WASHINGTON — The legislation that Senate Republicans hope to pass next week in a last-ditch effort to dismantle Obamacare would strip away some of the federal funds sent to New York and other states for expanding Medicaid to give to the states that didn’t.
New York would lose $45 billion and California $78 billion, for example, while Texas would gain $35 billion and Georgia $10 billion under the bill’s conversion of Affordable Care Act funds into state block grants from 2020 to 2026, the Avalere consulting firm said.
The Center for Budget and Policy Priorities, a think tank that favors the current health law, said New York State would lose $18.9 billion in 2026 alone. And earlier independent congressional budget analysts said such Medicaid cuts could leave millions more uninsured.
“If you’re in a state which has not expanded Medicaid, you’re going to do great,” said Sen. Bill Cassidy (R-La.), who sponsors the bill with Sen. Lindsey Graham (R-S.C.). “If you’re a state which has expanded Medicaid, we do our best to hold you harmless.”
Graham said the bill gives governors and states control over health care. “I’m trying to take the money and power in Washington and send it back closer to the patient,” he said.
But with that flexibility also comes the challenge of fixing a broken health care system with less money, a task that New York Gov. Andrew M. Cuomo and at least 10 other governors have publicly rejected.
“I would not trade $19 billion for the flexibility. Because if they cut us $19 billion, if I was as flexible as a Gumby doll, we could not fund our health care system,” he said. “It also puts 2.7 million New Yorkers at risk of losing their health insurance.”
The shift in funds is one key part of the bill that Senate Republicans will bring up for a vote next week to beat the Sept. 30 expiration of a budget rule that allows them to pass it with 51 votes instead of the 60 needed to break a filibuster.
The passage comes down to a three or four Republicans. And if it passes in the Senate, it faces a difficult path in the House, said Rep. Peter King (R-Seaford), who opposes the bill because of the funding cuts for New York.
The Graham-Cassidy bill also repeals requirements that individuals buy health insurance and employers offer it, ends subsidies to help people pay premiums, cuts off funding for Medicaid expansion and make significant cuts as its reshapes Medicaid.
“They are designed, these cuts, to hurt states that have expanded Medicaid,” Cuomo said. “To penalize us for doing a better job than other states is a gross unfairness.”
Residents of New York and California, which expanded Medicaid and set up insurance marketplaces, had fared better than people living in Texas and Florida, which opted out of both, according to a March 2017 study by the Commonwealth Fund, which studies health issues.
The 2016 uninsured rate was 7 percent in New York, 10 percent in California, 17 percent in Texas and 19 percent in Florida. And people were less likely to have medical bill problems in New York and California than in Texas and Florida.
Robert Romano, a policy expert at the conservative Americans for Limited Government, supports the bill because it encourages economic growth and creation of jobs that provide health insurance. But he acknowledged states such as New York “might have to make hard choices.”
Bill Hammond, a health care expert at the Empire Center for Public Policy, said he is a free-market advocate but wary of Graham-Cassidy. “They’re throwing up their hands, you fix it. And fix it with less billions of dollars.”