Republican senators have said they are "starting from scratch" and writing their own bill, but that is misleading because "the House bill's core provisions remain firmly at the center of Senate discussion," said Shannon Buckingham, spokesperson for the liberal-leaning group.
The report says the House health bill, called the American Health Care Act, would "effectively end" the Medicaid expansion because "beginning in 2020, states would receive only the regular federal Medicaid matching rate, which averages 57 percent for any new enrollees under the expansion instead of the permanent expansion matching rate of 90 percent." The matching rate for Kentucky is 70 percent, so the state would have to pay "2.8 to 5 times more than under current law for each new enrollee," the report said.The bill also allows states to stop enrolling people in expanded Medicaid.
The detailed CBPP report, which offers state-level details on many measures, found that in at least eight expansion states, more than one-third of expansion enrollees live in rural areas.
Mary Wakefield, former acting deputy secretary for the U.S. Department of Health and Human Services, said the rural states of Kentucky and Arkansas, which expanded Medicaid, saw a "one-third increase in the share of low-income adults getting regular check-ups and a two-thirds decrease in the share depending on the emergency room for care."
Wakefield said Medicaid expansion has reduced people's risk of medical bankruptcy, improved treatment access for people with substance use disorders and dramatically decreased uncompensated care in rural hospitals.
"The House health bill is a threat to rural hospitals," said Jesse Cross-Call, a senior policy analyst at CBPP and co-author of the report. "Over the past few years, closures of rural hospitals around the country have been heavily concentrated in states that have not expanded Medicaid."