June 22, 2017

The Republican war on public healh

Washington Post - The Republican health-care bill wouldn't just unravel the Affordable Care Act, also known as Obamacare. Republicans are also planning to restructure Medicaid, a program established by President Lyndon B. Johnson in 1965 that provides health insurance to poor households, pregnant women and elderly patients.

Already, the version of the bill the House passed last month included drastic reductions in Medicaid outlays of about $834 billion over 10 years. GOP senators' own version of the bill, which they made public Thursday, could go even further over the long term.

Both the House and Senate bills aim to set a per-person cap on Medicaid spending in each state. That cap would adjust annually to take into account inflation. Through 2025, both bills would adjust the cap based on a measure of how rapidly medical costs are expanding — a measure known as the CPI-M.

Starting in 2025, however, the Senate bill would change the formula, instead funding Medicaid based on a measure of how rapidly all costs are rising (technically, the Consumer Price Index for urban consumers, or just CPI-U).

Washington Post -  The health-care bill that Senate Republicans released Thursday would eliminate critical funds for core public health programs that make up about 12 percent of the budget for the Centers for Disease Control and Prevention. The money supports programs to prevent bioterrorism and disease outbreaks, as well as to provide immunizations and screenings for cancer and heart disease.

The Senate bill would end funding starting in fiscal 2018, which begins in October. That’s more quickly than the House GOP legislation, which would gut funding for the Prevention and Public Health Fund starting in October 2018.

As a provision of the Affordable Care Act, also known as Obamacare, the Prevention and Public Health Fund provides the CDC almost $1 billion annually. Since the ACA's passage in 2010, it has been an increasingly important source of money for fundamental CDC programs.

General costs, however, typically rise more slowly than medical costs. After 2025, the increases to Medicaid would no longer be able to keep pace, with the gap growing each year. After a decade or two, that discrepancy would add up to of hundreds of billions of dollars.

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