By THE ASSOCIATED PRESS
SEPT. 26, 2017, 1:03
P.M. E.D.T.
With the latest
Republican health care overhaul teetering near collapse, one group in
particular is watching with heightened anxiety.
The debate in Congress
is personal for many of those who gained coverage through Medicaid in the 31
states that expanded the program under former President Barack Obama's
Affordable Care Act.
Alan Purser, who lives
in eastern Arkansas, credits expanded Medicaid with saving his life, after a
routine doctor's visit ended with him being hospitalized and treated for
multiple blood clots in both lungs. The 60-year-old diabetic said he would not
be able to afford his insulin medication because he does not qualify for
traditional Medicaid.
"I am going to be
up a creek if it goes through," he said.
The Medicaid expansion
brought health insurance to some 11 million lower-income Americans, helping
drive the nation's uninsured rate to just 9 percent. That program would have
ended in three years under the initial version of the Republican's latest
health care bill, triggering widespread uncertainty for both recipients and
states facing the prospect of winding down their coverage.
The latest GOP effort
appeared to be doomed late Monday when Republican Sen. Susan Collins of Maine
announced her opposition, citing in part the proposed cuts to Medicaid that she
described as "devastating." With Democrats united in opposition, the
only way Republicans can revive the bill is to alter it in ways they hope will
change opposing senators' minds.
The bill's demise is
welcome news to New Jersey state Sen. Joseph Vitale, a Democrat, who says the
legislation would have been devastating for people who are covered through the
Medicaid expansion. "They can now go to sleep at night like the rest of us
who have health insurance, knowing that if something happens to them or
something befalls a family member," Vitale said Tuesday, "that they
have access to affordable care and quality care."
States signed up for
the Medicaid expansion under the promise that the federal government would pick
up the vast majority of the costs. Experts and officials in several of the
states that opted for it said that under the GOP plan they would not have the
ability to cover the costs of all those who benefited.
"I don't want to
have to look those people in the eye and say you are losing your health
insurance," said Nevada state Assemblyman Michael Sprinkle, a Democrat.
In his state, more
than 300,000 people gained health insurance through the expansion, which
extended coverage to more lower-income Americans by raising the income limit.
Most were adults with no children at home.
Kentucky was another
state seeing big gains under Obama's health care law, its uninsured rate
dropping from 14.3 percent before it took effect to 5.1 percent last year. The
64 percent decline was the largest of any state, according to data from the
U.S. Census Bureau.
Nearly all that gain
was because Kentucky's former Democratic governor opted to expand Medicaid,
which provided coverage to 461,000 Kentuckians. The state also is home to
Senate Majority Leader Mitch McConnell, who is among those leading the
Republican effort to dismantle the law, and now has a Republican governor who
also favors repeal.
John Holbrook, of
Ashland, does not want to see the law repealed. He received substance abuse
treatment under the Medicaid expansion, after being hospitalized with a
dangerously high blood-alcohol level in December 2015.
"I would be dead
or still homeless," said Holbrook, 36, who now works as a peer support
specialist at a private treatment facility that accepts Medicaid. "Working
in recovery, I see it changing lives every day."
The original version
of the GOP bill would end funding for expansion enrollees in 2020, among other
changes that would shift more of the financial responsibility of the $500
billion-plus overall Medicaid program to the states. States already spend, on
average, about 25 percent of their budgets on Medicaid.
Republicans have long
sought to rework the program in an effort to rein in federal spending. But
cutting the program and shifting more responsibility away from the federal
government creates tricky math for the states.
In California, 3.8
million residents gained health coverage under the expansion, and a third of
the state's population is enrolled in Medicaid. Given that, there is little chance
the state program would be able to exist in its current form under the GOP
plan.
A state analysis of a
similar GOP proposal found that California would be on the hook for an
additional $30 billion a year starting a decade from now, and that didn't factor
in the total elimination of federal funding for the expansion population.
"We can't come up
with that kind of money," said Phil Ting, a Democrat who is chairman of
the budget committee in the state Assembly. "It's like picking and
choosing between your thumb and your pinky, what we could protect."
Under the Republican
bill, all the federal money currently being spent in various states on
expansion would be collected, beginning in 2020, into a single pool. It would
include other funding that is being used for subsidies that have helped an
additional 12 million people buy private health insurance through
government-sponsored markets.
That money would then
be shared among all states based partly on how many lower-income adults they
have. Under the initial version of the bill, that additional money would stop
entirely in 2027.
Stephanie McCoin of
Baton Rouge, Louisiana, fears her 27-year-old daughter will be among those hurt
by efforts to undo the Medicaid expansion. She has a chronic adrenal condition,
and at one point before the Affordable Care Act went to emergency rooms eight
times in a little over a month because she couldn't afford insurance.
"I'm afraid that
if she loses this," McCoin said, "she will die."
___
Cassidy reported from
Atlanta. Follow the reporters on Twitter at http://twitter.com/AP_Christina and
http://www.twitter.com/geoffmulvihill.
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