Who wins, who loses in bill aimed at upending Obamacare

The GOP’s last-ditch effort to repeal “Obamacare” would redistribute hundreds of billions of dollars in federal financing for insurance coverage, creating winners and losers among individual Americans and states in ways not yet fully clear.

Independent analysts say the latest Senate Republican bill is likely to leave more people uninsured than the Affordable Care Act, and allow states to make changes that raise costs for people with health problems or pre-existing medical conditions.

After closed-door meetings Tuesday, supporters seemed confident but acknowledged they’re not sure if the bill can pass. There’s only a narrow window for the Senate to act under special budget rules that expire at the end of the month.

The Congressional Budget Office has said it doesn’t have time to complete a full analysis of the impact on coverage before the deadline.

The biggest changes would start in 2020 — the next presidential election year. That’s a political risk for Republicans, since health care changes often involve unforeseen problems.

A key feature of the legislation from Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana would put the ACA’s financing for subsidized private health insurance and Medicaid expansion into a giant pot and redistribute it among states according to new formulas. States could obtain federal waivers allowing them to modify insurance market safeguards for consumers. For example, states could let insurers charge higher premiums for older adults.

The 31 states that expanded Medicaid are likely to see a funding reduction over time, as well as states, like Florida, where many residents received subsidies for private health insurance, said Larry Levitt of the nonpartisan Kaiser Family Foundation.

“Every state has to start from scratch creating its own health insurance program, in some cases with reduced federal funding and in some cases with increased federal funding,” Levitt said. “I don’t think at this point anybody knows what states are going to do.”

Following the framework of previous Republican bills, the new legislation would also limit overall federal financing for Medicaid, which serves more than 70 million low-income people. That feature affects the entire program, not just former President Barack Obama’s expansion to cover more low-income adults. It would change the current open-ended nature of Medicaid financing, a move that prompts deep concern from hospitals, doctors, nursing homes, consumer groups,…

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