Wednesday, June 21, 2017

Senate GOP health bill would dramatically roll back Medicaid

Kentucky Health News

The health bill that Senate Republicans will unveil Thursday "would reshape a big piece of the U.S. health-care system by dramatically rolling back Medicaid while providing a softer landing to Americans who stand to lose coverage gained under the Affordable Care Act," Paige Winfield Cunningham reports for The Washington Post.

As Kentucky Health News indicated Tuesday, the bill would "cut off Medicaid expansion more gradually than the House bill, but would enact deeper long-term cuts to the health-care program for low-income Americans," Cunningham reports. It also would keep Obamacare's income-based subsidies for private insurance, but scale them back.

"Subsidies are currently available to Americans earning up to 400 percent of the federal poverty level," Cunningham writes. "Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill -- but anyone below that line could get the subsidies if they’re not eligible for Medicaid."

The House bill would end the Medicaid expansion, which serves 470,000 Kentuckians, in 2020. The Senate bill is expected to phase out the expansion over a longer period, but it would cut scale back the overall Medicaid program farther in the long run. "In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill," Cunningham writes. "That move could prompt states to reduce the size of their Medicaid programs."

That would be the biggest change in Medicaid since a heavily Democratic Congress created it in 1965, and would perhaps reflect the different attitude that Republicans have toward the program. "Republicans view Medicaid as a form of welfare, and pretty much everyone else views it as a government insurance program," Drew Altman of the Kaiser Family Foundation writes for Axios.

"Perceptions of Medicaid as welfare don't seem bothered much by facts, such as, for example, that two thirds of Medicaid spending goes for the low-income elderly and disabled who don't fit the Ronald Reagan era image of the welfare king or queen. But it's not the majority view in any case. A little less than a third of voters identify as Republicans today, and about half of them see Medicaid as welfare," Altman writes. "It's this group and their perceptions of the program, and elected officials who share their views, that seem to be driving debate about Medicaid today." About 1.3 million Kentuckians are on Medicaid.

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