Vox

By: Dylan Matthews

The Better Care Reconciliation Act, Senate Republicans’ plan to repeal and replace Obamacare, would if passed lead to one of the largest redistributions of income in American history, just as Obamacare itself did.

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Joan Alker, a Medicaid expert at Georgetown University, estimates that those eight states alone could lead to 3.3 million Medicaid enrollees losing coverage. But many of the other 24 states will abandon the expansion due to the lower match rate as well. And keeping it going will be even harder due to other, fundamental changes the bill makes to the Medicaid program.

However, there is still a lot of variation in cost within those categories. “Within your elderly group, you have the young and old, 67-year-olds and 85-year-olds, and the latter are much more expensive,” Georgetown’s Alker told me in March. A state like Florida, which has a large senior population, could see costs rise fast as its population ages with time. But a per capita cap wouldn’t keep up with that. To get around that, the state might be motivated to kick off older seniors and focus enrollment on younger ones.

There are some federal requirements as to whom states must cover, but they only go so far, and most states now provide additional coverage that they can roll back. “You do have to cover people on Supplemental Security Income” — a program for disabled, elderly, and blind people with low incomes — ”but a lot of folks in nursing homes [are] optional coverage,” Alker continued.

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