This morning, Senate Republicans put forth a third version of the Better Care Reconciliation Act (BCRA), and the Congressional Budget Office (CBO) has released an analysis of it. Like previous versions, today’s bill would decimate Medicaid. The CBO projects that, by 2026, federal Medicaid spending would be cut by 26%, and 15 million Americans would lose Medicaid coverage. These cuts would grow even larger over the longer term, rising to 35% by 2036.
The California Department of Health Care Services (DHCS) projects that, under an earlier version of the BCRA with similar Medicaid provisions, the state would lose over $30 billion in Medicaid funding in 2027 alone, rising quickly from the $3 billion the state would lose in 2020. These losses include a drastic reduction in federal spending for the Affordable Care Act Medicaid expansion, as well as a cap on federal spending per Medicaid enrollee that applies to nearly all eligibility groups, including children, seniors, individuals with disabilities, and other adults.
In a recent blog post, we provided some examples to demonstrate how big $30 billion is in the context of the state’s 2016-2017 budget. One comparison we made was that $30 billion in today’s dollars is equivalent to the total cost of Medi-Cal coverage for all 3.8 million low-income adults enrolled under the Affordable Care Act (ACA) expansion; plus 1.3 million California children enrolled through the Healthy Families Program (now part of Medi-Cal); plus 180,000 medically needy seniors; plus 65,000 medically needy individuals with disabilities.
If state policymakers were to respond to federal cuts of this magnitude by eliminating eligibility or capping enrollment for these groups, nearly 5.4 million adults, children, seniors, and individuals with disabilities would lose Medi-Cal coverage. Using DHCS data on Medi-Cal enrollment by eligibility group, we estimated which California congressional districts would face the largest Medi-Cal coverage losses under this scenario. On average, 100,000 residents in each district would lose Medi-Cal, but there is wide regional variation.
These estimates show that congressional districts in certain parts of the state, such as the Central Valley, Imperial Valley, and parts of Los Angeles, face the greatest projected Medi-Cal coverage losses. These findings are consistent with our previous research and that of the California Budget & Policy Center, which showed that these regions have higher-than-average enrollment rates in the ACA Medi-Cal expansion and in Medi-Cal overall.
Our interactive state map illustrates the effects by congressional district of this one approach to responding to such deep federal cuts. There are other possible approaches—state policymakers could also reduce Medi-Cal eligibility for other groups, cut Medi-Cal benefits, make cuts outside of health services, or raise taxes—but all of the options present difficult decisions for state policymakers. Regardless of how they respond, the BCRA is likely to have catastrophic consequences for Californians and the state budget.
Projected Medi-Cal Coverage Loss by Congressional District
Under one possible state response to the BCRA: eliminating Medi-Cal eligibility for low-income adults enrolled under the ACA expansion and children enrolled through the Healthy Families Program, and capping enrollment for certain seniors and individuals with disabilities.
Scroll over your district to see how many individuals would be projected to lose Medi-Cal under this scenario. To zoom into a particular area, scroll over any part of the map until a magnifying glass appears, click the magnifying glass once to activate zoom, and then double click the area you would like to enlarge.
Notes: Estimates may not sum to totals due to rounding. These estimates approximate the coverage losses that would occur in 2017 if the BCRA were fully implemented today.
Source: UC Berkeley analysis using California 2016-2017 budget estimates of the total cost of coverage for these nearly 5.4 million Medi-Cal enrollees, DHCS enrollment data by congressional district, and DHCS estimates of the projected lost federal funding under BCRA converted to 2017 dollars.