Representative David Young (IA-03) is denying that the American Health Care Act “will kick millions of people off of Medicaid,” telling constituents the bill “Modernizes and strengthens Medicaid so the state can better serve our Iowa neighbors and patients who are most in need.”

Of all the misleading things Young has said to justify his late decision to support an atrocious bill, this one may be the most blatant lie.

Despite his previous calls for “thoughtful and deliberate” consideration of health care policy, Young joined 216 other House Republicans to pass a revised version of the AHCA on May 4 without waiting for a non-partisan Congressional Budget Office analysis of its costs and impacts.

Neither the MacArthur amendment, which brought many House Freedom Caucus members on board, nor the Upton amendment, which Young co-sponsored, changed the AHCA provisions on Medicaid. Indisputably, the bill “would cut Medicaid by $880 billion, or 25 percent, over 10 years and impose a ‘per-capita cap’ on funding for certain groups of people, such as children and the elderly […].”

On May 5, Iowans who had contacted Young to oppose the AHCA received a letter about his vote. In that through-the-looking-glass version of reality, Young asserted the Republican bill “Modernizes and strengthens Medicaid so the state can better serve our Iowa neighbors and patients who are most in need.”

The letter links to an online document called “THE AFFORDABLE CARE ACT [sic] (AHCA) – MYTHS AND FACTS.” One of the so-called “myths” is “The AHCA will kick millions of people off of Medicaid.” Young would have you believe,

Our Medicaid program is a critical lifeline for some of our nation’s most vulnerable patients. But the program now has three times as many people and costs three times as much as it did under former President Clinton. By expanding Medicaid, the ACA/Obamacare prioritized able-bodied adults above those the Medicaid program was originally designed to help. We will not pull the rug out from anyone as we work to give states the flexibility they need to take care of those most in need.

The AHCA responsibly unwinds Obamacare’s Medicaid expansion, freezing enrollment and allowing natural turnover in the Medicaid program as beneficiaries see their life circumstances change. This strategy is both fiscally responsible and fair, ensuring we don’t pull the rug out on anyone while also ending the Obamacare expansion that unfairly prioritizes able-bodied working adults over the most vulnerable.

The CBO determined in March that the AHCA would lead to millions of people losing Medicaid coverage. This Kaiser Family Foundation brief by Julia Paradise explained how the process would unfold. Timothy Jost covered the CBO report for the Health Affairs blog.

AHCA would reduce the budget deficit by $337 billion over the 2017-2026 period, primarily by cutting the Medicaid program by $880 billion and the current Affordable Care Act means-tested tax credits and cost-sharing reduction payment by $673 billion (replaced by a much smaller $361 billion fixed-dollar, age-adjusted tax credit program). Meanwhile, the bill would cut taxes by $883 billion. […]

Several factors would contribute to the predicted growth in the uninsured. The repeal of the individual mandate, retroactive to 2016, would, CBO projects, result in 4 million people dropping coverage for 2017. By 2018, 14 million more would be uninsured, as 6 million dropped coverage in the nongroup market, 5 million dropped Medicaid coverage, and 2 million fewer people had employer coverage. (The components sum to 13 million because of rounding and “other” coverage losses.) Two million more would drop coverage for 2019, with most of the losses due to the repeal of the individual mandate. […]

Between 2020 and 2026, the number who would lose Medicaid coverage would increase to 14 million as states dropped the Medicaid expansions and the per-capita Medicaid caps started to force the states to drop coverage. […]

The reductions in Medicaid spending would be primarily attributable to 14 million fewer people enrolled in Medicaid by 2026, a reduction of 17 percent compared to those who would have been covered under current law. Before 2020, reductions in Medicaid enrollment would be due to the repeal of the individual mandate penalties, which currently apply to single individuals with incomes above 90 percent of the federal poverty level.

