Repeal Bill Threatens Texas Medicaid

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Last week’s Congressional Budget Office (CBO) official “score” for the House’s ACA Repeal bill found that it would cut Medicaid spending by 880 billion over 10 years, with 14 million fewer Americans receiving Medicaid coverage in 2026 than under current federal law. The bill also slashes today’s tax credit subsidies for health insurance by 44%, with seniors, older adults, and rural Americans taking the brunt of the impact.  CBO projects that the combined impact of the Medicaid and private insurance cuts would be 14 million fewer Americans insured in 2018, increasing to 24 million fewer in 2026: a complete reversal of the coverage gains the country has seen under the ACA.

Here is CPPP’s newest list explaining the major Medicaid changes the U.S. House will likely vote on this week, noting the specific problems and impacts for Texas (note: this brief covers the latest changes to the bill announced late Monday 3/20, which made the Medicaid provisions harsher, not better for Texas).  To recap the top Medicaid concerns with the repeal bill:

  • Under the proposed Per Capita Cap, if Texas makes errors in predicting and budgeting for Medicaid spending in an upcoming year and our federal funds are inadequate, our Legislature’s history indicates they will cut benefits, payment, or enrollment in response—not fill the gap with state funds—to pay for the federal recoupment of funds.
  • Rigid use of a 2016 Medicaid spending for a “base year” will lock Texas and other states into permanent inadequate provider networks.
  • If the make-up of Texas Medicaid enrollees in one of the four Per Capita Cap enrollment groups changes over time to have more intensive needs—e.g., for our elders or Texans with disabilities—we will be unable to meet their needs, and it will take an act of Congress to fix a too-low funding cap.
  • Limits to 2016 benefits also make our Medicaid funding allocation too low to allow us to adopt best treatment practices and standards of care without first cutting elsewhere.

Read the brief to learn more about these four points, and more, including:

  • Roll-back of Medicaid Expansion;
  • Allows Texas to roll back Medicaid eligibility for kids;
  • Medicaid expansion possible still, but no enhanced match in future years. Still, Texas will lose billions each year if we do not move ahead, locking in a system with no coverage option for working poor adults.
  • Cuts federal funds for Attendant Care under Community First Choice;
  • Eliminates Medicaid “3-months prior” coverage, which is a safety net back-up for state Medicaid eligibility system failures, and also hits hospitals and enrollees; and
  • Locks Texas into inadequate provider payment rates, creating a fund to address rates that is far too small to meet Texas’ needs.

Click here to learn more about what’s at stake for Texas Medicaid.

TAKE ACTION – ACA repeal and Medicaid Block Grants

Speaker of the House Paul Ryan is aiming to hold the vote on the federal health care repeal bill on Thursday March 23 if he can count up enough votes to support it. It’s going to come down to a handful of votes. So now is the time to call Congress at 866-426-2631, alert your friends, get on social media, visit the local office for your member of Congress, or raise your voice in your own way. Visit here for more information on the detrimental ACA repeal and the House health care proposal.

Anne Dunkelberg oversees health care policy for CPPP. She focuses on policy and budget issues related to health care access and immigrants’ access to public benefits. She joined the Center in 1994 from the State Medicaid Director’s Office at the Texas Health and Human Services Commission. Anne is a founding member of the statewide Children’s Health Coverage Coalition (formerly the Texas CHIP Coalition) and the Cover Texas Now Coalition. She has been recognized by Families USA as an outstanding Consumer Health Advocate and by the LBJ School of Public Affairs Alumni Association as a Distinguished Public Servant. She was the primary author of the first edition of Texas Medicaid in Perspective (“the Pink Book”) and serves on the Texas Medicaid Managed Care Statewide advisory committee and the Texas Healthcare Transformation Waiver Executive Waiver Committee. Anne is a native Texan, and received her B.A. from the University of Texas at Austin, and her M.P.A. from the LBJ School of Public Affairs at the University of Texas at Austin.

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