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Report projects 22 million Americans will lose insurance under Senate health bill, unlikely to sway Heller

Megan Messerly
Megan Messerly
CongressHealth Care

A nonpartisan analysis projecting that the Senate’s bill to repeal and replace the Affordable Care Act will result in 22 million Americans losing health insurance by 2026 is unlikely to sway Republican Sen. Dean Heller, who said Friday he could not support legislation that removes large swaths of Americans from the nation’s health care rolls.

The report by the Congressional Budget Office released Monday projects that 22 million Americans will lose health insurance by 2026 under the Better Care Reconciliation Act, only slightly fewer than the 23 million who would’ve lost insurance under the House’s version of the bill, the AHCA. The analysis projects the legislation will reduce the federal deficit by $321 billion over the next decade, $202 billion more than projected under the House bill.

The CBO report is expected to alleviate some concerns raised by the conservative contingent of the party that opposes the current version of the Senate bill — Sens. Rand Paul of Kentucky, Ron Johnson of Wisconsin, Ted Cruz of Texas and Mike Lee of Utah — who thought the legislation didn’t go far enough in its efforts to undo the ACA. But it is unlikely to appease Heller, who stood alongside Republican Gov. Brian Sandoval at a Friday press conference and vowed to vote against the legislation in its current form.

“Barring significant changes from the Congressional Budget Office, this bill will mean a loss of coverage for millions of Americans and many Nevadans,” Heller said on Friday. “I’m telling you right now I cannot support a piece of legislation that takes insurance away from tens of millions of Americans and hundreds of thousands of Nevadans.”

Heller said the legislation does not protect Nevadans on Medicaid and the most vulnerable individuals in the state, threatens critical services in Nevada, will result in millions of Americans losing coverage and is not likely to lower the cost of health care coverage. The Senate bill phases out Medicaid expansion under the Affordable Care Act — which Nevada opted into in 2012 — starting in 2021 and caps future federal funding per enrollee based on how much states have spent historically on Medicaid.

The House’s version of the health care bill, the AHCA, would have immediately rolled back Medicaid expansion and, like the Senate bill, cut the program as it existed prior to the ACA by limiting reimbursements to states. The CBO estimated that the AHCA would result in 14 million fewer people being covered by Medicaid.

Heller’s office did not respond to repeated requests for comment about the CBO report Monday afternoon, but Democratic members of Nevada’s Congressional delegation immediately slammed the legislation. Democratic Sen. Catherine Cortez Masto said the report was “appalling” as Republicans “continue their despicable mission” to repeal and replace the ACA.

“I stand with the 400,000 Nevadans who are at risk of losing their healthcare due to this reckless bill,” Cortez Masto said in a statement. “We will continue to speak out before this bill – a tax cut for the wealthy masquerading as a healthcare bill that cuts funding for the poor – can do any real damage.”

The biggest projected savings under the report would come from cuts to the Medicaid program and from changes to the subsidies people receive for securing coverage under the nongroup market. The CBO projects that enrollment in Medicaid would fall by about 16 percent and, coupled with removing the penalty for not having insurance, would lead to an estimated 49 million Americans being uninsured, compared to 28 million under current law; 47 million Americans lacked health insurance when the ACA was signed into law in 2010.

Sandoval, who was the first Republican governor to commit to expanding Medicaid under the Affordable Care Act in December 2012, said on Friday he felt he had made a “personal commitment” to the newly eligible population and promised to fight to maintain insurance coverage. If the Senate version of the bill passes, Nevada would need to find approximately $480 million to continue existing levels of coverage, Sandoval said.

The governor’s chief of staff Mike Willden, who previously headed the state’s Department of Health and Human Services, recently said the state has a plan to cover cuts made to the pre-ACA Medicaid population but deciding what to do with 276,000 additional Nevadans who now receive Medicaid coverage under the expansion would be a difficult decision for lawmakers.

The expansion, which went into effect in Nevada in January 2014, extended Medicaid eligibility to nearly all low-income individuals with incomes at or below 138 percent of the federal poverty level, filling in the gap in eligibility for childless adults. In total, thirty-one states and Washington D.C. opted to expand Medicaid, allowing more than 11 million newly-eligible people to be covered under the program.

Sandoval’s decision to opt in to the federal expansion took Nevada’s overall uninsured rate from 23 to 12 percent and the percent of uninsured children from 18 percent to 8 percent. More than 630,000 Nevadans were covered under Medicaid in November 2016, a number that’s projected to increase to 680,000 by mid-2019, if the ACA stays in place, with the costs for those newly eligible enrollees is almost entirely covered by the federal government.

For the newly-eligible Medicaid population, the federal government covered 100 percent of Medicaid payments in the 2014-16 fiscal years, dropping to 97.5 percent in fiscal year 2017 and 94.5 percent in fiscal year 2018. Under the status quo, the federal share of Medicaid payments will continue to decline slightly each year until it reaches 90 percent in 2020, where it will remain.

The state’s Medicaid budget in fiscal year 2016 was $3.4 billion, including $1 billion for more than 200,000 newly-eligible childless adults, $850,000 million for 300,000 moms and children and $750 million for roughly 70,000 aged, blind and disabled individuals. Currently, Nevada receives $1,437 from the federal government per resident, including $873 in Medicaid funding.

Photo: Senator Dean Heller speaks with media inside the Grant Sawyer State Office Building in Las Vegas on Friday, June 23, 2017. Daniel Clark/The Nevada Independent


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