CHERRY HILL, N.J. -- Even as the Republican health care overhaul remains a work in progress, states are planning for big changes that could swell the ranks of the uninsured and hit them with higher costs.
A key tenet underlying the GOP plan is to give states more authority over how to structure their health care markets. That approach is welcome in states that want fewer mandates from the federal government but is causing alarm in states that embraced former President Barack Obama's Affordable Care Act.
This is especially true for states that expanded their Medicaid programs and could now see a huge pool of federal health care money evaporate. They will face tough decisions about balancing costs and care.
States' preparations come even as Republican members of the U.S. Senate promise significant revisions to the health care bill that narrowly passed last week in the House. Some governors already have begun pressing their senators to soften the bill in ways that would lessen the financial blow to the states.
The current GOP plan would undo a mostly federally funded expansion of Medicaid coverage for low-income adults and allow insurance companies to charge far higher premiums on older Americans and some people with pre-existing conditions.
Republican Gov. Bruce Rauner of Illinois, a state that expanded coverage under Obama's law, said he will push senators to change the legislation so the impacts are not as dire for the state.
"Recent changes did not address fundamental concerns about the bill's impact on the 650,000 individuals that are part of our Medicaid expansion population," he said, "nor have those changes eased the concerns of the 350,000 people in the individual market who are dealing with skyrocketing premiums and fewer choices."
Undoing Obama's law has been a goal for Republican lawmakers since it was adopted in 2011 and was a top campaign promise of President Donald Trump.
As soon as Trump was elected, state officials were on notice that changes were likely.
Even if it gets major revisions in the Senate, the House bill is serving as a baseline for a task force in New Jersey organized by Joseph Vitale, chairman of the state Senate's health committee.
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