The nonpartisan Congressional Budget Office estimates that 24 million people would lose coverage by 2026 under the American Health Care Act, and almost a half-million Kentuckians are included in that number, according to the Urban Institute.
The American Health Care Act (AHCA) would effectively eliminate the Medicaid expansion and change existing tax credits to be based on age instead of income. That could reduce assistance in paying for coverage by as much as $6,000 a year.
Dustin Pugel, research and policy associate with the Kentucky Center for Economic Policy, says Kentucky has drastically reduced the number of uninsured in the last seven years, and under the House plan, the change will be felt in a big way.
"The states that gained the most have the most to lose, and by several measures, Kentucky has gained the most," he explained. "We've seen one of the largest declines in our rate of uninsured. Our folks are able to get to the doctor better like never before. Many of them are reporting actually having better health already."
The CBO report also highlights the fact that insurers will be able to charge older Americans five times more than their younger counterparts. With potentially fewer people insured, Pugel and others predict insurance pools will be made up of sicker people, driving up the demands on insurers and therefore the cost of insurance. Supporters of the AHCA say they are trying to fix a flawed system.
As it stands, the AHCA also would cap federal payments to a certain dollar amount per Medicaid enrollee starting in 2019. Pugel says Kentucky then would have to make up the difference, or drastically reduce benefits.
"It shifts billions in responsibility to the state, making the state responsible for paying more and more, and having a shrinking pot to be able to do that," he said.
Reducing the affordability and availability of coverage also would mean thousands of Kentuckians suffering from illnesses that require expensive prescription drugs will go untreated, and the amount of uncompensated care for hospitals and doctors will increase.
Pugel says capping what the state can spend per person will make it difficult for the state to respond to outbreaks such as Zika or addressing Kentucky's Opioid addiction epidemic.