The repeal of Obamacare could cost the State of Maryland nearly $2 billion in Medicaid funding for more than 260,000 people, state legislative analysts told lawmakers Thursday.
Hospitals could lose an additional $2.3 billion, the analysts told the House Health and Government Operations Committee. That's federal money they receive for working to keep health care costs down.
The conclusions for the next fiscal year alarmed Democratic lawmakers, advocates, insurers and others. They spoke of a sharp increase in the number of uninsured people in the state, more debt for hospitals and eventually higher premiums for everyone else.
"Our option is leaving people without coverage," said Del. Shane Pendergrass, the Howard County Democrat who chairs the committee. "But that means people don't get treatment and hospitals incur uncompensated care costs when people come in at their wits' end."
The GOP-led Congress, backed by President-elect Donald Trump, has begun the process of repealing the Affordable Care Act.
Trump recently promised "insurance for everyone." But he has not provided details, and his pick for health secretary, Rep. Tom Price, stopped short of promising universal coverage.
Suggestions for replacing Obamacare include block grants to states to cover recipients of Medicaid, the federal-state health program for the poor, and a tax credit to help consumers buy insurance.
The moves would reduce the cost of the health law and give states flexibility in implementing programs, conservative advocates say.
More than 20 million people are estimated to have gained insurance nationally through the health law. The nonpartisan Congressional Budget Office found that 18 million could lose coverage if Obamacare were repealed without a program to replace it.
In Maryland, more than 400,000 people have gained coverage under the health law, either through the expansion of Medicaid or by buying coverage on the state health exchange. The uninsured rate in Maryland declined from 10 percent in 2012 to 6.7 percent in 2015.
It's unclear what the state would do if the federal funding were to evaporate. The Hogan administration hasn't said if it has a contingency plan. A spokesperson for the governor did not respond to a request for comment.
Senate President Thomas V. Mike Miller has said the legislature would look for ways to prevent people from losing coverage.
Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, the state's dominant insurer, told panel members that private insurance sold on the state's health exchange would be too expensive for many without federal tax subsidies.
He said only the very sick would likely bother buying plans, which would cause premiums to rise and chase more people from the market.
Carmela Coyle, president and CEO of the Maryland Hospital Association, said repeal would cause the hospitals' debt from unpaid bills to increase.
Legislative analysts said the health law caused uncompensated care to fall by $311 million from 2013 to 2015. Coyle said repeal could raise hospital rates and insurance premiums for everyone.
"What this shows, and this is true everywhere, is there is a great deal of uncertainty," said John M. Colmers, the former state health secretary who brokered the special arrangement with federal authorities that governs hospital budgets and billing.
"We do know that the Affordable Care Act was effective in providing coverage, and when people lose coverage there are consequences to them as individuals and the rest of the system."
Jeananne Sciabarra, executive director of the advocacy group Consumer Health First, said state officials must summon "political will" to continue covering residents if there is a repeal.
"It's doom and gloom wherever you look," she said. "The question is what does Maryland do? How do you smartly spend resources to promote the common good?"