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Republicans in the U.S. House of Representatives worked around the clock to push a replacement for the Affordable Care Act — called the America Health Care Act — through two key committees this week.

In Minnesota, officials are getting a clearer picture of what the potential changes will mean for the state — and the 1.2 million Minnesotans who are enrolled in state-sponsored health coverage. 

GOP health overhaul plan

The Minnesota Department of Human Services estimates that the financial costs are steep. In the first five years of the new plan — starting in fiscal year 2020 — the state estimates it will lose a total of about $10.3 billion in federal funding. In the 10 years after the proposal would go into effect, Minnesota estimates a total loss of $27.8 billion in federal funds. 

Who will be most affected by some of the proposed changes?

In short: Everyone who doesn't get their health insurance through an employer-sponsored plan will be affected.

That population gets coverage in one of three ways:

Medicaid — in Minnesota, we call it Medical Assistance —

 which covers primarily low-income Minnesotans.

. This is a state-subsidized program for people who earn too much to qualify for Medicaid, but not enough to afford the premiums and out-of-pocket costs of commercial insurance.

• And finally, the third tier: Commercial insurance — either through MNsure, the state exchange, or directly from a health plan.

All three of these groups would see big changes if the House Republicans' American Health Care Act becomes law. Some of those changes would be immediate, and some wouldn't kick in for a few years.

Under the America Health Care Act, up to 1.2 million people enrolled in Minnesota's Medical Assistance and MinnesotaCare programs could either lose coverage altogether or have significantly reduced coverage.

What about Medicaid? How many Minnesotans are enrolled, and what would happen to that program? 

People who are covered by Medicaid — just over 1 million state residents — make up the largest group of people affected.

Minnesota Human Services Commissioner Emily Piper said Thursday that the most immediate impact will be among the roughly 250,000 single adults who are newly eligible for Medicaid under the Obamacare Medicaid expansion, because the new plan freezes funding in 2019. That means the state will have trouble paying for everyone in this group to get coverage.

But Piper also said that the House Republicans' proposal would dial back Medicaid funding in the future. Medicaid in Minnesota costs $11 billion, which is paid for by the state and the federal government. Piper's department projects that, by 2025, Minnesota will lose between $5 and $8 billion in contributions from the federal government.

That means that families with children, the elderly, and the disabled will eventually be affected, too. Piper said the change will likely have a ripple effect.

"It will impact not only those seniors getting into nursing homes," she said, "but it's also a real middle-class issue for the families of those seniors, who will bear the burden of having to fund in other ways the really expensive care for their aging parents."

One question that remains unanswered is whether the state would replace some or all of the federal dollars that would disappear.

Piper said the Republican proposal would effectively eliminate all federal funding for the program by Jan. 1, 2020 — $500 million per year. That would be a huge loss to the state, because the federal government pays for nearly all of MinnesotaCare, which covers 100,000 people.

Megan McGuire, a boutique owner in Saint Paul, said she and her family have been on the program for years. 
 
It's one thing to be uninsured when you're young and single, she said. But "when you have kids, the most terrifying thought is not having insurance."

For people who buy insurance through MNsure and get federal premium subsidies, what might change under the new plan?

Analysis by the Kaiser Family Foundation, a nonpartisan health care think tank in Washington, shows that, in general, people who are older, lower-income and living in high premium areas would see their subsidies shrink — in some cases, by as much as $10,000 a year. People who are younger, higher-income and live in lower-premium areas, will get more assistance under the GOP's replacement bill.

How Affordable Care Act repeal and replace plans might shift health insurance tax credits

In Minnesota, it appears that people who are living in the southern and western parts of the state will 

see the most dramatic decline in subsidies

Tax credits under the ACA versus AHCA, in 2020

For instance: If you are 40 years old and make $30,000 annually and live in Pipestone County, you'll pay 44 percent more when it comes time to sign up for MNsure. That's because, for you, federal support to pay for health insurance through the exchange will go down 44 percent.

What are Republicans saying about the plan?

Of Minnesota's House GOP delegation, only Rep. Erik Paulsen, who represents Minnesota's 3rd Congressional District, has issued a statement on the bill. 

 saying it will lower costs and give patients immediate relief.

While the replacement bill is barreling through the U.S. House, some Republicans in the Senate are urging caution. That includes Senate Leader Mitch McConnell, who said he wants to the see the price tag for all these changes first.

From Kaiser Family Foundation: Tax credits under the ACA versus AHCA, in 2020 

compare county-level estimates of premium tax credits

 consumers would receive under the Affordable Care Act in 2020 with what they'd receive under the American Health Care Act, as unveiled March 6 by Congressional Republicans.

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In short: Everyone who doesn't get their health insurance through an employer-sponsored plan will be affected.


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