Medicaid coverage under Republican health plan could cost RI up to $70 million by 2021

By Lynn Arditi
Journal staff writer

Rhode Island may need to spend another $25 million to $30 million to keep 70,000 low-income adults from losing their Medicaid coverage under the House Republicans’ plan to replace the Affordable Care Act in 2020, according a preliminary analysis performed by health experts for The Providence Journal.

And that’s just in the first year. In 2021, the additional cost is projected to run between $65 million and $70 million — an expense, some experts say, the state would likely be unable or unwilling to absorb.

The preliminary analysis, provided by former state Health Insurance Commissioner Christopher F. Koller and reviewed by several local health experts, is the first publicly released estimate of the impact of the proposed funding cuts on Rhode Island’s Medicaid expansion program.

The Republican plan to replace Obamacare would dramatically reduce the amount of funding the federal government provides to help states pay for Medicaid, according to the Congressional Budget Office report released this week.

Medicaid insures close to 300,000 Rhode Islanders, or nearly one-third of the population. State health experts say the first hit from the proposed changes would be to the state’s Medicaid expansion population — roughly 70,000 adults who became newly eligible for coverage in 2014 under Obamacare.

Rhode Island is among 31 states, along with the District of Columbia, that adopted the federal law’s expanded eligibility criteria for Medicaid. In Rhode Island, that meant low-income adults who are not disabled and have no dependent children. Their coverage currently costs $450 million — or one-fifth of the state’s $2.3-billion Medicaid program.

Even some observers who differ over the appropriateness of the growth of the state’s Medicaid program agree about the impact of the GOP plan on the 70,000 residents in the expansion population.

“The American Health Care Act would for all practical purposes end ACA’s Medicaid expansion in 2020,” said Gary Sasse, founding director of the Hassenfeld Institute for Public Leadership at Bryant University.

Linda Katz, co-founder and policy director of the Economic Progress Institute in Providence, said the proposed cuts to the Medicaid expansion program would “eviscerate coverage for 70,000 adults … threatening their access to primary care, medication and life-saving health care services.”

Here’s why. Rhode Island currently pays 5 percent — $22.5 million — of the program’s $450-million cost. The other 95 percent is paid for by the federal government. The federal government’s contribution is scheduled to incrementally drop to 90 percent by 2020. Under Obamacare, it would never fall below 90 percent.