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Senate health care bill would cut billions of federal aid to Md.

Carmela Coyle, president of the Maryland Hospital Association. (File)

Carmela Coyle, president of the Maryland Hospital Association. (File)

The current Republican proposal to replace the Affordable Care Act could cost Maryland billions of dollars, lead to more uninsured and undermine the state’s unique hospital payment system, state health advocates and policy leaders are warning.

The proposal, led by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana would end Medicaid expansion and individual market subsidies while replacing those funds with a block grant system.

According to a Kaiser Family Foundation analysis, Maryland would lose more than $2.5 billion by 2026. After 2026, the funding for the block grants would expire and the state would lose another $3.8 billion in 2027 if the funding is not renewed.

Ending Medicaid expansion in Maryland would also disenroll the 310,000 low-income adults who gained coverage through the Affordable Care Act. The Maryland Hospital Association said another 160,000 who gained health insurance from a previous expansion in Maryland could be at “serious risk” of losing their insurance as well.

“High-quality, efficient health care simply cannot be achieved without broad-based continuous coverage, which would be drastically reduced under this proposal,” said Carmela Coyle, president and CEO of the hospital association, in a statement. “Reductions of this magnitude inhibit hospitals from getting people the right care, at the right time, in the right setting, which in turn reduces people’s chances to live healthier lives.”

The Congressional Budget Office, the nonpartisan agency that reviews the fiscal effects of legislation, expects to release a partial analysis of the bill next week. But it will not assess how the bill would affect coverage losses because it does not have enough time before the Senate votes. If the Senate wants to pass the legislation with only 50 votes under budget reconciliation rules, it must vote by Sept. 30.

Still, health officials in the state warned that Maryland would see coverage losses as a result of the legislation.

Dr. Leana Wen, the Baltimore City health commissioner who practiced as a physician before and after the Affordable Care Act, said it could bring the state back to a time when people could not afford necessary medical coverage.

“I find it unconscionable that we are choosing to go back to a time when people were dying because they could not afford health coverage,” she said. “We are choosing to go back to that time by having this proposal on the table. It is disappointing and extremely worrisome.”

In addition to the loss of Medicaid expansion, the block grant system could prove difficult for the state as well. Under the bill, states would have until 2020 to set up a system to use the block grant or risk losing the funding.

The idea of the legislation is to allow states to have more control over the federal dollars they get for health care. But Wen said that control will not amount to much with fewer federal funds available. Furthermore, she said, additional costs would be passed on to patients.

“What’s challenging about this bill is that the rhetoric sounds good,” she said. “It sounds good to talk about giving power and autonomy to the states. But look just a little bit deeper and we see that that autonomy comes with a heavy price tag, a price tag that states are not prepared to pay.”

Finally, the ramifications of the Graham-Cassidy bill for Maryland’s unique global budgeting system for hospitals remain unclear. The hospital association said there have been no indications about what would happen to the model, which was authorized under the Affordable Care Act.

But Coyle cautioned that cutting the Medicaid expansion could be just as damaging as removing the model statutorily.

“The loss of broad-based coverage also jeopardizes Maryland’s unique hospital payment system, which has benefited the state, insurers, patients and communities by shifting from volume-driven to value-driven care,” she said. “But without health care coverage, this system, which is containing costs as well as improving patient outcomes, is unsustainable.”

This latest attempt to amend the Affordable Care Act comes after the exchange set up by the law to sell health plans to individuals saw increased volatility. Premiums next year will rise significantly for enrollees, and an insurer left the market.

A second insurer, Evergreen Health, was initially created as a co-op under the Affordable Care Act, but collapsed, joining most of the co-ops created in other states under the law.

Still, Gov. Larry Hogan said the plan under consideration in the Senate would not help fix the problems and would not work for Maryland.

“Unfortunately, the Graham-Cassidy bill is not a solution that works for Maryland,” he said in a statement. “It will cost our state over $2 billion annually while directly jeopardizing the health care of our citizens. We need common-sense, bipartisan solutions that will stabilize markets and actually expand affordable coverage.”

While Hogan, along with the hospital association, the state medical association and other health care groups have opposed other repeal-and-replace plans in Congress over the past year, two additional groups joined the opposition this month.

The Blue Cross Blue Shield Association and America’s Health Insurance Plans, a political advocacy group representing health insurers, came out in opposition to the Graham-Cassidy plan earlier this week. America’s Health Insurance Plans said the legislation would destabilize the insurance market and open the door to a single-payer system in some markets.


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