Like Obamacare, But Worse: The GOP ACA Healthcare Bill Explained, Part 3

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MIAMI, FL – MARCH 02: Margalie Williams, a cancer survivor, is hugged after speaking during a rally near Jackson Memorial hospital to show support for the Affordable Care Act on March 2, 2017 in Miami, Florida. Mrs. Williams said that without the health care insurance provided by ACA she would probably be six feet under by now. The rally was part of the Save My Care Bus Tour, a two-month, cross-country tour focused on telling the stories of the more than 30 million Americans that are helped by ACA. (Photo by Joe Raedle/Getty Images)

The GOP’s Obamacare replacement plan looks forward to 2020, when they kick Grandma out of her nursing home for not being rich enough to pay for it herself.

I will admit right up front that I do not understand every detail of Medicaid enrollment/eligibility (my job mainly deals with what happens after you have coverage and are trying to use it), so my knowledge here will be a tiny bit incomplete.

However, there is at least one big proposed change to Medicaid that I want to make sure people understand, because it has catastrophic implications if it goes through.

Medicaid and Medicare

Currently, the ACA includes a Medicaid expansion provision. What this means, in practice, is that if you fill out an application for coverage on healthcare dot gov and your reported income is very low, the ACA will NOT provide you with a subsidy but will instead refer you to Medicaid to get coverage. (In many states, but not all. This was supposed to be the case in all states, but the Supreme Court changed it.)

Once you have Medicaid coverage, you have very minimal out of pocket costs (copays, etc) and there are no limits on how much healthcare you can use while you’re enrolled, as long as you’re getting a covered service under Medicaid. (So Medicaid will pay for twelve broken legs, but will not pay for an elective abortion because that’s not a covered Medicaid benefit.)

There are definite downsides to Medicaid – the coverages can be stingy, and it’s sometimes hard to find providers who will treat you. However, it’s coverage that definitely, absolutely helps people who are in a tough financial situation or health situation.
The GOP, naturally, does not like Medicaid. Their original plans all included a removal of the Medicaid expansion, until a bunch of Republican governors vocally opposed that plan.

So the new Ryan plan *does* include a provision that says that the Medicaid expansion established by the ACA will be kept in place until 2020.
After that, enrollment in the expansions would “freeze” and new enrollees would *not* be allowed to be added to Medicaid.

(The assumption they’re making, apparently, is that people will be able to get off of Medicaid by 2020 and then it won’t be needed anymore. By anyone? Or else they just want to kill this program they don’t like regardless of its impact on people…but not until after the next presidential election. Of course.)

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