Health Overhaul Could Cost Maryland $2B

The state Department of Legislative Services sent a letter to top lawmakers Thursday laying out the impact of the Republican plan's provision that unwinds the expansion of Medicaid under President Barack Obama's health care law. That element of the GOP bill would have the most significant impact on the state budget, the department said.

"Although this should be considered a preliminary analysis, it is intended to offer a sense of the magnitude that the State could be facing," the department's executive director, Warren Deschenaux, wrote.

The analysis found Maryland would lose $147.7 million in federal Medicaid funding in fiscal year 2020, when any changes would kick in. It would lose $696.6 million in 2021 and around $1.1 billion in 2022.

Sen. Richard Madaleno, D-Montgomery, said the analysis shows how high the stakes are.

"The report demonstrates the risk to the people of Maryland with the repeal of the Affordable Care Act and how cruel and unfair it will be to people who can least afford to lose health care," Madaleno said Friday.

The state could choose to revisit the Medicaid benefits it provides, as well as who it covers under the program, Deschenaux wrote.

"However, absent such changes, the State would be in a position of having to significantly increase general fund spending to accommodate those expenditures," he said.

Maryland, along with 30 other states and the District of Columbia, expanded Medicaid under the ACA to include all non-disabled adults with incomes at or below 138 percent of the federal poverty level, or about $16,640 for an individual. The federal government picks up almost all of the cost at first, gradually phasing down to a 90 percent share.

But the House bill would end Medicaid expansion. States could continue to receive the higher federal rate only for those enrolled by Dec. 31, 2019.

The analysis doesn't account for other changes Maryland could see under the proposal, which also would halt Obama's tax penalties for people who don't buy coverage and provide tax credits to help people pay medical bills, though generally at skimpier levels than Obama's statute provides.

The plan was headed for a House vote sometime Friday, but its chances of passage were unclear. Even if it wins there, Republicans face an uphill climb in the Senate, where conservatives and moderates are also threatening to sink it.

The nonpartisan Congressional Budget Office has said the measure would result in higher out-of-pocket costs for many low-income and older people and 24 million more uninsured people in a decade.

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Associated Press writer Sarah Rankin reported from Richmond, Va.