As plans to repeal and replace the Affordable Care Act, or ACA, are under construction, states face the possibility of losing significant federal funding for their Medicaid programs.

The implementation of the Medicaid expansion through the ACA, established access to healthcare for low-income adults who were not previously eligible. Specifically, nonelderly adults with an income at or below 138 percent of the federal poverty level— about $16,394 for an individual in 2016—gained access to coverage. As a result,...

In Coventry Health Care of Missouri v. Nevils the State and Local Legal Center (SLLC) asked the Supreme Court in its amicus brief to rule that Chevron deference does not apply when an agency is construing the scope of a statute’s preemption provision, absent Congress’s assent. The Court didn’t rule on (or even discuss) this issue in its brief, unanimous opinion.

The Court held that the Federal Employees Health Benefits Act (FEHBA) preemption clause overrides state laws prohibiting subrogation and reimbursement and that the preemption clause is consistent with the Supremacy Clause.    

The Kansas Legislature’s attempt to join the ranks of the 31 states and the District of Columbia that have already expanded their Medicaid programs came to a halt during the first week of April. The Kansas House voted narrowly to uphold Gov. Sam Brownback’s veto of a bill to expand Medicaid. The vote fell three votes short of the necessary super majority required to override the veto.

The Urban Institute released an analysis of the state-by-state impact of the AHCA, 2019 to 2028. The Urban Institute looked at the impact of the proposal on state funding (see Table 5). If states made up for the loss of federal funds with state funds, it would require a 16.1 percent increase in all states' Medicaid spending over the ten year period. 

Yesterday the Congressional Budget Office – or CBO – released its cost estimate for the House Republican plan to repeal and replace the Affordable Care Act. All told, the report says, the federal deficit would be reduced by $337 billion over the 2017-2026 decade. Reducing the federal deficit is welcome news to most federal policymakers.

On Monday, March 6, the House Republicans released the American Health Care Act, the measure intended to fulfill their campaign pledges to repeal and replace the Obama administration Affordable Care Act. Here is the summary provided by the House Republicans. 

Of primary interest to state policymakers, the House plan implements a per capita cap in Medicaid funding, beginning in 2020, based on FFY 2016 spending levels. The House Republican plan has not been scored by the Congressional Budget Office so there are no publicly available data on how much this change will cost states and save the federal government.

CSG Midwest
The first bill signed into law in Minnesota this year will provide relief to the state’s 125,000 residents who purchase their health insurance in the individual market and are not eligible for subsidies under the Affordable Care Act. The cost of premiums for Minnesotans in this population is rising by 55 percent in 2017. 

Yesterday, in response to concerns about insurers pulling out of the ACA marketplaces and raising premiums, the federal government published proposed rules to stabilize the individual and small group health insurance markets.

In a press release, Dr. Patrick Conway, Acting Administrator of the Centers for Medicare & Medicaid Services acknowledged the changes are short term relief “while future reforms are being debated.” 

CSG South

Among the many concerns currently facing America's healthcare system, few are more significant, both medically and fiscally, than long-term care (LTC). Broadly defined as a range of services that support individuals who are limited in their ability to care for themselves, long-term care stands to become one of America's foremost healthcare challenges in the years ahead. With the continuing rise of U.S citizens 65 and over — statistically, the demographic most in need of LTC — states need to begin preparing for the growing pressures that will be placed on their budgets by the nation's aging population. This SLC Special Series Report explores the challenges long-term care poses for states in the SLC region. Subsequent reports will examine possibilities for managing long-term care and highlight actions that states in the SLC region have taken to tackle this important issue.

Kaiser Health News has created a special website to keep track of news about changes to the Affordable Care Act. KHN says it will provide analysis, explanation, investigation and data on its site called Repeal & Replace Watch. You can bookmark this on your browser.

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