The House Republican plan to overhaul Obamacare would cost Ohio $19 billion to $26 billion in federal funding for Medicaid over six years, according to an analysis released today by the Center for Community Solutions.

The massive cuts, the Ohio-based research group concluded, would lead to substantial reductions in eligibility, services, or payments to health-care providers in the tax-funded health insurance program serving more than 3 million poor and disabled people, or 1 in 4 Ohioans.

The analysis by Community Solutions fellow Loren Anthes is one of the first that looks specifically at the impact of proposed per-capita funding caps on Ohio.

Among a number of policy changes, the American Health Care Act would alter how the federal government helps states pay for Medicaid. Currently, the federal government guarantees to cover a set share of costs with rates established for each state. Ohio's rate is about 63 percent, although the Affordable Care Act, or Obamacare, is temporarily covering almost the entire cost of the 700,000 low-income adults who came on to the rolls through expanded eligibility.

The GOP plan would switch to a capped federal contribution for each beneficiary based on how much the state spent on health care in 2016 and would eliminate the higher match rate for Medicaid expansion enrollees in 2020.

"If tied to the medical consumer price index, even when accounting for a reduction in total members due to population loss, the all-funds reduction to Ohio Medicaid would be about $19 (billion) to $26 billion between 2019 and 2025," Anthes wrote in the analysis.

Ohio's proposed Medicaid budget for next year, state and federal spending combined, is projected to be $28 billion.

The largest decreases would be in federal aid for children, the disabled, and adults, and those losses would increase if enhanced reimbursement for the Medicaid expansion population is ended earlier, as some in Congress and President Donald Trump are proposing. For example, monthly funding for a child enrolled in Medicaid would drop 21 percent under proposed funding caps and by a third for adults.

Ohio was one of 31 states to expand Medicaid through Obamacare, and Republican Gov. John Kasich has been lobbying Congress and the Trump administration to nix the plan, which, in addition to abolishing Medicaid expansion, would eliminate tax subsidies for private coverage and replace them with tax credits. Administration officials project the loss of federal funding for the Medicaid expansion population alone to be $1.5 billion a year.

A separate report by the liberal group Policy Matters Ohio said the state will be forced to abolish Medicaid expansion because of lower federal aid, stripping health coverage from 700,000 working-age adults, most of whom have jobs. Funding caps also threaten seniors, children and parents on the program as reduced funding in the years to come will result in restrictions in eligibility for coverage and the benefits available.

Policy Matters' Wendy Patton, the author of the report, said the GOP plan eliminates the flexible, eligibility-based financing structure of Medicaid and replaces it with a less flexible “per-capita cap” in which each state will receive a share of federal funding for Medicaid based on 2016 costs.

"This is bad news for Ohio, where the population is aging rapidly," she said. "Health care is most costly among the elderly, so as the population ages, costs rise. But the federal share will not. This could lead to reduced Medicaid coverage for all Ohioans, but especially for growing and costly segments of the population, like seniors."