Twenty-two million more Americans would be uninsured under the U.S. Senate Republicans’ healthcare bill than under the Affordable Care Act, also known as Obamacare, by 2026, according to the Congressional Budget Office’s report released June 26. But that loss would fall much harder on some states than others, according to a new analysis from the Urban Institute and Robert Wood Johnson Foundation.

West Virginia would see its uninsured rate more than quadruple by 2022. In Kentucky and Arkansas the uninsured rate would more than triple. All three states strongly supported Donald Trump in the presidential election.

Rust Belt states, such as Pennsylvania, Ohio and Michigan, would also see large increases in the uninsured rate. Many of those states narrowly supported the president, but have historically leaned left.

The “no” votes in the Senate’s health-care bill are piling up.

But senators’ positions on the bill, by and large, don’t reflect how their state would be affected. Of Kentucky’s two Republican senators, Majority Leader Mitch McConnell is spearheading the repeal effort, and Rand Paul is objecting to the bill for not going far enough to end the ACA’s regulations and spending. Sen. Shelley Moore Capito, R-West Virginia, voiced concerns about the bill early on but wasn’t outright against it until after McConnell called off the vote.

The early moderate defectors, Sens. Susan Collins, R-Maine, and Dean Heller, R-Nevada, come from states with sizable, but much smaller, coverage losses. They both cited coverage loss among their objections.

Federal funding losses

Kansas would lose $449 million, or 18 percent, of their federal Medicaid and ACA funding under the Senate health care bill in 2022.

The bill would save the federal government a lot of money, a big selling point for Republicans.

Over the next decade, the CBO projected, the federal government would spend nearly $800 billion less on Medicaid and $400 billion less on marketplace tax credits than under the ACA.

And much like the coverage losses, those spending cuts would affect some states more than others. States that expanded Medicaid would tend to lose more, because the bill would roll back the expansion.

That would leave such states as Kentucky, where huge swaths of the population enrolled under the expansion, losing half of their funding or more.

Premium hikes

In Kansas, the average monthly premium for a silver plan under the Senate bill would be $379, 82 percent higher than under the ACA in 2020.

The Senate bill would also cause premiums to spike nationwide, according to a separate analysis by the Kaiser Family Foundation.

The increases would disproportionately affect older Americans, those with low and moderate incomes and those who live in rural areas, where health-care costs tend to be higher.

This would hit especially hard in Alaska, where health-care costs are much higher than in other states because of its rural geography, among other things. Alabama would also see a big increase, in part because of its high population of low-income people.

The increases are so large, people may opt out of buying insurance altogether. According to the CBO report, “Many [low-income] people ... would not purchase any plan.”

At this point, it’s unclear whether the Senate GOP’s bill will pass. Republicans will need almost all of their members to support it, but several senators have already expressed concern or outright opposition.

A vote was expected last week but was then pushed back until after the Senate’s Fourth of July recess.

Tim Carpenter is a political reporter for The Topeka Capital-Journal. Email him at tim.carpenter@cjonline.com