Q 1 :  What should average Americans think about changes to the Affordable Care Act (ACA) market-places that are being proposed under the new American Health Care Act (AHCA)?

Short Answer:

For most people who get their coverage through their employers, the VA or Medicare, marketplace changes under the AHCA will have minimal impact, unless you lose your job or your employer decides to no longer offer coverage.  For people who want to enter, or are currently in the marketplace, subsidies that make coverage affordable could be substantially lower for many.  The elimination of the individual mandate to require insurance coverage along with those lower subsidies could cause marketplace enrollment to drop along with the market advantages of a larger and more diverse risk pool.  All of this could result in less affordable coverage for many and a greater number of uninsured Americans.

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Q 2 :  How will Medicaid be funded under the American Health Care Act? 

Short Answer:

The AHCA will have the single biggest impact on Medicaid.  Under the AHCA the Medicaid expansion program (which covered an additional 425,000 uninsured Coloradans) will be defunded without any phase-in beginning in 2020.  Medicaid funding will also be restructured into a “per capita block grant” that would cap federal Medicaid contributions per enrollee and defines an annual growth rate for future funding.

In total the AHCA will cut Medicaid funding by $880 billion dollars over the next decade.  States with the largest coverage gains under the ACA would be more negatively affected than states that did not expand Medicaid.  To make up the cuts, low-income expansion states would have to increase their Medicaid spending anywhere from 34 to 55 percent under the AHCA.

Colorado will see a total loss of $14 billion in federal funding over the first 10 years of the AHCA’s Medicaid changes.  Since Colorado is a TABOR state, that requires a popular election to increase revenues, it is extremely unlikely that Colorado can compensate for the shortfall in federal funding.  There will be 600,000 fewer Medicaid members by 2030, most them will likely end up uninsured.

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Q3 :  What will be the impact of the new Trump budget on Medicaid and medical research?



Under the Trump Administration’s new budget proposal, Medicaid would see an additional funding cut of $610 billion over the next decade, on top of the $839 billion that would already be cut from the program under the American Health Care Act passed by the House of Representatives earlier this year.  The budget proposal suggests that these additional cuts would come from per capita caps, block grants, and new forms of flexibility for states.  The proposal would give states more power to pass laws requiring employment in order to receive Medicaid benefits

Trump’s new budget would massively cut funding for medical research and disease prevention programs.  Compared to the 2017 budget, the following organizations would receive the following funding cuts:

  • National Institutes of Health:  $5.8 billion in cuts
  • National Cancer Institute:  $1 billion in cuts
  • National Heart, Lung and Blood Institute:  $575 million in cuts
  • National Institute of Allergy and Infectious Diseases:  $838 million in cuts

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