a special emphasis on the states role in health care,” according to information provided to reporters.

Democratic governors are reaching out to Republican colleagues in states that expanded Medicaid and “now have a very sick feeling in their stomachs,” Malloy, who’s chairman of the Democratic Governors Association, told reporters Saturday at an earlier press conference. “I know that there is tremendous pressure on them, but we have to stand tall and make sure our fellow Americans have the coverage that they need.”

Democrats were more willing than their Republican colleagues to talk to reporters after the closed-door meeting. Virginia Governor Terry McCauliffe called the presentation on what might happen if the ACA is repealed, or if Medicaid funding is limited, “scary.”

Roughly 12 million people gained Medicaid coverage after Obamacare broadened eligibility for the program. From 2014 through the middle of 2015, states got $79 billion of extra funding from the Medicaid expansion, according to the Kaiser Family Foundation. Under the health law, the federal government paid 100 percent of the cost of the expansion from 2014 to 2016. The government’s share fell to 95 percent this year and was scheduled to fall to 90 percent by 2020.

Former Wyoming Governor Jim Geringer, a Republican, asked why current governors aren’t coming together to develop a plan to repeal and replace Obamacare.

“For members of Congress, it’s primarily a political debate, not a health-care debate,” Geringer said. “Giving Congress cover is probably the best thing you can do right now.”

With assistance from Mark Niquette and Billy House.