The House Republican health plan is seriously flawed. Because it would repeal or severely weaken health reform’s coverage expansions, force people to rely instead on a badly flawed tax credit to buy coverage in a largely unregulated individual market, weaken or end key measures to protect consumers in that market, and restructure and substantially cut Medicaid over time, millions of Americans would likely lose their existing health coverage — with many of them likely ending up uninsured or underinsured.
The Medicaid changes raise particular concern. Not only would the plan bar any more states from taking health reform’s Medicaid expansion, but it would sharply reduce the federal share of Medicaid costs for beneficiaries covered under the expansion in states that have taken it — likely driving many such states to drop it in coming years. On top of that, the plan would force each state to accept the conversion of its Medicaid program to a block grant or to a program with rigid caps on federal funding provided per beneficiary (i.e., a “per capita cap”). While this part of the plan lacks full detail, the budget that the House Budget Committee’s Republican majority adopted in March includes a virtually identical proposal — and it was designed to shrink federal Medicaid funding for states by $1 trillion over the next ten years. That would almost certainly prompt states to impose substantial Medicaid cuts to offset their large federal funding losses.
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