Senate GOP health bill would likely slash Medicaid. Here's how.

This specific state line divides the Medicaid debate

Republicans have wanted to repeal Obamacare for years — although they’ve wanted to overhaul Medicaid for far longer.

They are right now getting their chance.

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The health care legislation working its way through Congress would likely do much more than its stated purpose of repealing in addition to replacing Obamacare. of which would likely make the most far-reaching adjustments in addition to deepest cuts to Medicaid inside the program’s 52-year history.

“Medicaid: Sending of which back to the states. Capping its growth rate. We’ve been dreaming of This specific since I’ve been around, since you in addition to I were drinking at a keg,” House Speaker Paul Ryan said in March at an event hosted by the conservative National Review magazine.

Senators are still hashing out the details of their bill, which differs somewhat via the one of which passed the House last month.

although the general thrust of both chambers’ plans will be clear: Lawmakers would likely effectively end Obamacare’s expansion of Medicaid to low-income adults in addition to would likely dramatically curtail federal support for the overall program, which covers more than 70 million low-income Americans. They would likely give states more control in addition to flexibility in administering the program, although also require governors in addition to legislators to foot much more of the bill.

President Trump will be committed to doing sure of which no one currently receiving Medicaid “would likely be affected in any way,” White House Press Secretary Sean Spicer said Friday. The president feels the Senate bill reflects This specific in addition to “he’s pleased with of which,” Spicer added.

of which’s hard to see how these adjustments would likely have no impact, however. The overhaul laid out inside the House bill would likely reduce federal spending on Medicaid by nearly a quarter by 2026, compared to current law, according to a Congressional Budget Office assessment. Some 14 million fewer people would likely be covered by the program at of which time.

The CBO will be likely to Discharge its score of the Senate plan early This specific week.

Related: Medicaid covers a lot more people than you might think

Medicaid will be the nation’s largest single health insurer, covering nearly one-fifth of all Americans. of which insures two in 5 children in addition to the same share of the disabled, as well as three in 5 nursing home residents. of which pays for nearly half of all births in addition to spending on long-term care inside the U.S.

The majority of Americans, regardless of political party, have a favorable view of Medicaid in addition to say of which works well for most low-income people inside the program, according to a brand new Kaiser Family Foundation poll.

Republican lawmakers, however, have long blasted Medicaid as inefficient in addition to bloated. Many stress of which one-third of doctors don’t see Medicaid patients in addition to say the program provides poor-quality health care.

Enrollment shot up to 54.5 million people inside the decade before the Affordable Care Act was passed, in addition to total spending nearly doubled to $402 billion, in part because of the Great Recession.

Also, many Republicans say of which the program’s current open-ended funding design encourages states to “game the system.” The federal government matches between half in addition to three-quarters of what states shell out on enrollees, providing the biggest injection of federal funds into state budgets. So states have an incentive to spend more to get a larger federal match.

“Medicaid has been a real winner for states,” said Joe Antos, a scholar at the American Enterprise Institute, a conservative think tank. “States find ways to get their Medicaid billing up.”

Medicaid expansion under Obamacare, which began in 2014, irked many conservatives even more. of which has added 11 million newly eligible adults to the rolls in addition to requires the federal government to cover at least 0% of the tab. Many of these adults are able bodied, although the Obama administration did not permit states to impose work requirements on them.

Republicans want to rein in Medicaid by jettisoning the expansion program, sending a fixed amount of money to the states each year for the overall program in addition to reducing the growth rate of of which funding. They would likely also let states require some adult enrollees to work.

Related: Who gets hurt in addition to who gets helped by the Senate health care bill

“The bill will be framed as repealing in addition to replacing the ACA, although for Medicaid, the adjustments are much broader,” said Robin Rudowitz, an associate director at the Kaiser Family Foundation. The legislation “would likely genuinely change the basic core in addition to financing of the program.”

Under the Senate plan, the enhanced funding for Medicaid expansion would likely end by 2024, after which states would likely receive the same match for low-income adults as they do for additional enrollees. This specific will be four years later than the House bill in addition to serves as a concession to moderate Republicans who don’t want to swiftly turn off the federal spigot. Governors such as John Kasich of Ohio in addition to Brian Sandoval of Nevada, as well as senators via expansion states, have defended the program as critical to helping those affected by the opioid epidemic.

although of which’s unlikely of which most states could afford to continue covering low-income adults at the reduced match rate, so they would likely likely have to end their expansions.

Related: Senate GOP health plan may not protect millions on Medicaid expansion

When of which comes to the overall program, both chambers would likely convert of which into a per capita cap system, which would likely send a set amount of money each year based on a state’s enrollment, starting in 2020. The cap would likely differ for each group covered by Medicaid — expansion adults, children, pregnant women in addition to parents, disabled adults in addition to the elderly — based on the state’s historical spending for of which population.

States could also opt to receive a lump sum, known as a block grant, although only to cover pregnant women in addition to parents. (The House bill would likely allow states to receive funding for children as a block grant, too.)

In addition, the Senate in addition to the House would likely slow the growth rate of Medicaid spending by pegging the annual funding increases to an inflation index.

Under the current system, Medicaid will be likely to grow at a 4.4% average annual rate over the next decade. The House would likely tie the growth to the medical inflation rate, estimated by CBO to be 3.7%, on average, over the next decade, while the Senate would likely tighten of which even more by pegging of which to the standard inflation rate, which will be projected to grow at an average 2.4% rate. The Senate’s inflation provision would likely take effect in 2025.

chart medicaid growth

All these funding adjustments would likely have a huge impact on the Medicaid program, experts say. The House bill would likely reduce spending by $834 billion over 10 years, compared to current law, according to the CBO analysis.

The cuts might be even more dramatic under the Senate bill, though the CBO analysis might not show of which since many of the adjustments would likely take place near the end of the 10-year budget window of which CBO studies.

Related: Trump called House bill ‘mean’; critics say Senate could go further

Still, looking longer term, switching the growth rate to a standard inflation index more than doubles the magnitude of the cuts resulting via turning Medicaid into a block grant or per capita cap program, according to calculations done by Manatt Health, a consulting firm. of which could mean hundreds of billions of dollars of deeper cuts for some states under the Senate bill.

“States will face intense fiscal pressure to reduce benefits, cut provider rates in addition to keep higher-cost people off Medicaid,” said Jocelyn Guyer, managing director at Manatt.

sy88pgw (brand new York) First published June 26, 2017: 6:01 AM ET

Senate GOP health bill would likely slash Medicaid. Here's how.

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