After 2020, much of the Medicaid contraction would be due to the termination of enhanced federal matching funds for the Medicaid expansion population. CBO projects that no states would expand Medicaid if AHCA is adopted, resulting in 5 million fewer people enrolled by 2026 than under current law, which would have resulted in additional states expanding Medicaid in CBO’s opinion. AHCA grandfathers in the ACA’s enhanced match rate for continuously enrolled expansion population enrollees, but because of the normal churn of the low-income Medicaid population, CBO projects that fewer than one-third of those enrolled at the higher match rate at the end of 2019 would still be enrolled two years later. States would also lose funding under AHCA’s per-capita cap program, which goes into effect in 2020—Medicaid costs would grow at 4.4 percent and the federal matching funds would grow at a rate of 3.7 percent, a percentage point lower. States would have to cut Medicaid expenditures, and would likely do much of it by cutting eligibility.

Young asserts that under the Republican bill, a “modernized” Medicaid would “better serve” the needy. However, funding cuts would almost certainly reduce access to services for some Medicaid recipients, Aviva Aron-Dine of the Center on Budget and Policy Priorities explained.

Under the House bill, the federal government would no longer provide enhanced funding for new Medicaid enrollees after 2019, forcing most or all of the 31 states and Washington D.C. that have adopted the ACA’s Medicaid expansion to drop it. The Medicaid expansion now covers 11 million people – and that group has high rates of pre-existing conditions.[…]

The House bill would cap and cut federal funding for virtually the entire Medicaid program, setting annual limits on federal funding per-enrollee that would grow more slowly than the need for that funding would rise, forcing states to make deeper cuts in their Medicaid programs with each passing year. Faced with these large cuts in federal Medicaid funding, many states would have to cut home- and community-based services, an optional Medicaid benefit that most states already limit based on available funds. These services, which include nursing and home health care and help with chores, meals, transportation, and other services, let people with serious health problems remain in their homes instead of having to be placed in a nursing home. Under the House bill, tens of millions of people with disabilities, seniors, and children with special health care needs and disabilities – all of them people with pre-existing conditions – would face the risk of losing coverage or going without needed care as states scaled back eligibility, covered benefits, and provider payments over time.

Paradise of the Kaiser Foundation concurred.

States have used their flexibility in Medicaid extensively to cover optional Medicaid groups and services to meet the long-term care needs of their residents, and a large share of their Medicaid spending is associated with these policy choices (Figure 4). Because of Medicaid, many people who would otherwise be in nursing homes are able to live independently and safely in the community. Under the House bill, states facing budget pressures might reconsider their optional expansions of Medicaid eligibility and services.

I enclose below the full text of Young’s May 5 letter and the “myths and facts” document, in case it disappears after the new CBO report confirms that the revised AHCA would cause millions of people to lose Medicaid coverage, not through “natural turnover.”

Young’s letter also pushes the fiction that the Republican bill “guarantees coverage to all Americans with pre-existing conditions.” Professional health care policy analysts have uniformly reached a different conclusion, as Bleeding Heartland discussed in detail here. Young claims that insurance companies would not be able to deny coverage for pre-existing conditions or charge higher prices because of those conditions. But the AARP, American Medical Association, Kaiser Family Foundation, and others have concluded that many people with pre-existing conditions would be priced out of the market, because insurers could charge much higher rates to older Americans than current law allows.

Young’s letter doesn’t address the fact that the AHCA paves the way for insurance companies to bring back annual and lifetime caps, including for Americans with employer-provided coverage. Only two weeks ago, Young assured a group of concerned constituents, “I want to make sure there’s no cap” on benefits. Before the Affordable Care Act went into effect, people with expensive chronic health problems or catastrophic illnesses like cancer often had to declare bankruptcy after exhausting their insurance policy’s lifetime cap.

According to one Facebook commenter, a staffer told him on May 5 that Young did all his town hall events for the year in March and April. How convenient.

P.S.- If any resident of Iowa’s third Congressional district is able to speak to Young in person while the House is in recess, please consider recording the conversation. You could either write a guest post later or send the video or audio clip to me at the e-mail address near the lower right corner of this page.

Document posted on Representative David Young’s official website on May 5. Note: a different version of Young’s AHCA myths and facts does not include the claims about Medicaid.