States wouldn’t be able to remake their health-care systems if Obamacare is repealed under the Graham-Cassidy legislation that the Senate may vote on next week.
“In Graham-Cassidy, they’re kind of envisioning, within the next two years, literally every state would just create this infrastructure and architecture of a brand new way of doing things,” Dan Meuse, deputy director of state health and value strategies at the Robert Wood Johnson Foundation, said at a Bloomberg Government conference I covered.
That would be impossible, he said.
The plan to replace Affordable Care Act funding with a new block grant to states, and cap federal Medicaid payments, would reduce federal funding for states by $160 billion from 2020 to 2026, according to a report from the Kaiser Family Foundation.
Plans by many states to apply for waivers of major provisions of the ACA under Section 1332 of the law are on hold as the Senate prepares to vote on Graham-Cassidy.
Many states are considering applying for a reinsurance program to cover high-cost claims similar to a program devised by Alaska, which received approval for its waiver in July. The program is expected to save federal money that would have been spent on ACA premium tax credits and it reduced 2017 premium increases from 42 percent to 7 percent.
States want more flexibility to implement the ACA 1332 waivers, such as by combining them with Social Security Act Section 1115 Medicaid waivers. That could enable states to set up programs to help low-income people with housing, food and jobs, which can have a big effect on peoples’ health, Matt Salo, executive director of the National Association of Medicaid Directors, said at the conference.
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