Pennsylvania would lose billions of federal Medicaid dollars in a decade under Republican legislation pending in the U.S. Senate to replace "Obamacare," according to figures released Monday by Democratic Gov. Tom Wolf's administration.
Wolf, an opponent of the bill, released a statement that says Pennsylvania could lose $12.7 billion in 2030 alone under a high-cost growth rate in Medicaid, and $5.5 billion that year under a low-cost growth rate in Medicaid.
Starting in 2020, Pennsylvania could lose nearly $1 billion under a high-cost growth rate.
The losses "are unacceptable and insurmountable," Wolf said in a statement.
The fate of the bill is uncertain, and a vote is indefinitely postponed.
Pennsylvania's Republican U.S. Sen. Pat Toomey helped write the bill and says it puts Medicaid on a sustainable path. Toomey's office pointed out the bill still would allow Medicaid to continue growing and still deliver $200 billion to the state over a decade, but declined to offer its own assessment of the bill's impact on Pennsylvania's Medicaid dollars.
In a statement, his office accused Wolf of "fearmongering instead of finding constructive ways to help make Medicaid sustainable for future generations."
Against the bill are Pennsylvania's Democratic U.S. Sen Bob Casey, the Hospital and Healthsystem Association of Pennsylvania, the Arc of Pennsylvania, the AARP of Pennsylvania and labor unions.
Pennsylvania's largest business association for nursing homes, the Pennsylvania Health Care Association, has "significant and grave concerns" about the bill, it's president and CEO, W. Russell McDaid, said Monday.
Nearly 2.9 million Pennsylvanians — almost one in four — are covered by the state's $30 billion Medicaid program, a federal-state partnership. Pennsylvania's per capita and per beneficiary Medicaid spending is among the nation's highest.
Opponents say paring back Medicaid payments would force the states to cut reimbursements for many Medicaid enrollees, potentially including the elderly, disabled and children.
The federal government pays slightly more than half the bill for most people on Medicaid. It pays nearly the whole bill for the more than 700,000 primarily childless low-income working adults who joined Medicaid starting Jan. 1, 2015, when Pennsylvania expanded income eligibility guidelines to take advantage of the more generous federal contribution rate under President Barack Obama's law.
Under the Senate bill, the federal government would still commit to funding the Medicaid expansion, albeit at a roughly 52 percent rate in Pennsylvania, compared to the 90 percent long-term rate under Obama's law.
The bill's cap on Medicaid costs also would allow that expense to rise with inflation, a rate that nonetheless rises more slowly than the program's historical growth rate.
Pennsylvania's hospitals get 13 percent of their total revenue, or $5 billion in payments, from Medicaid, the Wolf administration said.
Andy Carter, the president and CEO of the Hospital and Healthsystem Association of Pennsylvania, said a reduction in federal commitment to Medicaid would particularly threaten hospitals with a relatively heavy Medicaid caseload and the one-third of the state's 168 general acute care hospitals that operate at a loss.
Many of those hospitals are smaller and rural. With fewer federal dollars, first on the chopping block might be maternity units and cardiovascular services, Carter said, as well as damage to the quality of care, with nothing in exchange to improve the affordability and access to health care.
"It has to stand out as one of the most aggressive attempts to undermine a 50-year joint state-federal partnership I've ever seen," Carter said.
The most expensive Medicaid enrollees are the elderly and disabled, accounting for fewer than one-third of all enrollees in Pennsylvania, but driving nearly two-thirds of the program's cost. More than 1 million children in Pennsylvania are on Medicaid, and almost two-thirds of Pennsylvania's 88,000 nursing home beds are subsidized by Medicaid.
The state already is giving nursing homes below-cost reimbursements for Medicaid patients, and the Senate bill would balance the federal budget on the backs of the frailest elderly, McDaid said.
"Very little good can come of that," McDaid said.