Analysis: Congressional Republicans taking quieter approach to undermining Obama care

But the GOP plan making its way through Congress would sharply increase the number of people without health insurance, largely by narrowing the path for poor Americans to gain coverage and making it easier for them to be booted off it. It would target the twin pillars of Medicaid expansion and federally subsidized insurance marketplaces, with new rules Republicans say will reduce waste, fraud and abuse.

That’s a notable departure from the Obamacare repeal-and-replace Republicans pursued for years, but an approach that still undermines the law’s broad goal of getting most Americans covered.

“It is very much like a backdoor repeal and replace,” said Matt Salo, former executive director of the National Association of Medicaid Directors and now a health-care consultant. “They’ve been too cute by half by doing it but not calling it that.”

Animosity toward the Affordable Care Act, which still exists among some Republicans, isn’t what gave rise to this latest slate of proposed cuts. Rather, it was the need to help pay for extending Trump’s tax breaks in the budget reconciliation bill the president has urged them to pass this summer.

House Republicans managed to find more than $800 billion over 10 years in savings from Medicaid and the marketplaces in a bill they passed last month, which is now under consideration in the Senate. The Congressional Budget Office has estimated that should their bill become law, 7.6 million fewer people would be enrolled in Medicaid and 3.1 million fewer would be enrolled in the marketplaces than would be on the rolls a decade from now.

“They’re not calling this ACA repeal and replace, but the coverage losses would be among many of the same people who would have lost their insurance under ACA repeal,” said Larry Levitt, executive vice president for health policy at KFF.

States would face new mandates and restrictions under the GOP bill. They would need to verify Medicaid expansion eligibility every six months instead of once a year. They could no longer sign up the lowest-income marketplace enrollees throughout the year. They would have to collect more paperwork from certain marketplace applicants. The open enrollment period would be shortened by a month.

The bill would also delay two Biden-era regulations aimed at easing and streamlining enrollment by helping people more easily transition between Medicaid and Children’s Health Insurance Program and private marketplace plans.

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Taken together, those changes would amount to the biggest slash in enrollment since repeal failed eight years ago, except for when states resumed eligibility checks after a pause during the coronavirus pandemic.

States would face a steeper burden in administering their Medicaid programs and marketplaces, resulting in eligible people losing coverage, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.