Vice President for Health Policy
The Senate bill to repeal the Affordable Care Act (ACA), which would effectively end the ACA’s Medicaid expansion starting in 2021 and convert the program to a per capita cap starting in 2020, would cut federal Medicaid spending and enrollment more in 2026 than the House-passed bill, Congressional Budget Office (CBO) estimates show.
All told, the bill would cut federal Medicaid spending by $772 billion over ten years. By 2026, the annual spending cut would grow to $158 billion — or 25 percent — relative to current law, CBO finds. That’s $8 billion larger than under the House bill. As a result, Medicaid enrollment would fall by 15 million in 2026, 1 million more than under the House bill, relative to current law. (The Senate bill’s cuts in 2026 are bigger than the House’s, even though it ends enhanced funding for the Medicaid expansion more gradually than the House, most likely because it lowers the growth rate for federal funding under the per capita cap below even the House bill’s inadequate level starting in 2025.)
CBO’s other key findings on the Senate bill’s Medicaid provisions include:
[If] states reduced payment rates, fewer providers might be willing to accept Medicaid patients, especially given that, in many cases, Medicaid’s rates are already significantly below those of Medicare or private insurance for some of the same services. If states reduced payments to Medicaid’s managed care plans, some plans might shrink their provider networks, curtail quality assurance, or drop out of the managed care program altogether. If states reduced covered services, some enrollees might decide either to pay out of pocket or to forgo those services entirely. And if states narrowed their categories of eligibility or used administrative procedures that make it more difficult to enroll, some enrollees would lose access to Medicaid coverage….
People with income below 100 percent of the FPL [federal poverty level] who were not eligible for Medicaid could generally receive premium tax credits under this legislation and not under current law. However, even with the net premium of $300 shown in the illustrative examples for a person with income at 75 percent of the FPL ($11,400 in 2026), the deductible would be more than half their annual income. The net premium of a silver plan for a 40-year-old would be about 15 percent of their annual income, and the deductible would be more than one-third of their annual income. Many people in that situation would not purchase any plan, CBO and JCT estimate….