Optimism is the prevailing attitude among Republicans who wish to repeal and then replace the Affordable Care Act (ACA) or Obamacare before the window to do so closes at the end of September. Even if the Republicans do manage anyhow to push in the legislation supported by Louisiana’s Senator Bill Cassidy and South Carolina's Senator Lindsey Graham, there is a problem that such an action will result in greater political problems than what the GOP face now.
According to an analysis by Avalere Health, in case the legislation gets passed in its present form, federal money to the tune of $215 billion, originally earmarked for states, will be cut over the subsequent 10 years. About 34 states would suffer cuts to the amount of federal dollars they get for healthcare as per the ACA. Only 16 states would enjoy an increase.
Large states are affected most of all. Texas, which has previously rejected the expansion of Medicaid under the ACA, will enjoy a rise of $35 billion federal dollars. In contrast, New York and California, whose governors accepted the expansion of Medicaid, will see funding reductions of $45 billion and $78 billion respectively. All these states are the extreme states. The remaining 47 states, especially the 34 which will suffer reduced quantity of federal dollars as per the Graham Cassidy scheme should worry the GOP politicians. The list of states set to suffer dips in federal funding includes Michigan (about $8 billion), Pennsylvania and Colorado (about $6 billion each), and Ohio (about $9 billion).
These are the states which voted for Trump in 2016. He must win them again during the Presidential campaign in 2020. The intervening year of 2018 would see a number of competitive Senate races and House races in the above states. The stakes are high: if the GOP suffer losses in numbers in the Houses they have a majority in Michigan, Ohio, and Pennsylvania, there is more than an even chance that their House majority could be at stake.
The Avalere analysis is one of many in concluding the disastrous effect Graham-Cassidy will have on states. According to Tami Luhby of CNN, analyzing an earlier repeal bill in the Senate exhibited that a like restructuring of standard Medicaid program and the steady winding down of the Medicaid expansion will reduce the federal spends by about $772 million within 2026, as compared to the present law.