In a report released on Monday, the Congressional Budget Office and the staff of the Joint Committee on Taxation estimated that the House Republicans’ American Health Care Act would increase the number of uninsured Americans by 24 million over the next 10 years, result in big reductions in assistance for lower-income consumers who purchase insurance on state or federal exchanges, and lead to a precipitous 25 percent drop in federal funding for Medicaid over 10 years. CCLP’s fact sheet covers the details.
The short-term changes from the Act would be significant. With 14 million Americans projected to be uninsured just one year from now, approximately 238,000 more Coloradans could lose or forgo coverage. The repeal of the mandate to purchase insurance would be one factor in people’s decision-making. Those most likely to drop coverage would be younger Coloradans, while those with greater health needs would have reason to stay in. When carriers have to pay more for a typical enrollee, they raise premiums. That shift in the health status of those who are covered is projected to increase premium rates in 2018 and 2019 by 15 to 20 percent. These and successive drops in coverage will return Colorado to a scenario where hospitals must cover increasing amounts of uncompensated care, and that drives up costs for everyone.
The major changes to the market and Medicaid would begin in 2020. Premium assistance would be too meager to allow those with less income to purchase and use coverage — especially in more expensive areas like the Western Slope. Older Coloradans would have to pay more than five times the premium cost of younger residents, and would get only twice the amount of premium assistance, leading to particularly high rates of drop-out. Areas that have higher percentages of residents ages 50-64 would suffer, such as the southwest and northwest corners of the state. Although skimpier plans may result in lower premiums, those who get medical care will have to wrangle with higher deductibles and cost-sharing.
But the big story is Medicaid. Health First Colorado, our state Medicaid program, could lose 25 percent of its funding by 2026 because of changes in the way federal funding is provided through the plan. Instead of a flexible matching system that allows Colorado to respond to need, the Act would impose a system that caps per enrollee spending and limits the annual growth of that per-capita cap. A funding cut of that size would require dramatic reductions in benefits to children, the elderly, people with disabilities, and parents.
For adults who received coverage from the Medicaid expansion–those without children as well as parents who make over 66 percent of the federal poverty limit – the cuts would be much deeper. Instead of covering almost all expansion costs, the federal government would give Colorado no more than 50 percent for new adult enrollees and adults who temporarily lost Medicaid coverage and reenrolled. To cover those individuals, Colorado would have to kick in roughly $800 million a year. More likely, Health First Colorado would have to drop many of these adults altogether. Furthermore, expansion dollars are a primary source of funding in the battle against opioid addiction, and the loss of those funds would hamper those efforts.
What is left unsaid in the CBO report is the effect on state and local economies. Coloradans with higher incomes will get hefty tax breaks while older Coloradans, rural Coloradans and lower-income Coloradans will feel the impact of the new, inadequate tax credits. Tens of thousands would lose Medicaid. Colorado won’t benefit from a system that reduces jobs in the health sector, that threatens to shutter rural hospitals, and that endangers the health of working Coloradans.
To ensure that Coloradans continue to have access to quality, affordable health care, please make your concerns known to members of Colorado’s Congressional delegation. You can also learn how to get involved through the Protect Our Care Colorado website.
– Bethany Pray