Senate expected to unveil health care bill
Medicaid likely to take a hit in Republican proposal set to be released Thursday.
WASHINGTON — Tucked inside the Republican House bill to replace the Affordable Care Act is a plan to impose a radical diet on a 52-year-old program that insures nearly 1 in 5 Americans.
The bill would modify changes to the health system brought by the Affordable Care Act. But it would also permanently restructure Medicaid, which covers tens of millions of poor or disabled Americans, including millions who are living in nursing homes with conditions like Alzheimer’s or the aftereffects of a stroke.
“This is the most consequential change in 50 years for lowincome people’s health care,” said Joan Alker, the executive director of the Center for Children and Families at Georgetown University.
Since its founding, Medicaid has operated as a partnership between the federal government and the states. Each pays a share of patients’ medical bills, with no overall limit on spending. The American Health Care Act would try to slim down the federal share of that spending by limiting how much the federal government would pay for each person enrolled in the program. The Senate version of the legislation, expected to be released Thursday, is likely to make the payments still leaner.
The results, according to independent analyses, would be major reductions in federal spending on Medicaid over time. States would be left deciding whether to raise more money to make up the difference or to cut back on medical coverage for people using the program. The Congressional Budget Office estimates that the changes would lead to a reduction in spending on Medicaid of more than $800 billion over a decade.
Medicaid is the country’s largest government health care program, covering more Americans than its better-known sibling, Medicare.
About half of all births in the country are covered by Medicaid, and nearly 40 percent of children are covered through the program. Medicaid covers the long-term care costs of twothirds of Americans living in nursing homes, many of them middle-class Americans who spent all of their savings on care before becoming eligible.
It covers children and adults with disabilities who require services that most commercial health insurance does not include. It covers poor women who are pregnant or raising young children.
It also provides insurance for poor adult Americans, and recent evidence shows that its expansion under Obamacare has given more poor people access to health care services and reduced their exposure to financial shocks.