Proposed GOP-backed Medicaid overhaul concerns advocates

March 13--A Republican-crafted bill that would overhaul the Affordable Care Act has begun making its way through Congress.

But in addition to changing then-President Barack Obama's signature health care law, the legislation also proposes major changes to the Medicaid program, the federal- and state-funded program that insures many disabled individuals, elderly people and children. And that has advocacy groups concerned.

The Affordable Care Act expanded the program to cover more low-income adults.

In Pennsylvania, about 2.8 million people are enrolled in Medicaid, about 700,000 of those are people who were enrolled under the Affordable Care Act expansion, according to state data.

Medicaid also is one of the most costly items in the state's budget, accounting for $25.9 billion -- about $15.2 billion in federal matching funds and $10.6 billion in state funds -- in fiscal year 2015-16, according to the state's Department of Human Services.

Under the proposal, which cleared early procedural hurdles in Washington last week, enrollment for those low-income adults who gained coverage under the Affordable Care Act's Medicaid expansion would start to wind down in 2020.

But the GOP-backed bill, the American Health Care Act, also proposes to restructure how the entire Medicaid program is financed, beginning in 2020 with what are called per capita caps, which would cap spending per enrollee.

Not all of the details of the plan are known yet, such as how much it would ultimately cost or how many people would gain or lose coverage.

A description of the bill from House Speaker Paul Ryan's website says the proposal will allow states to create the Medicaid plans that are best for them.

"Medicaid is not sustainable in its current condition," Mr. Ryan's website states.

A host of advocacy groups, such as those representing hospitals, the AARP and disability groups, have come out against the bill, and some against the Medicaid overhaul in particular.

"This legislation ends Medicaid as we know it," a statement from disability advocacy group The Arc said. "If it is enacted, Medicaid will no longer be a state and federal partnership -- the federal government will cap what it provides, leaving the states to pick up the pieces."

Pennsylvania Gov. Tom Wolf, a Democrat, who expanded the program as permitted under the Affordable Care Act, has vocally opposed the bill.

The proposal would essentially end what is currently an open-ended federal commitment, said Joan Benso, CEO of Pennsylvania Partnerships for Children.

"We've had a 50-year federal handshake that says the children who are eligible for Medicaid by income or disability get the medical services they need, period. And the state pays around 50 percent of that cost and the federal government pays about 50 percent of that cost," she said.

The plan is also risky for children with greater medical needs, Ms. Benso said, as costs could grow to exceed the cap.

Nancy Murray, president of The Arc of Greater Pittsburgh at ACHIEVA, said she was troubled by the speed at which the legislation seemed to be moving to undo a health care program that has existed since 1965.

"You just don't dismantle a good part of the health care system in a couple of weeks. That is what's happening. That's what is so frightening," she said.

Kate Giammarise: [email protected] or 412-263-3909 or on Twitter @KateGiammarise.

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