MINNEAPOLIS - There's a lot of rhetoric right now on what would happen if the new Republican health care bill became law.
For the average person, it's difficult to decipher fact from fiction, especially when it comes to how the bill would affect Medicaid recipients.
To learn more about the possible impact, KARE 11 sat down with the man who wrote the book on this topic, literally.
"I read the 2,700 or so pages of the Affordable Care Act several times to write my book on it," says University of St. Thomas medical affairs researcher Dan McLaughlin.
"I often say my book has been repealed," McLaughlin laughs.
Besides teaching classes, McLaughlin is also the director of the Center for Health and Medical Affairs at the University of St. Thomas.
He says this latest bill undoes a lot of what the Affordable Care Act aimed to accomplish, but doesn't eliminate it altogether.
"Some Republicans see this as not doing enough," McLaughlin says. "They're working on compromises to entice the last few votes they would need to pass it."
McLaughlin says those on Medicaid may be some of the most affected by this bill, not because their coverage will change, but because their eligibility might.
"If they're eligible they're going to get the same services they get today. The eligibility is what could cause some people to not be covered," McLaughlin explains.
Under the Affordable Care Act, the eligibility for Medicaid was bumped up to 133 percent of the Federal Poverty Line. Basically, that means anyone making less than $16,039 a year as an individual would be covered.
For a family of three, that number is around $28,000 a year.
McLaughlin says the new Republican bill would bring the poverty line requirement back down to 100 percent.
That means anyone making between $12,060 and $16,039 as an individual, and between $20,420 and $28,000 as a family of three, would no longer qualify for Medicaid.
"The people who became eligible because of the Medicaid expansion thanks to the Affordable Care Act are concerned by this," McLaughlin says. "All of a sudden they won't be eligible and won't have coverage."
The Republican bill does create some additional tax credits to help these individuals and others pay for insurance on the public marketplace. However, McLaughlin says many who used to be on Medicaid will still struggle to pay for it.
"This will send some people to the 'emergency room' health care system, which isn't a good way for people to get health care."
Proponents of the Republican bill say shrinking eligibility will lead to lower rates as a whole and will save the federal government millions of dollars.
McLaughlin says the states will have to decide whether or not to cover those people on their own.
"States like Minnesota could change the eligibility. They could raise state taxes, or find other money and continue at the 133 percent Federal Poverty Level, but that would cost a fair amount of money."
What makes this even less likely is the fact that the only reason many states were covering those between the 100 percent and 133 percent poverty level is because of the high reimbursement rate from the federal government.
"States are reimbursed up to 90 percent for those users. That's quite a bit higher than the 50 percent they're reimbursed for all other Medicaid patients."
McLaughlin says this higher rate was created by the Affordable Care Act as a way to motivate states to expand Medicaid coverage. With that incentive no longer available, he says states will be less likely to fund those Medicaid users on their own.
Not everyone is happy with the new Republican bill. Obviously, those on the other side of the aisle see it as a drastic change over the Affordable Care Act, but some in the Republican party are also upset.
"Some don't think it goes far enough," McLaughlin says. "They're going to have to sway those last three or four Republicans to get this passed."
Lawmakers are scheduled to vote on the bill this Thursday. However, it's likely a new version of the bill will come out before then. A new version was already released on Monday and it's likely others will follow.
The House and Senate versions are different in many ways. Both houses will have to come together on a final version before they can write the new bill into law.
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