That's the consensus that health care experts reached after a close look at the legislation.
What concerns analysts most is the
While the House bill includes Medicaid changes that are expected to eventually cost the state
But there's no doubt the
- Shrinks federal Medicaid payments to states over time by changing the way they are tied to inflation.
- Includes an "equity adjustment" that reduces funds even more for states such as
- Curbs federal funding for states that expanded Medicaid under Obamacare in a way that will cost
- Preserves the House's controversial Collins-Faso amendment ending the
"It's a bill that will end up being much worse than the House bill," said
Senate Republican leaders defended the measure, including the Medicaid cuts. They argue that under the current way of funding Medicaid, states have no incentive to control costs, meaning they offer increasingly generous health benefits to an increasing number of people.
The changes in the
Tighter caps on fed funding
Some of the Medicaid changes would roll out more slowly under the
Both bills replace the current system of federal Medicaid subsidies -- which is largely open-ended and dependent on how states structure their Medicaid programs as well as how many people enroll -- with per-capita caps on federal funding.
The result: Over the years,
On top of that, the
"Based on 2014 spending numbers,
Lower subsidy for Medicaid
Then there's the matter of the state's Medicaid expansion. Under Obamacare, states were allowed to expand Medicaid to people just above the poverty line. And while both the
In contrast, the
Adding it all up, the
"This would be the biggest assault on a social insurance program in American history," he said.
Shifting cost from upstate counties and LI to state
And it would be an especially complicated change in
Those counties currently pay about a 13 percent share of Medicaid, and shifting those costs onto the state would boost the state's expenses by
That's because the five boroughs of
Collins and Faso opted not to include
"It would be a knotty, complicated, divisive issue for the legislature to deal with," Hammond said.
No penalty for being uninsured
If something similar to the
While most people get their health insurance through their employer or from the government, the
Most notably, the
That could disrupt the individual market, said
In addition, Rifkin said the
"We can't sell our health plans for less than they cost," she said. "The premiums have to equal the cost of the medical expenses. The only thing we can do is try to reduce the cost of care."
State plans could dry up
Most notably, under both bills, the state's Essential Plan -- aimed at people who earn just a little bit more than those on Medicaid -- would likely dry up with the federal funding that supports it, Hammond said. That means the people currently on that plan would either have to get more expensive insurance on the private market or go without.
The same thing could happen to Medicaid recipients if the state decides to end its Medicaid expansion to cope with the cuts in federal funding. That's just one of the likely ramifications if the
"Many states would be forced to kick low-income and disabled people off their health care coverage once federal funding for the Medicaid program is cut, as this
"Medicaid is a lifeline that allows people with developmental disabilities to live in the community close to their family and friends and not in some institution somewhere," she said. "People are wondering what all of this means and are concerned."
News medical reporter
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