How AHCA Hurts States That Voted For Trump

The American Health Care Act puts all states at risk financially as it rolls back Medicaid expansion under the Affordable Care Act even in the 19 states that didn’t expand coverage to poor Americans, new reports indicate.

The new “score” of the AHCA, also known as Trumpcare, would cause 23 million Americans to lose coverage by 2026, the Congressional Budget Office said, largely in rolling back the ACA Medicaid expansion that 31 states opted to do. These expansion states are “particularly at risk,” a new report from Fitch Ratings says.

“But even non-expansion states will face budgetary challenges, which will likely accelerate over time,” Fitch said in a new report.

The non-expansion states politically lean Republican and voted last November for Donald Trump in the race for President over Democrat Hillary Clinton. Despite the political ramifications in these GOP-friendly regions, the AHCA narrowly passed the U.S. House of Representatives earlier this month with all Republican votes. Its fate in the U.S. Senate remains uncertain.

Because Medicaid represents one-third of most state budgets, changes to its funding threaten the ability of lawmakers and governors in these localities flexibility in how they provide care for their residents, Fitch contends. The AHCA puts a per-capita cap on Medicaid funding to states in what House Republicans say is a good way to restrain what they see as out-of-control entitlement spending.

But capping Medicaid spending doesn’t account for cyclical changes in employment and other times when state residents enroll in the health insurance program for the poor.

“Imposing capped federal spending shifts the risks for higher costs, whether due to new treatment regimens, health emergencies or other events, away from the federal government and to the states, providers and enrollees,” Fitch’s report said. “Establishing a growth cap on Medicaid spending opens the program up to future reductions through legislative tightening of the growth factor.”

The AHCA cuts $880 billion in spending out of the Medicaid program over the next 10 years. These spending cuts don’t include those proposed by the Donald Trump White House in the fiscal 2018 budget the administration unveiled last week.

Health insurance companies that manage most of the coverage for Americans enrolled in Medicaid are hoping the Senate doesn’t roll back expansion. Insurers say per-capita caps in Medicaid could “disrupt” patient care.

“We are concerned that key components of the proposed new funding formulas in the AHCA–such as the base year selection, annual increases tied to the consumer price index for medical care and applying per capita caps to certain populations–could result in unnecessary disruptions in the coverage and care beneficiaries depend on,” Marilyn Tavenner, CEO of the health insurance lobby, America’s Health Insurance Plans, wrote Thursday in a letter to U.S. Sen. Orrin Hatch, chairman of the Senate Finance Committee.

AHIP represents several key health insurers providing Medicaid benefits such as Centene , Molina, Anthem and other Blue Cross and Blue Shield plans.

“Medicaid health plans are at the forefront of providing coverage for and access to behavioral health services and treatment for opioid use disorders, and insufficient funding could jeopardize the progress being made on these important public health fronts,” Tavenner said.