CBO Paints Grim Medicaid Picture as Senate Delays Health Care Vote

Faced with growing dissent from both the conservative and moderate wings of his own party, Senate Majority Leader Mitch McConnell delayed a vote on the Republican plan to repeal and replace Obamacare — one day after the Congressional Budget Office foresaw a dark future for Medicaid under the bill.

McConnell announced Tuesday that the Senate would wait until after the upcoming July 4 holiday to vote on its Better Care Reconciliation Act, proving wrong predictions that the legislation was on pace to pass prior to Independence Day.

The move comes as Washington and the general public continue to digest the contents of the nonpartisan CBO’s report about the effects of the bill. While the office’s assertion that 22 million people would lose coverage by 2026 under the Senate’s version of Trumpcare — just 1 million fewer than would be uninsured under the House’s plan — grabbed headlines Monday and Tuesday, the full report also confirms dire predictions about Medicaid coverage.


Funding for the program, the largest payer for skilled nursing services, would be slashed by $772 billion over the next decade, more or less in line with the House’s plan to shed more than $800 billion from Medicaid funding.

“The largest effects on spending under this bill would be for Medicaid,” the CBO noted.

By 2026, the Senate health plan would result in 15 million fewer Medicaid enrollees than projected under current law, both through the switch from open-ended funding to per-capita caps and by rolling back expanded eligibility offered in some states under Obamacare.


The legislation would actually give states two options — a lump-sum block grant and the per-capita cap, which provides a set amount of per-enrollee funding — but the CBO claims that states would be unlikely to choose the former option.

“Because this option would be attractive mainly to a few states that expect to decline in population (and not in most states experiencing population growth, as it would further constrain federal reimbursement), CBO expects this option would have little effect on enrollment in Medicaid,” the office wrote.

As American Health Care Association president Mark Parkinson noted in his comments to reporters on Monday, making definitive predictions about the exact impact of these Medicaid cuts on SNFs is difficult on a nationwide scale, as different states could craft varying responses to the cuts in federal funding.

“Other ways in which Medicaid spending caps affected enrollees would depend greatly on how states responded to the caps, which would be affected by the particular structure of their program,” the CBO said, adding that states could potentially find efficiencies that would result in largely uninterrupted care. “If states chose to leave their Medicaid program unchanged and instead found other ways to offset the loss of federal funds, enrollees would notice little or no change in their Medicaid coverage.”

Still, according to the AHCA’s predictions, individual SNFs would lose an average of $600,000 in funding per year by the 2030s under the plan, well more than most facilities make annually.

GOP leadership did not provide a timeline for a future vote on the legislation, but Republican senators were expected to meet with President Trump Tuesday afternoon. House Speaker Paul Ryan had similarly pulled an initial version of the American Health Care Act from a floor vote before introducing and eventually passing that chamber’s proposal to repeal Obamacare in May.

Written by Alex Spanko

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