Todd Spangler

Detroit Free Press

WASHINGT0N – An analysis of the Republican health care plan released Monday by the nonpartisan Congressional Budget Office didn’t break out state-by-state impacts, but there was reason to believe it could significantly cut back Medicaid coverage for lower-income individuals in Michigan.

The CBO estimated that under the Republican-proposed replacement for Obamacare, the number of uninsured Americans would grow by 24 million by 2026, with some 14 million people not getting coverage under Medicaid between now and then as limits are placed on who qualifies and state reimbursements are scaled back.

Related:

CBO: Obamacare repeal will increase uninsured by 24 million by 2026

Health care future uncertain for low-income Michiganders

Michigan is one of several states that expanded Medicaid coverage under the Affordable Care Act — also known as Obamacare — with an estimated 637,000 people qualifying under Gov. Rick Snyder’s Healthy Michigan program. If the plan severely scales back Medicaid payments, many Michiganders would be expected to ultimately lose or fail to qualify for coverage.

Snyder — who has lobbied Republican leaders on Capitol Hill and the Trump administration for flexibility in continuing the Medicaid program — has remained mum on his opinion of the proposal since its unveiling last week. It faces an uncertain future in Congress, with Democrats and many more conservative Republican opposing it, though for different reasons.

Some Republican members of Michigan's congressional delegation, however, said the CBO analysis of House Speaker Paul Ryan's indicated many positive impacts -- lowering overall premiums past 2020, reducing the deficit and making what they argue are needed reforms to Medicaid, the government's program to insure lower-income Americans.

"The CBO report serves as another reminder that Republicans are following through on the promise to lower premiums, provide major tax relief and reduce the deficit," U.S. Rep. Mike Bishop, R-Rochester, said in response to the analysis, while adding that more proposals are to follow which were not yet analyzed. "I am confident that Congress will build on the progress outlined in this report to make health care work for everyone," he said.

Bishop did not mention the analysis' finding that millions could become uninsured or what specifically those Medicaid reforms might mean to people slightly above the poverty line receiving care under Healthy Michigan, however.

Overall, more than a million Michiganders have received coverage under Obamacare, cutting the rate of uninsured people in the state. In recent years, however, premiums have jumped — including by 17% in the last year as the number of insurers offering plans has declined. In many cases, those increases are covered by federal subsidies, reducing the impact on individuals — but those subsidies must be borne by taxpayers.

Republicans have campaigned on ending Obamacare since it was passed in 2010. Now, with a Republican president in office and the party in control of both chambers of Congress, it is expected to follow through. But while more conservative members want government to drastically scale back its involvement immediately, others have argued that constituents who have come to rely on coverage can't simply be dropped.

The CBO analysis said passage of the Republican plan — which proposes a move to tax credits for insurance based on age — would cut some $337 billion from the deficit over a decade, largely by scaling back Medicaid and subsidies guaranteed under Obamacare. By dropping a mandate that all Americans get insurance, however, and limiting access to the Medicaid expansion, it is expected to nearly double the number of people no longer covered.

It would also in the years after 2020 reduce premiums overall and especially for younger, healthier individuals, though it was expected to see prices potentially increase for those who are older and sicker. Insurers would have greater freedom to dictate policies and be allowed to set premiums for older Americans at five times those for younger people. Tax credits would be worth $2,000 a year for those under 30 and $4,000 a year for those over age 60.

The report found that “in particular, people between 50 and 64 years old with income of less than (twice the federal poverty limit) would make up a larger share of the uninsured.”

While the White House and Republican leaders defended the plan in the face of an analysis they said was incomplete, Michigan Democrats quickly used it to denounce the plan.

U.S. Rep. Sander Levin, D-Royal Oak, said the CBO report “shows in a clear, shocking way (that) the Republican plan jeopardizes for the American people insurance vital for their health, and often their lives," and U.S. Rep. Dan Kildee, D-Flint Township, called the plan "reckless and dangerous," saying it will cost lives.

U.S. Rep. Debbie Dingell, D-Dearborn, added, “Instead of rolling back the coverage and protections millions of families depend upon, we should be working together to strengthen health care for all Americans. Putting seniors, children and working families out in the cold is not the answer.”

Another Republican member of the state's delegation to Congress, U.S. Rep. Bill Huizenga of Zeeland, defended the proposal in light of the analysis, saying it ultimately will give people choices -- including to not purchase insurance "they don't want or fails to meet their needs."

"Obamacare is in the midst of collapsing," he said. "As conversations translate into legislative action on improving health care options, increasing affordability, and enacting (legal) tort reform, I hope those who are more interested in playing partisan political games reset their priorities and become constructive voices in the process."

Contact Todd Spangler: 703-854-8947 or tspangler@freepress.com. Follow him on Twitter @tsspangler.