Counselor to the president Kellyanne Conway insisted this week that the Senate GOP health care bill does not include cuts to Medicaid.
Meanwhile, Health and Human Services Secretary Tom Price said the health care proposal would not cause Medicaid recipients to lose their health coverage. The government “would not allow individuals to fall through the cracks,” he noted. “We would not pull the rug out from under anybody.”
President Donald Trump promised during his campaign that he would not touch Medicaid, the federal health care program for lower-income Americans. This group includes expected mothers, children, seniors and disabled individuals.
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But does the Senate Republican health care bill actually cut Medicaid funding and coverage?
While the estimated government spending on Medicaid would increase under the Senate health care bill gradually over time, it will spend less each year on the program than what the Affordable Care Act, also known as Obamacare, currently allots.
If Obamacare remains intact, the government would spend an estimated $415 billion next year on Medicaid, and $624 billion by the year 2026, according to the review of the bill from the Congressional Budget Office (CBO).
If the Senate bill is passed and goes into effect in 2018, the government would spend an estimated $403 billion on Medicaid that fiscal year. That number increases to $466 billion by the year 2026, according to the CBO.
The CBO also estimated that federal spending on Medicaid from now until 2026 would be $772 billion less than what is projected to be spent under the current law. The Senate bill, however, leads to more government spending on Medicaid in that amount of time than the House GOP bill.
The CBO’s latest analysis was done using its March 2016 baseline.
States that opted into Medicaid expansion under the ACA by March 2017 would see government funding reduced starting in 2021.
The bill phases out funding at a lower rate for Medicaid expansion under Obamacare by 2024.
In 2021 under the ACA, states would receive 90 percent matching rate for states that opted into Medicaid expansion, but the Senate bill will chip it down to 85 percent. The Senate bill drops the federal matching rate by five percentage points each year until 2024. After 2024, Medicaid funding to states will be at the regular rate and could be cut further due to changes in how rate increases and payments to states are calculated. At that point, with reduced funds and little enrollment presumably, states’ governors may choose to forgo Medicaid expansion.
If the current version of the Senate GOP bill becomes law, states can choose whether to receive funds by a per capita cap, determined by the number of people enrolled, or a block grant.
The CBO report makes one thing clear: the amount of federal revenues collected and the amount of spending on Medicaid “would almost surely both be lower than under current law,” and the number of uninsured people under the Senate health care bill “would almost surely be greater than under current law.”