WASHINGTON – As Republicans made a last-ditch push to replace Obamacare with a new GOP proposal, Ohioans jammed Sen. Rob Portman's phone lines to weigh in –with 9,000 callers dialing the Ohio GOP senator's office on Wednesday alone.
It's no wonder, given what's at stake. The new Republican bill could cost Ohio as much as $9 billion over a decade, and it would end the state's controversial expansion of Medicaid.
Like other states, Ohio would also gain new flexibility in determining how to spend the federal money it receives under the Senate bill, crafted by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La.
The Graham-Cassidy bill could come up for a vote in the Senate as early as next week, and there are still more questions than answers about the proposal's fate and its impact.
But here are four ways this new proposal would affect Ohioans:
Fewer regulations, protections
The Graham-Cassidy bill unravels most of Obamacare’s requirements and relaxes some of its consumer protections.
Ohio employers would no longer be required, for example, to offer insurance to their workers. And individuals would not face a tax penalty if they decided to forgo insurance.
The measure would also allow states to:
• Evade protections for those with pre-existing conditions, by letting insurance companies charge sick patients more than they currently can under Obamacare.
• Set their own minimum standards for insurance plans, excluding coverage, for example, of maternity care or substance abuse treatment.
The Graham-Cassidy bill calls for scrapping the Affordable Care Act’s subsidies and Medicaid expansion, both aimed at helping low-income Americans gain coverage. Instead, that money would flow directly to the states in the form of block grants, which they could use to design their own health care initiatives.
Graham-Cassidy would also transform traditional Medicaid, a joint state-federal health care program, by giving states a limited per-capita allotment to cover beneficiaries instead of paying a percentage of the state’s overall Medicaid costs.
Overall, Ohio would lose $9 billion from 2020 through 2026 under the bill, according to an analysis by Avalere Health, a consulting firm. Estimates from the Kaiser Family Foundation, a nonpartisan health policy organization, put Ohio’s shortfall at $6 billion over that same time period.
Both organizations projected that Ohio, along with almost every other state, would face a “funding cliff” starting in 2027, when funding for the block grants ends. If Congress did not renew the grant money, Ohio would face a shortfall of $7.5 billion in that year alone, according to the Kaiser analysis.
Obamacare allowed states to expand Medicaid to cover low-income childless adults, with the federal government paying most of the cost for those new enrollees. Ohio took advantage of that provision, with about 700,000 residents gaining access to health care as a result.
The Graham-Cassidy bill would kill the Medicaid expansion by prohibiting states from covering low-income childless adults under that program. States could use their block grant money on other initiatives aimed at covering their high-risk and low-income populations.
There are no state-specific estimates of the Graham-Cassidy bill’s impact on the number of uninsured. Supporters of the Graham-Cassidy bill argue it would allow local policymakers to innovate and come up with cost-effective coverage.
“We’re giving states more flexibility to design programs that meets our needs,” said Portman, who will be a critical vote in determining the bill's fate. Portman said he’s still reviewing the legislation but likes the general approach.
Critics say it would result in millions of people losing their insurance, especially those who are most vulnerable.
“It has no guardrails to protect people who are the mentally ill, the drug addicted, the chronically ill,” Ohio Gov. John Kasich’s said in a Sept. 20 appearance on MSNBC. Kasich’s staff is doing its own assessment of the proposal’s impact on Ohio.
The opioid crisis has ravaged Ohio families, and many advocates say cutting Medicaid would severely undermine efforts to get people into treatment.
The Graham-Cassidy bill cuts Medicaid in two ways, first by ending the expansion and second by limiting the federal share to a per-capita cap. An estimated 150,000 Ohioans who suffer from addiction gained insurance through the Medicaid expansion, and they could be at risk of losing that coverage under the bill.
In addition, Kaiser concluded that states with high-health care needs – “like those hardest hit by the opioid epidemic” – could confront tough choices under the proposed caps on Medicaid spending.
“ ... With substantially reduced federal funding, states would face difficult choices: raise revenue, reduce spending in other areas, or cut Medicaid provider payments,” Kaiser stated in an analysis focused on the Graham-Cassidy Medicaid changes.
A previous GOP Obamacare replacement bill included $45 billion in extra funding for opioid treatment to offset cuts to Medicaid, a provision pushed by Portman and others. The Graham-Cassidy bill does not include any new funding to combat the opioid epidemic.