Pennsylvania could lose tens of billions under Senate bill

(Harrisburg) –Pennsylvania would lose billions of federal Medicaid dollars in a decade under Republican legislation pending in the U.S. Senate to replace “Obamacare,” according to figures released Monday by Democratic Gov. Tom Wolf’s administration.

Wolf, an opponent of the bill, released an analysis that says Pennsylvania could lose $12.7 billion in 2030 alone under a high-cost growth rate in Medicaid, and $5.5 billion that year under a low-cost growth rate in Medicaid.

Starting in 2020, Pennsylvania could lose nearly $1 billion under a high-cost growth rate.

“The losses in federal funds to protect health care benefits for Pennsylvania’s most vulnerable are unacceptable and insurmountable,” Wolf said in a statement.

The fate of the bill is uncertain, and a vote is indefinitely postponed.

Pennsylvania’s Republican U.S. Sen. Pat Toomey helped write the bill and says it puts Medicaid on a sustainable path. His office pointed out the bill still would allow Medicaid to continue growing.

The office said it did not have a detailed methodology for how Wolf’s administration came up with those numbers and declined to offer its own assessment of the bill’s impact on Pennsylvania’s Medicaid dollars.

Against the bill are Pennsylvania’s Democratic U.S. Sen Bob Casey, Pennsylvania’s hospitals, the Arc of Pennsylvania, the AARP of Pennsylvania and labor unions.

Nearly 2.9 million Pennsylvanians — almost one in four — are covered by the state’s $30 billion Medicaid program, a federal-state partnership. Pennsylvania’s per capita and per beneficiary Medicaid spending is among the nation’s highest.

Opponents say paring back Medicaid payments to the states would force the states to cut reimbursements to many Medicaid enrollees, potentially including the elderly, disabled and children.

The federal government pays slightly more than half the bill for most people on Medicaid. It pays nearly the whole bill for the more than 700,000 primarily childless low-income working adults who joined Medicaid starting Jan. 1, 2015, when Pennsylvania expanded income eligibility guidelines to take advantage of the more generous federal contribution rate under President Barack Obama’s law.

Under the Senate bill, the federal government would still commit to funding the Medicaid expansion, albeit at a roughly 52 percent rate in Pennsylvania, compared to the 90 percent long-term rate under Obama’s law.

The bill’s cap on Medicaid costs also would allow that expense to rise with inflation, a rate that nonetheless rises more slowly than the program’s historical growth rate.

The most expensive Medicaid enrollees are the elderly and disabled, accounting for fewer than one-third of all enrollees in Pennsylvania, but driving nearly two-thirds of the program’s cost. More than 1 million children in Pennsylvania are on Medicaid, and almost two-thirds of Pennsylvania’s 88,000 nursing home beds are subsidized by Medicaid.

In 2015, Medicaid paid for more than 58,000 births in Pennsylvania, or nearly 40 percent of total births in the state that year, the Wolf administration said. Hospitals get 13 percent of their total revenue, or $5 billion in payments, from Pennsylvania’s Medicaid program, it said.

An earlier version is below:

Democratic Gov. Tom Wolf’s administration says Pennsylvania would lose tens of billions of federal Medicaid dollars in a decade under legislation pending in the U.S. Senate.

The Wolf administration released its analysis Monday of Republican legislation to repeal and replace the Affordable Care Act.

The fate of the bill is uncertain, and a vote is indefinitely postponed. Pennsylvania’s Republican Sen. Pat Toomey helped write the bill, and says it puts Medicaid on a sustainable path.

Against it are Pennsylvania’s Democratic Sen Bob Casey, Pennsylvania’s hospitals, the Arc of Pennsylvania, the AARP of Pennsylvania and labor unions.

Nearly 2.9 million Pennsylvanians are covered by Pennsylvania’s $30 billion Medicaid program, a federal-state partnership. Under the Senate bill, the federal government would pare back its commitment to funding the Medicaid expansion, slow the program’s growth.

A recent analysis found that uncompensated care would rise 81 percent in the state. 

Medicaid spending would also be cut by more than 10 percent in that same time period. Health leaders in the midstate are concerned they would have to shut down some services to make their budgets work.