Key Findings

• While most coverage of the Republican reconciliation proposals has focused on Medicaid, the largest financial impact on New York’s healthcare system comes from another program – the Essential Plan. The current House Republican budget proposal threatens to cut the program by $7.6 billion or 57 percent, while increasing state Medicaid costs by $2.7 billion.
• The Essential Plan is an Affordable Care Act-funded program that provides high-quality insurance for 1.6 million New Yorkers earning less than 250% of the federal poverty line, funded entirely by $13.2 billion in federal dollars.
• Republican changes to eligibility for the Affordable Care Act’s (ACA) Premium Tax Credits would cut funding to the Essential Plan by an estimated $7.6 billion and eliminate ACA eligibility for nearly one million people – a cut of nearly 57% in total funding. New York would be constitutionally required to cover approximately 506,000 current Essential Plan enrollees, who are lawfully present, through its Medicaid program. This will require $2.7 billion in state-only Medicaid funds. Ironically, Republicans are increasing the State’s Medicaid rolls.
• This funding cut puts the Essential Program’s financial viability at risk, threatening a program that currently offers affordable or free high-quality health insurance to over 1.6 million New Yorkers.
• Because legal immigrants will no longer have access to Marketplace subsidies, this funding cut also jeopardizes the viability of New York’s individual marketplace, which provides health insurance to 260,000 people. Lawfully present immigrants are typically younger and healthier than the average exchange enrollee.  If they leave the marketplace, premiums for the remaining (relatively sicker and older) population will rise.