House Republican plans to repeal the new healthcare law and to convert the Medicaid insurance program into a block grant to states could force as many 44 million poor and disabled Americans out of the program over the next decade, according to a new analysis by the nonprofit Kaiser Family Foundation.
Hardest hit would be states, many in the South and West, that have not built up their healthcare safety nets in recent years.
These states would have received a large influx of federal money in the healthcare law President Obama signed last year. In 2014, the law will make all Americans making less than 133% of the federal poverty level eligible for Medicaid.
The House GOP plan, authored by Budget Committee chairman Paul Ryan (R-Wis.), would eliminate that expansion and also slash $750 billion in federal spending on Medicaid over the next decade. The plan was approved by the House last month, though it is not expected to pass the Democratic-controlled Senate.
The Medicaid program, which insures more 50 million poor and disabled people, is jointly funded by the federal government and by the states, each of which operates a slightly different program.
Because of these differences, the cuts to each state would vary widely, according to the analysis of Ryan's plan.
Florida, for example, could see a 44% cut in federal funding for its Medicaid program by 2021, the report concludes.
Other states projected to see major cutbacks in federal aid include Wyoming, Alaska, Colorado, Georgia, Oregon and Nevada.
Nationally, the Kaiser report estimates that federal assistance for Medicaid will drop 34%. Illinois, with a projected 32% cut, and California, with a 31% cut, are expected to suffer relatively less than some other states.
Least affected would be Washington, Vermont, Minnesota, the District of Columbia and Iowa.
Many states are already struggling to hold together their Medicaid programs while trying to balance budgets and deal with millions of new enrollees who signed up for the insurance program during the last recession.
Ryan has touted his budget plan as a way to preserve Medicaid by offering states more flexibility to wring savings from their programs. "States will no longer be shackled by federally determined program requirements and enrollment criteria," he said of the block grants.
But many experts -- including the nonpartisan Congressional Budget Office -- have concluded that House budget proposal would more likely simply result in major cutbacks.
"The repeal of the ACA combined with the adoption of the Medicaid block grant would add millions more to the number of uninsured Americans and compromise Medicaid's role as the health safety net in the next recession," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured.
The commission produced the report in conjunction with the Washington, D.C.,-based Urban Institute.
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