The House Republican plan to overhaul Obamacare would cost Ohio $19 billion to $26 billion in federal funding for Medicaid over six years, according to an analysis released today by the Center for Community Solutions.
The massive cuts, the Ohio-based research group concluded, would lead to substantial reductions in eligibility, services, or payments to health-care providers in the tax-funded health insurance program serving more than 3 million poor and disabled people, or 1 in 4 Ohioans. . . .
The largest decreases would be in federal aid for children, the disabled, and adults, and those losses would increase if enhanced reimbursement for the Medicaid expansion population is ended earlier, as some in Congress and President Donald Trump are proposing. For example, monthly funding for a child enrolled in Medicaid would drop 21 percent under proposed funding caps and by a third for adults.
That’s quite a payback to a state that elected Trump by about 8 points. If such a calamitous bill passed does anyone think Ohio Republicans at the state level would push for massive tax cuts to cover the shortfall?
Likewise, using the Kaiser Family Foundation figures, the Los Angeles Times found: “Most affected by the Republican health plan would be parts of Alaska, Arizona, Nebraska, Tennessee and Oklahoma, where Obamacare insurance subsidies have been crucial in making high-priced insurance affordable. All five states went for Trump. Also hit hard would be parts of key swing states that backed Trump, including Pennsylvania, North Carolina and Michigan.” If someone set out to devise a plan to hit Trump voters the hardest it would be difficult to come up with something to match House Republicans’ plan:
In 27 Nebraska counties — all of which backed Trump — a 60-year-old shopper with a $30,000 income would see financial aid drop by $12,950 a year under the House Republican legislation.
The annual subsidy in 22 counties in Oklahoma, another Republican stronghold, would plummet by $11,970. Trump won all but one of the counties by more than 28 percentage points. . . .
In Berks and Lancaster counties, west of Philadelphia, subsidies would drop by $9,500. Trump narrowly won both Pennsylvania counties.
And in western North Carolina, which helped power Trump’s victory in that state, subsidies would fall by more than $10,000.
If, somehow, the bill were to get through both the House and Senate, voters in many of these states — those adversely affected by the GOP plan, those confronted with state tax hikes to compensate for the GOP plan’s limits on federal funding and those bombarded by stories of hardship inflicted by Trumpcare — likely would conclude that they were conned in 2016. Trump’s blue-state, Rust Belt coalition would crumble and congressmen and senators who voted for the bill would be hard-pressed to explain how they could support such a bill.
Trump’s red states would fare poorly as well according to a study by the generally liberal Center on Budget and Policy Priorities, which found as an illustrative example a chasm between ACA subsidies and AHCA tax credits for a 45-year-old with income of $22,000 living in Alaska:
Under the ACA, consumers at this income level pay 5.38 percent of income for benchmark coverage, or $1,200 per year. Premium tax credits make up the rest: $14,000 in Alaska, $6,900 in Wyoming, and $3,300 in Indiana. In contrast, under the House plan, all three consumers would receive tax credits of $3,000. That leaves the Indiana consumer paying the remaining $1,500 in annual premiums — an increase compared to current law, but a small one compared to the Wyoming consumer, who would face a net premium of $5,100 after tax credits, or the Alaska consumer, who would pay $11,800 (assuming no changes in pre-credit premiums). . . .
The average tax credit in high-cost states would fall sharply under the House plan. Enrollees in 11 states would see their tax credits cut by more than half, and people in seven states — Alaska, North Carolina, Oklahoma, Alabama, Nebraska, Wyoming, and West Virginia — would face average credit reductions of more than $4,000. These steep cuts would greatly reduce the affordability of coverage and almost certainly increase the number of uninsured in those states.
All seven voted for Trump in 2016.
Looking ahead to 2018, red-state Democrats who stood up to Trump in opposing the ACHA most likely would be rewarded by voters, thereby undermining the GOP’s goal of expanding its narrow 2-seat majority in the Senate. At least one Republican would be very much at risk. We know that since Sen. Dean Heller (R-Nev.) already is distancing himself from the bill. (“Sen. Dean Heller panned House Speaker Paul Ryan’s bill to repeal and replace Obamacare during a closed meeting with constituents on Saturday, according to audio obtained by POLITICO.”)
Trumpcare in the aggregate looks like a bad bill. When you get down to a state-by-state analysis, however, the true awfulness of Trumpcare (both on a policy and political basis) should stun members of Congress, regardless of party.