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US President Donald Trump stands with Speaker of the House Paul Ryan (L) alongside US Vice President Mike Pence (R) (Photo by Saul Loeb | Getty Images)
WASHINGTON -- House Republican legislation to repeal and replace the Affordable Care Act would leave 500,000 more New Jersey residents without health insurance, according to a study released just two days before lawmakers will be asked to vote on the bill.
The losses will fall heaviest on those congressional districts represented by Republicans, whose support is crucial to the measure's passage since every House Democrat is expected to vote no on the bill championed by President Donald Trump.
The number of uninsured residents in New Jersey's five GOP-held districts would rise 74 percent, while those in the seven districts represented by Democrats would increase 58 percent.
"A lot of those folks are the white working class who were given certain promises when Trump was running for election," said Ray Castro, a senior policy analyst with New Jersey Policy Perspective, a progressive research group that conducted the study. "They're going to be harmed the most under this proposal."
Rep. Leonard Lance (R-7th Dist.) said he would oppose the legislation, the first House Republican from New Jersey to do so.
"I campaigned in support of a repeal and replace bill that would make health care more affordable and accessible and provide a smooth transition to those who were forced into Obamacare through no fault of their own," Lance said. "The bill, as currently drafted, does none of these things."
Just one House Republican from New Jersey, Rep. Tom MacArthur (R-3rd Dist.), has said he will back the measure. MacArthur's district would see its uninsured population rise by 94 percent under the Republican measure, more than anywhere else in the state, the study said.
MacArthur said he agreed to support the bill because GOP leaders provided an extra $85 billion to allow the Senate to boost tax credits for lower-income Americans aged 50 to 64.
The Republican bill would end the traditional Medicaid health-care program for the poor and elderly, giving states a fixed sum rather than adjusting funding when more people need help.
MacArthur won agreement to boost the Medicaid payments to the states for seniors and people with disabilities by a percentage point higher than the annual increase in medical costs. He said that would mean an extra $60 billion.
"That moved me to a yes," MacArthur said. "Is it a perfect bill? No. But I think at some point, you have to, if you're going to be a constructive part of the process, move to a yes."
The Center for Budget and Policy Priorities, a Washington research group, said the increase wouldn't prevent states from having to cut their Medicaid program as the federal payments, no longer tied to need, become increasingly inadequate.
Both MacArthur and Lance were among the 16 more moderate House Republicans meeting with Trump, Vice President Mike Pence and top aides to the president in advance of Thursday's scheduled vote on the health care bill.
Lance said he told Trump that he could not support the American Health Care Act.
"I was clear in my opposition to the bill in its current form," Lance said. "I hope and expect to work with the president in the future on important ideas like purchase of policies across state lines, small business pooling and medical malpractice reform, all of which are absent from the current legislation. These reforms will drive down costs and offer greater choice and competition for all Americans."
The Congressional Budget Office reported last week that the Republican plan would increase the number of those without health insurance by 24 million in 2026 over current law.
The CBO said millions would be without coverage as Republicans cut Medicaid funding and millions more would lose insurance because employers would no longer be required to provide it.
The change in Medicaid would save $880 billion over 10 years, most of which would go to cutting taxes for those making more than $200,000 a year and corporations.
Besides the provision championed by MacArthur, other changes would end the taxes on high earners and corporations this year rather than wait until 2018.
There also would be a new tax break for the better-off, allowing taxpayers who itemize expenses to deduct medical costs exceeding 5.8 percent of income rather than the current 10 percent.
Just 6 percent of those earning $25,000 or less choose to itemize, compared with 94 percent of those with incomes higher than $200,000, according to the Tax Foundation, a Washington-based research group whose board includes two former House Republicans.
Jonathan D. Salant may be reached at jsalant@njadvancemedia.com. Follow him on Twitter @JDSalant or on Facebook. Find NJ.com Politics on Facebook.