Tinkering with bad bill

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The health bill passed by the House would effectively end the Affordable Care Act’s (ACA) expansion of Medicaid and cause millions to lose coverage, according to reports released today from the Center on Budget and Policy Priorities. Delaying or phasing in the House bill’s massive cost shifts to states, as the Senate is reportedly considering, would have no effect on the ultimate outcome.

The House bill is estimated to shift $155 million in costs to West Virginia, roughly equal to the amount West Virginia spends to support West Virginia University and Marshall University annually. West Virginia would almost certainly be unable to absorb these additional costs, especially amid on-going budget deficits. As a result, West Virginia would likely be forced to end its expansion, leaving 169,000 low-income adults who have gained Medicaid coverage under the expansion at severe risk of becoming uninsured.

As the Senate considers changes to the House GOP health bill, some have claimed that phasing the repeal out more slowly or delaying it by two years would avoid these harms. But neither of these proposals change the ultimate outcome: a huge cost-shift to states ending the Medicaid expansion and causing millions to lose coverage.

“It doesn’t matter if you end the Medicaid expansion in two years or four years, or if you do it quickly or slowly – the bottom line is that West Virginia gets hit with massive costs and well over a hundred thousand West Virginians will lose the health coverage they need,” said Ted Boettner, Executive Director of the West Virginia Center on Budget and Policy. “Senator Capito and Senator Manchin must stand up and reject any health bill that ends the Medicaid expansion no matter the timing. Anything less would threaten the historic gains in health coverage and access to care that we have achieved under the expansion.”

Other proponents of the House bill have suggested that people who would lose expansion coverage could instead purchase private coverage on their own using the House bill’s tax credits. That is false, the new reports show. Low-income adults would face unaffordable premiums if the expansion were repealed, even after taking the House bill’s tax credits into account. For example, premiums after tax credits for West Virginians in poverty would be equal to 34 percent of their income for 45-year-olds and would exceed as a share of total income for 60-year-olds by 104 percent. And that’s without taking into account provisions in the House bill that would let insurers go back to charging people with pre-existing conditions exorbitant premiums, stop covering critical services like mental health services and substance use treatment and imposing annual and lifetime limits.

“Tinkering around the edges of a bad bill won’t solve its fundamental flaws and West Virginians won’t be fooled by those who claim otherwise,” said Boettner. “Senators Capito and Manchin should call for the Senate to scrap the House bill and focus on bipartisan efforts to strengthen, not dramatically weaken, our health care system.”

(The West Virginia Center on Budget and Policy is a public policy research organization that is nonpartisan, nonprofit, and statewide. The Center focuses on how policy decisions affect all West Virginians, especially low- and moderate-income families.)