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What CBO's GOP Health Plan Forecast Means For California


The numbers are in on the Republican health care overhaul, at least according to the nonpartisan Congressional Budget Office. That's the group that gives its best estimate of what the proposed legislation will cost and what its impact will be. The CBO says 24 million fewer people will have health insurance within 10 years if the Republican plan becomes law.

It would also reduce the federal budget deficit by $337 billion over a decade. The White House and Republicans in Congress are skeptical of the CBO numbers. Any change in the health care system will be felt most acutely in the states. And for more on that, we go to health care reporter Stephanie O'Neill in Los Angeles. Good morning, Stephanie.


MARTIN: So California, the biggest economy in the country, is sure to feel some kind of effects from the health care change if it passes. Explain what the impact could be.

O'NEILL: Well, there are about a million and a half Californians who buy their insurance through the exchange. And most of them get subsidized coverage that helps offset their monthly insurance premiums. But under the GOP plan, those who were in the 50 to 64 age range would face significantly higher premiums and would get far smaller tax subsidies than they do now under Obamacare.

The other group to consider are the 1 in 3 Californians who now get their health insurance through Medicaid, known here in California as Medi-Cal. About 4 million Californians receive that coverage through the Obamacare expansion of the program, and they'd face losing it under the phase out of the Medicaid expansion that would start in 2020 if the GOP plan passes.

MARTIN: So any idea how the proposed spending caps on Medicaid could affect the program in California?

O'NEILL: Well, Medicaid is the jointly funded federal state safety net program that also covers pregnant women, children, the elderly and disabled. And so in California, it covers around 14 million people or about 1 in every 3 Californians. The GOP plan would totally revamp how the feds contribute to the program. So instead of providing the states with matching dollars, the feds would provide a fixed per-person amount to the states.

And the CBO report says that would mean less federal funding for Medicaid in California and really everywhere else in the nation. And that, in turn, means states would have to either come up with the difference themselves or cut programs and eligibility.

MARTIN: How would that affect enrollees then?

O'NEILL: Well, it's not clear how any given state will deal with the reductions in federal spending. But one thing patient advocates will point to is that the Medicaid program spends two-thirds of its total annual budget on the elderly and the disabled. So in states like California where providers are already getting some of the lowest payments in the nation, it raises concerns about whether providers will even want to take on these patients.

MARTIN: So what about healthy, younger workers who are covered by the Medicaid program?

O'NEILL: Well, I spoke with Micah Weinberg, he's a health policy analyst with the Bay Area Council, which is a think tank supported by the San Francisco Bay Area business community. And he pointed out to me that two-thirds of the adults on California's Medicaid program are actively involved in the labor market, either working full time or part time or actively seeking work.

And his employer-backed group measured the economic value of that Medicaid coverage to the state. And here's what they found.

MICAH WEINBERG: Our estimates are that, you know, Medicaid coverage alone in California increases the amount of economic activity in the state by $1.7 billion because people are healthier and they're showing up to work and they're more productive when they're there.

O'NEILL: And that's bound to be the case in other states as well.

MARTIN: Like other states around the country, under Obamacare, California was able to reduce the number of uninsured people. So if this change goes through, if Republicans move forward with this replacement plan, what happens to those people?

O'NEILL: Well, it just depends. I mean, some of them will continue to get coverage. And Republicans will say that some of them will drop out because they're no longer going to be required to have health insurance under the GOP plan if that one passes. So it's unclear exactly what will happen to the numbers. So we will see more uninsured, according to the Congressional Budget Office.

But how many will be uninsured because they don't want to buy coverage is unclear.

MARTIN: Stephanie O'Neill is part of NPR's reporting partnership with member stations and Kaiser Health News. Thanks so much, Stephanie.

O'NEILL: You're welcome.


The nonpartisan estimate of the Republican health care bill is generating a range of responses. Tom Price, president Trump's top health care official, said there must be some mistake. He insisted it was, quote, "virtually impossible for so many to drop their coverage."

MARTIN: House Speaker Paul Ryan is closely associated with the plan. Ryan said he was, quote, "encouraged." What Ryan likes is a drop in the federal budget deficit - $337 billion over a decade, which in federal budget terms is relatively modest but still a drop.

INSKEEP: Democrats called the bill a disaster. And House Democratic Leader Nancy Pelosi says withdrawing it is, quote, "really the only decent thing to do." Transcript provided by NPR, Copyright NPR.

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