Archives
Categories
Repeal Bill Threatens Texas Medicaid
Last week’s Congressional Budget Office (CBO) official “score” for the House’s ACA Repeal bill found that it would cut Medicaid spending by 880 billion over 10 years, with 14 million fewer Americans receiving Medicaid coverage in 2026 than under current federal law. The bill also slashes today’s tax credit subsidies for health insurance by 44%, with seniors, older adults, and rural Americans taking the brunt of the impact. CBO projects that the combined impact of the Medicaid and private insurance cuts would be 14 million fewer Americans insured in 2018, increasing to 24 million fewer in 2026: a complete reversal of the coverage gains the country has seen under the ACA.
Here is CPPP’s newest list explaining the major Medicaid changes the U.S. House will likely vote on this week, noting the specific problems and impacts for Texas (note: this brief covers the latest changes to the bill announced late Monday 3/20, which made the Medicaid provisions harsher, not better for Texas). To recap the top Medicaid concerns with the repeal bill:
- Under the proposed Per Capita Cap, if Texas makes errors in predicting and budgeting for Medicaid spending in an upcoming year and our federal funds are inadequate, our Legislature’s history indicates they will cut benefits, payment, or enrollment in response—not fill the gap with state funds—to pay for the federal recoupment of funds.
- Rigid use of a 2016 Medicaid spending for a “base year” will lock Texas and other states into permanent inadequate provider networks.
- If the make-up of Texas Medicaid enrollees in one of the four Per Capita Cap enrollment groups changes over time to have more intensive needs—e.g., for our elders or Texans with disabilities—we will be unable to meet their needs, and it will take an act of Congress to fix a too-low funding cap.
- Limits to 2016 benefits also make our Medicaid funding allocation too low to allow us to adopt best treatment practices and standards of care without first cutting elsewhere.
Read the brief to learn more about these four points, and more, including:
- Roll-back of Medicaid Expansion;
- Allows Texas to roll back Medicaid eligibility for kids;
- Medicaid expansion possible still, but no enhanced match in future years. Still, Texas will lose billions each year if we do not move ahead, locking in a system with no coverage option for working poor adults.
- Cuts federal funds for Attendant Care under Community First Choice;
- Eliminates Medicaid “3-months prior” coverage, which is a safety net back-up for state Medicaid eligibility system failures, and also hits hospitals and enrollees; and
- Locks Texas into inadequate provider payment rates, creating a fund to address rates that is far too small to meet Texas’ needs.
Click here to learn more about what’s at stake for Texas Medicaid.
TAKE ACTION – ACA repeal and Medicaid Block Grants
Speaker of the House Paul Ryan is aiming to hold the vote on the federal health care repeal bill on Thursday March 23 if he can count up enough votes to support it. It’s going to come down to a handful of votes. So now is the time to call Congress at 866-426-2631, alert your friends, get on social media, visit the local office for your member of Congress, or raise your voice in your own way. Visit here for more information on the detrimental ACA repeal and the House health care proposal.
Categories
STUCK IN THE MIDDLE GRADES
By Anne Dunkelberg
This week I joined CPPP Senior Policy Analyst Stacey Pogue for a Facebook Live discussion about what Congressional health care proposals might mean for Texas.
You can watch a recording of the discussion here.
Overall: The most distressing part of the Congressional plan is that it doesn’t provide a pathway to reach the remaining 4.6 million uninsured Texans, and instead would likely increase that number and erase the coverage gains of the last several years.
Some of the other key takeaways from our early analysis of the health care proposal coming out of Congress include the following:
Marketplace and Individual Market Insurance
• This proposal makes private coverage unaffordable for millions of Americans. Premiums will rise for many people getting affordable coverage today in the Health Insurance Marketplace, and out-of-pocket costs like deductibles will go up, too.
