If you are middle class, or poor, or sick don’t read this. You may get sick or sicker.

affordablecareact

House Republican leaders on Thursday presented their rank-and-file members with the outlines of their plan to replace the Affordable Care Act, leaning heavily on tax credits to finance individual insurance purchases and sharply reducing federal payments to the 31 states that have expanded Medicaid eligibility.

What does ‘expanded Medicaid’ mean?

ACA Medicaid Expansion – What is it?

The Affordable Care Act (ACA) called for a nationwide expansion of Medicaid eligibility, set to begin in 2014. Under health care reform law, nearly all U.S. citizens under 65 with family incomes up to 138 percent of the federal poverty level (FPL) ($15,415 for an individual or $26,344 for a family of three in 2012) will now qualify for Medicaid.

Some states opted in to expanded Medicaid, some states did not. An interactive map by state of Medicaid and expanded Medicaid recipients is available here.

As of January 2016, 72.9 million people were enrolled in Medicaid and CHIP. Over two-thirds of enrollees resided in states that have implemented the ACA Medicaid expansion.

Between Summer 2013 and January 2016, there was a net increase of nearly 15.5 million or 27% enrolled in Medicaid and CHIP among the 49 states reporting data for both periods. Most of this growth occurred in year one. Most of this growth was in large states in the West that implemented the Medicaid expansion.

Expansion states experienced significantly greater enrollment growth over the two year period, although there was variation across states. States that implemented the Medicaid expansion experienced over three times greater enrollment growth compared to states where the Medicaid expansion is not in effect (36% vs. 12%). Over the period, growth ranged from a high of 95% in Kentucky to slight decline in Wyoming and Nebraska.

Children account for a greater share of total Medicaid and CHIP enrollment in nearly all states that have not expanded Medicaid compared to states that have expanded. Reflecting higher eligibility levels for children, children accounted for a greater share of total Medicaid and CHIP enrollees in non-expansion states compared to states that have implemented the expansion to adults (68% vs. 44%). Read complete report from Kaiser Family Foundation here.

The federal government now pays more than 90 percent of the costs for newly eligible beneficiaries in states that expanded Medicaid. Under the House Republican plan, the federal share would decline to 50 percent in states like New York, New Jersey, Connecticut and California, resulting in a significant loss of federal revenue.

In a number of states that have expanded Medicaid, Republican governors and Republican members of Congress have made clear that they do not like the idea of a block grant or a per-beneficiary allotment.

The Congressional Budget Office says that 12 million people have insurance because they became eligible for Medicaid under the Affordable Care Act, and it estimates that federal spending for this group will be $70 billion this year. This 12 million figure differs from the 15 million reported by Kaiser Family Foundation. The KFF figure is net amount, the CBO doesn’t state how they arrive at their smaller figure.

The House Republican plan would immediately eliminate tax penalties for people who do not have insurance and employers that do not offer it.

It would also eliminate taxes and fees that help pay for the expansion of coverage under the 2010 health care law. These include fees collected from health insurance companies and manufacturers of brand-name prescription drugs and an excise tax on makers of medical devices.

The Republicans are removing any fees or taxes charged medical related companies which went towards providing funding for at least 12 million Americans.  They are also shifting the cost of providing health care away from the federal government and pushing costs onto the states. This means you the lucky taxpayer will have to pony up more cash in the way of taxes or fees or other costs to cover the lost revenue from the federal government.

So if you are middle class, poor, sick or may become ill during the time the Republicans are in office my word of advice to you or your family or your childen is ‘you can’t afford to get sick‘.

Read more about the Republicans health care plans on the New York Times web site. State Mandated Benefits map and legislation information by state.