State would be hit hard by ACA repeal

Connecticut is one of nine states that would be hit the hardest in the latest GOP Senate proposal to repeal the Affordable Care Act and replace it with a block grant.

That was the conclusion of the Center on Budget and Policy Priorities out of Washington, D.C., which said the Cassidy-Graham bill would cut Connecticut’s federal health care funding coverage by $2.48 billion in 2026. The cuts across the country would be $124 billion in the same timeframe.

“Despite claims to the contrary, the Cassidy-Graham plan is just another ACA repeal bill and would have the same devastating effects on Connecticut as the previous, failed GOP repeals bills,” Karen Siegel, health policy fellow at Connecticut Voices for Children, wrote in a statement.

“Like every other ACA repeal bill, it would take coverage from hundreds of thousands of Connecticut residents and tens of millions nationwide,” Siegel wrote.

The bill’s proposed block grant formula not only cuts overall funding for Medicaid expansion and marketplace subsidies, but redistributes it across the country. States, like Connecticut, that expanded Medicaid coverage, would lose funds to non-expansion states.

The report also said that states with higher per capita income would lose money to lower-income states, even though some of the richer states have a large share of low-income residents.

More densely populated states would lose out to the less densely populated. The analysis labels the density thresholds “arbitrary ... with the only apparent rationale being to include or exclude particular states from the categories.”

U.S. Sen. Lindsey Graham, RS.C., said his bill turns decisions about mandates and spending levels over to the states.

“They’ve got a better handle on it than any bureaucrat in Washington,” Graham told CNN.

“The essential health benefits will still be there,” U.S. Sen. Bill Cassidy, R-La., said.

But according to the analysis, Connecticut, California, Delaware, Florida, Massachusetts, New Jersey, New York, North Carolina and Virginia, plus the District of Columbia would see cuts of 50 percent or more to federal funding for Medicaid expansion and/or marketplace subsidies by

2026.

New York would see an estimated 70 percent cut.

Connecticut’s Medicaid expansion under the ACA covers more than 216,000 residents. The tax credits now in place help more than 75,000 moderate-income residents, according to Voices.

The smaller block grant also caps and cuts the basic Medicaid program before the expansion was put in place,

The capita cap increases quickly over time, reaching $41 billion annually by 2016. The CBO said this equals an almost 9 percent cut to Medicaid spending “for seniors, people with disabilities, families with children and other adults ... in that year (2026.)

Under the present system, funding for the Medicaid expansion and marketplace subsidies adjust to cover increases in enrollment or health care costs. The block grants will not adjust, forcing the states to pick up increased costs.

There would be very large

cuts in 2027 when the block grants are eliminated.

At that point there would be no federal funding to replace states’ Medicaid expansions and marketplace tax credits and cost-sharing reductions that helped cover low- and moderateincome residents, the analysis found.

“The casualness with which Republicans are trying to rip health care from hundreds of thousands of people in our state is terrifying,” U.S. Sen. Chris Murphy said in a statement. “People’s lives are at stake, and Democrats are once again being shut out of the process. This is a terrible bill, and I’ll fight it every step of the way.”

The Center for Budget and Policy Priorities also warned about “other harmful changes.”

Chief among them is the provision that allows states to waive certain coverages, such as maternity and mental health care, from inclusion in policies. It would also allow the insurers to impose annual and lifetime limits, while also greatly increasing the cost of deductibles and other out-of-pocket expenses.

Under review, according to the center, is adding the

“Cruz amendment,” which would let insurers charge much higher premiums for people with pre-existing conditions, or completely deny them coverage.

Voices said previous attempts to repeal the ACA failed because a majority did not want to see millions lose health care coverage.

It suggested another path: “a transparent, bipartisan effort to strengthen our health care system without taking people’s coverage away or gutting Medicaid. The public supports this approach and bipartisan Senate hearings slated for September offer a first step forward.”

“The public, experts across the political spectrum, and groups representing patients, hospitals, physicians, seniors, people with disabilities and others have forcefully and repeatedly rejected this misguided approach,” Sharon Langer, advocacy director at Connecticut Voices for Children, wrote in a statement. “It’s time to focus on bipartisan solutions that strengthen — rather than weaken — our health care system.”

Connecticut Voices for Children is a research-based child advocacy organization located in New Haven.