GOP’s ACA re­write could mean cut in ben­e­fits for poor Tex­ans

Austin American-Statesman - - FRONT PAGE - By Bob Sech­ler bsech­ler@states­man.com

Ad­vo­cates for low-in­come Tex­ans warn that the state’s bill for Med­i­caid costs is likely to grow — which could po­ten­tially lead to loss of ben­e­fits for some res­i­dents — if Repub­li­cans move for­ward with their newly re­leased plan to dis­man­tle and re­place the Af­ford­able Care Act.

The pro­posed leg­is­la­tion, which the GOP dubbed the Amer­i­can Health Care Act, comes as bud­get writers in Austin are al­ready wrestling with how to deal with nearly $2 bil­lion in in­creased Med­i­caid costs.

The GOP plan would es­tab­lish — among other things — a per-per­son cap on how much the fed­eral gov­ern­ment gives states for Med­i­caid.

But if fed­eral fund­ing for the pro­gram no longer grows along with health care in­fla­tion and other factors, some mem­bers of the lo­cal health care sec­tor say Texas and other state gov­ern­ments ei­ther will have to bridge the gap or re­duce med­i­cal ben­e­fits for poor and dis­abled peo­ple.

“If they don’t give (the states) enough money to pay for th­ese ser­vices, the money is go­ing to have to come from some­where” or ben­e­fits will have to be cut, said Kay Ghahre­mani, chief ex­ec­u­tive of the Texas As­so­ci­a­tion of Com­mu­nity Health Plans, a con­sor­tium of 11 health plans across the state that pro­vide cov­er­age to about 2 mil­lion Tex­ans, most of whom are on Med­i­caid. “A

per-capita cap is not in the best in­ter­est of any state.”

Larry Wallace, in­terim chief ex­ec­u­tive of Cen­tral Health, Travis County’s health care dis­trict, said he is con­cerned that the GOP plan could re­sult in re­duc­tions in the fed­eral gov­ern­ment’s Med­i­caid pay­ments to states, al­though he noted that the is­sue isn’t set­tled and he’s still mon­i­tor­ing it.

Cen­tral Health of­fers care for unin­sured and un­der­in­sured peo­ple who aren’t el­i­gi­ble for Med­i­caid, so Med­i­caid cuts likely would in­crease the num­ber of peo­ple who need its ser­vices. Cen­tral Health is funded through prop­erty taxes.

“It does con­cern us, and it should con­cern ev­ery­one in the com­mu­nity who pro­vides health care,” Wallace said. “We are con­cerned about ad­di­tional peo­ple be­ing with­out cov­er­age as a re­sult of th­ese ac­tions.”

Texas law­mak­ers are de­bat­ing how to han­dle an es­ti­mated $1.9 bil­lion gap in the state’s Med­i­caid con­tri­bu­tions. The fig­ure in­cludes a $1.2 bil­lion short­fall in the cur­rent two-year bud­get cy­cle and an ad­di­tional $700 mil­lion in the 2018-19 cy­cle to ac­count for en­roll­ment growth, ac­cord­ing to the Cen­ter for Pub­lic Pol­icy Pri­or­i­ties, a non­par­ti­san re­search group.

A spokesman for Gov. Greg Ab­bott didn’t re­spond to a re­quest for com­ment Tues­day. State Rep. John Zer­was, R-Rich­mond — who chairs the Texas House Ap­pro­pri­a­tions Com­mit­tee and recently filed a bill that, among other things, calls for us­ing the state’s “rainy day” re­serve fund to bridge part of the Med­i­caid short­fall in the cur­rent two-year bud­get cy­cle — wasn’t avail­able for com­ment.

In ad­di­tion to the Med­i­caid changes, the U.S. House GOP’s planned re­place­ment for the Af­ford­able Care Act — com­monly known as Oba­macare — would elim­i­nate the man­date that ev­ery­one have cov­er­age or pay a penalty. It would also cre­ate a new tax credit tied to age and in­come to help in­di­vid­u­als buy in­surance.

The plan has got­ten a mixed re­cep­tion in Wash­ing­ton.

Some Repub­li­cans con­tend the tax cred­its es­tab­lished un­der it are a new en­ti­tle­ment, while other GOP mem­bers say they fear it will re­sult in lost cov­er­age for many Amer­i­cans. It re­mains to be de­ter­mined how much the pro­posed leg­is­la­tion would cost or how many peo­ple might lose cov­er­age un­der it, be­cause House Repub­li­cans re­leased it with­out es­ti­mates of those el­e­ments by the non­par­ti­san Con­gres­sional Bud­get Of­fice.

Pres­i­dent Don­ald Trump ap­plauded the plan’s un­veil­ing this week but also in­di­cated he views it as a start­ing point rather than a fin­ished prod­uct, say­ing it’s now “out for re­view and ne­go­ti­a­tion.” Some mem­bers of the Texas del­e­ga­tion fol­lowed suit, prais­ing the will­ing­ness to of­fer a health care plan but avoid­ing en­dors­ing it or com­ment­ing on its specifics.

U.S. Sen. John Cornyn, R-Texas, called the plan “a ma­jor step in the right di­rec­tion” in a pre­pared state­ment, adding that “we need to move health care de­ci­sions out of Wash­ing­ton and send them back to the states and back to pa­tients and fam­i­lies and their doc­tors.”

U.S. Sen. Ted Cruz, R-Texas, said he’s still study­ing the de­tails of the pro­posed leg­is­la­tion and is “work­ing closely with mem­bers of the House, mem­bers of the Se­nate and the Ad­min­is­tra­tion to pass a re­peal bill that hon­ors our com­mit­ment to re­peal Oba­macare, that low­ers costs, that ex­pands ac­cess and choices and pa­tient con­trol over your own health care.”

But Cruz re­it­er­ated his view that the Af­ford­able Care Act should first be re­pealed and then the GOP should fo­cus on ar­eas of con­sen­sus to build a re­place­ment.

U.S. Reps. John Carter, R-Round Rock, and La­mar Smith, R-San An­to­nio, were more en­thu­si­as­tic about the new pro­posal.

“Af­ter vot­ing more than 60 times to re­peal and re­place Oba­macare, I am proud that House Repub­li­cans have in­tro­duced an in­no­va­tive plan to re­place this dis­as­trous law,” Carter said. “The Amer­i­can Health Care Act pre­serves vi­tal pa­tient pro­tec­tions in­clud­ing pro­tect­ing those with pre-ex­ist­ing con­di­tions, lift­ing life­time caps on med­i­cal care, and al­low­ing de­pen­dents to stay on their par­ent’s plan un­til they are 26 years old.”

U.S. Rep. Lloyd Doggett, D-Austin, crit­i­cized the GOP’s health care plan be­fore it was re­leased, say­ing at a rally in Austin on Mon­day that ev­ery Amer­i­can should have “the ba­sic right of health care.”

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