Jeff Manning | The Oregonian/OregonLive

Oregon would be the hardest hit state – losing at least $13 billion in funding -- if the latest Republican health care bill becomes law, according to two analyses of the bill issued this week.

Avalere Health, a health care consulting firm, on Wednesday pegged Oregon's losses at $13 billion over 10 years and $111 billion over 20 years. The New York Times, working off data provided by the left-leaning Center for Budget and Policy Priorities, said Oregonians will lose more than $2,500 per person per year in funding, more than any other state in the nation.

The legislation known as Cassidy-Graham would repeal the Medicaid expansion under the Affordable Care Act, a move that could cost nearly 400,000 Oregonians their health care coverage beginning in 2020. The Center for Budget and Policy Priorities estimates that 32 million Americans would be affected by the legislation, named for Republican Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina.

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Oregon enthusiastically embraced the Affordable Care Act after it passed in 2010; the number of Medicaid recipients quickly ballooned from 600,000 to more than 1 million after the landmark legislation loosened up qualifying standards.

“The state has been very successful in leveraging opportunities afforded by the Affordable Care Act,” said Jeremy Vandehey, Gov. Kate Brown’s health care adviser. But that success also means Oregon has more to lose if Republicans accomplish their long-cherished goal of repealing the law.

“It’s clear Oregon would be among the most heavily impacted,” Vandehey said.

Graham contends his bill would restore power to the states and end the days when federal health care bureaucrats are issuing national dictates. “Liberals are going crazy because they know it spells the end of their dreams of a single-payer system,” Graham said this week in an interview with Fox News.

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Republicans hope to vote before Sept. 30, the last day they can pass the bill with just 50 votes. On Oct. 1, the start of a new fiscal year, the threshold reverts to 60 votes — an impossible hurdle since there are 52 Republicans and the Democratic caucus is solidly opposed.

President Donald Trump supports the measure. But as with previous Republican efforts, the new bill’s fate may rest with a handful of Republican moderates, Susan Collins of Maine and Lisa Murkowski of Alaska.

Given the Sept. 30 deadline, Republicans have scheduled just one hearing on the legislation. The influential Congressional Budget Office has said it will not have time to score the bill.

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Graham claims his bill protects those with pre-existing conditions. Opponents disagree.

The Center for Budget and Policy Priorities contends the legislation eliminates or weakens protections for people with pre-existing conditions by allowing states to waive the current prohibition against charging higher premiums based on health status.

The bill also eliminates the Affordable Care Act’s federal subsidies to purchase individual market coverage and eliminates the individual mandate to have insurance or pay a penalty.

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According to the new analyses of the bill, the real mind-bending numbers come after 2026. Cassidy-Graham would replace Medicaid expansion dollars with a block grant program and significantly fewer dollars than exists under current law. Those block grant funds would disappear altogether in 10 years.

By 2036, Avalere estimates, states would lose a cumulative $4.15 trillion in federal funding. Oregon’s share of those cuts would total $111 billion.

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Supporters of the bill say there is nothing preventing Congress from renewing block grant funding come 2026. Opponents don’t buy it and say the resulting funding “cliff,” will result in stunning cuts.

“The Cassidy-Graham ACA repeal bill is at least as damaging – and in some important ways even more damaging – than previous versions of repeal,” said Shannon Buckingham, spokeswoman for the Center for Budget and Policy Priorities. “It would hit Oregon extremely hard. Every state loses under this bill. There are no winners.”

--Jeff Manning

503-294-7606, jmanning@oregonian.com