• The plan would replace the ACA’s sliding scale tax credits (which adjust for income, age, and cost of insurance where you live) with a less generous, essentially flat tax credit (that adjusts only for age). This means there would be clear winners and losers. People hit the hardest are lower income, older (ages 50-64), and people who live in rural areas, where the underlying cost of health insurance is higher. Note that about 900,000 Texans get a tax credit under the ACA.
• There are some provisions in the plan that just don’t make sense. A family of four who makes $100,000 per year, under this new plan, would get the same subsidy / tax credit as a family that makes $30,000 per year.
• Premiums would also rise under this bill because there is much less incentive for younger and healthier people to get coverage. Today, there is a penalty that encourages people to get insurance. Eliminating this provision changes who is covered. More sick people keeping coverage, and more healthy people dropping it would mean raising premiums for everyone.
Medicaid
• In Medicaid, starting in 2020, the plan would cap the overall federal funding available to Texas, preventing necessary increases to allow Texas to add life-saving innovations, bring up seriously inadequate payments to care providers, or fill current gaps in basic health care services.
• In other words, the plan would make it really hard to improve anything that we are not doing well today. For example, Texas hasn’t given doctors regular pay increases under Medicaid since 1993, and there would be no space under a “cap” to improve that.
• There are also over 200,000 Texans on waiting lists for Community Care programs, and they wouldn’t have a way to get off those lists if Congress caps Medicaid funding.
Stay tuned for more updates from CPPP as the health care debates in Washington and Austin continue.
As CPPP’s Stacey Pogue recently explained, U.S. House leaders are expected to file legislation within days that will begin to repeal and “replace” the Affordable Care Act (“ACA” or Obamacare). Based on an outline made public in February, the bill is expected to result in fewer people being able to afford insurance—especially low- and moderate-income individuals—and in allowing insurance plans to cover fewer benefits.
Beyond cutting affordability and consumer protections for private health insurance coverage, the U.S. House outline also proposed a radical restructuring of Medicaid. Based on the outline, a leaked bill draft that was analyzed by many experts, and the actual bills filed and officially “scored” last summer (2016), last summer’s House bill did not just “bend the cost curve”—like dropping the growth in per-enrollee cost from six percent to three percent a year—but actually cut federal Medicaid funds to Texas below current levels by as much as 25 percent. So, the very first question we will ask when an actual bill is finally filed will be, “does it cut Texas Medicaid funds below current levels, which would force cuts to eligibility, benefits, or provider pay? And, by how much?”
Another critical point is that last summer’s bill would have cut Texas Medicaid by roughly $4.8 billion (20 percent of federal Medicaid dollars to Texas in 2016) in the second year of that law, regardless of whether Texas chose a Block Grant or a Per Capita Cap (also known as per beneficiary allotment). In other words, no matter what went into the complex formula for a state Medicaid block grant or per capita cap, Congress still planned to cut Medicaid funding to all the states below the base year! There is a big difference between “bending the curve” and this enormous cost shift from the federal budget to the state.
To give you a frame of reference, a $4.8 billion cut in federal Medicaid funds would be 48 times larger than the $150 million state dollar 2015 Medicaid Pediatric Therapy Cuts, and four to five times the size of even the massive 2003 Medicaid cuts (the $500 million federal funds annually then was just under 5% of total federal Medicaid funding for 2004).
Texas has many additional worries in a federal Medicaid cut-back, including whether we can keep our 1115 waiver dollars and other funds for hospitals; whether we will be locked in forever to physician and other health professional fees that have not had regular updates for over 20 years; whether we will forfeit an estimated $6 to $8 billion a year in Medicaid Expansion funding that 31 other states have received; and whether we can ever get federal dollars for our remaining uninsured or for over 200,000 Texans with disabilities on waiting lists for community care.
For a full check-list of all the issues and concerns for Texas Medicaid, see this new CPPP guide to understanding Medicaid Block Grant and Per Capita Cap proposals and how they could impact (and damage) Texans’ access to health care. Then follow along with our CPPP team as we analysis the next Congressional proposals as they become official. Then we can all work together to make sure all our elected officials in Austin and Washington know exactly what is at stake for Texas.