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The Republican health care bill could cost the average poor family benefits worth a third of their income while giving the most affluent families a $5,000 tax break, according to the first detailed report on the income distribution effects of President Trump and GOP lawmakers' plan to undo the Affordable Care Act. (Johnson and Ehrenfreund, 3/22)

Connie Dotts is a big fan of her insurance. “I like that we can choose our own doctors,” said the 60-year-old resident of Mesa, Ariz. “They also have extensive mental health coverage.” Dotts isn’t on some pricey plan, either. She’s among the nearly 2 million people enrolled in Medicaid in Arizona and one of the more than 400,000 who have signed up since the Republican-led state expanded Medicaid in 2014. (Stone, 3/23)

With House Republicans poised to vote Thursday to dismantle the Affordable Care Act by replacing it with a pared-down health plan, a new California analysis reveals that the substitute would severely impact the state’s ability to pay for health care for its poorest residents. The study released Wednesday by the Department of Health Care Services and Department of Finance shows that California would lose almost $6 billion in federal Medicaid funding in 2020 — a figure that would increase to $24.3 billion annually by 2027 if the GOP plan is passed by Congress and signed by President Donald Trump. (Seipel, 3/22)

California would lose $24.3 billion annually in federal funding by 2027 for low-income health coverage under the current Republican plan to replace the Affordable Care Act, according to a state analysis released Wednesday. The bill, up for a vote in the House on Thursday, represents a “massive and significant fiscal shift” from the federal to state governments by setting caps on Medicaid spending, reducing the amount of money available for new enrollees and eliminating other funding for hospitals and Planned Parenthood, the analysis said. (Gorman, 3/23)

Under Republican efforts to repeal, replace or reform the health law, many people on Medicaid — the nation’s single-largest insurer, with 72 million beneficiaries — could see their coverage slashed. The biggest chunk of them — 13.5 million — live in California. The state predicted Wednesday it could lose $24 billion in federal funding annually by 2027 under the current GOP proposal. Among the hardest hit regions would be the Central Valley, the state’s agricultural heartland, stretching hundreds of miles from Redding to Bakersfield. (Ibarra and de Marco, 3/22)

Gov. Jerry Brown, in Washington warning about the billions his state could lose on the eve of a Republican effort to repeal and replace Obamacare, strained Wednesday to understand the logic behind pushing another system like single-payer. ... Universal healthcare has gained in popularity, particularly among liberal groups in California, as an answer to what they see as the undermining of Obamacare. (Cadelago, 3/22)

The bill’s latest iteration, which may be voted on as early as today by the U.S. House of Representatives, could reduce Virginia’s Medicaid funding by $708 million over the next decade, Joe Flores, deputy secretary of Health and Human Resources, said late Wednesday afternoon. Had the bill been passed in its earliest version, the decrease in funding would have been around $1.8 billion, he said. McAuliffe and several of his cabinet secretaries met in Washington on Wednesday afternoon to discuss with Virginia’s congressional delegation their opposition to the bill, which has the support of several leading conservative groups. (Kleiner, 3/22)

The Republican bill to replace Obamacare could harm Illinois residents with disabilities — a group that hasn't gotten much attention in the debate, advocates warned Wednesday, one day before a scheduled House vote on the measure. More than 140,000 Illinois residents with disabilities receive Medicaid-funded services that allow them to remain in their homes or in community settings instead of nursing homes, according to the Illinois Department of Healthcare and Family Services. Another 19,000 Illinois residents with developmental disabilities want services but have not received them, according to the Illinois Department of Human Services. (Schencker, 3/22)

The plan also makes changes that critics including Gov. Rick Snyder say could end Healthy Michigan, which insures some 650,000 residents just over the poverty limit and force reductions in traditional Medicaid. Together, it could mean billions in tax dollars saved but fewer people covered nationwide. Republicans say the changes are necessary given premium hikes and fewer insurers providing policies under the existing program and most of Michigan’s Republican members of the U.S. House support the proposal. Even though the U.S. Senate is expect to change the plan if it passes, a vote this week could be the harbinger of drastic changes in coverage for people across Michigan. (Spangler, 3/22)

Anya Rader Wallack, interim head of the Executive Office of Health and Human Services, says the Republican proposal could mean a loss of nearly $200 million over four years for Rhode Island’s Medicaid program. That comes from scaling back the expanded coverage Medicaid offered to single adults under Obamacare and capping state Medicaid spending per person. Wallack says that could ultimately drive up the number of uninsured Rhode Islanders. (Gourlay, 3/22)

Rhode Island officials estimate it would cost the state $595 million more over five years to prevent up to 75,000 low-income adults from losing their Medicaid coverage under the U.S. House GOP plan to overhaul healthcare. And that's just for the adults without children who became newly eligible for coverage since 2014 under the Affordable Care Act. Medicaid insures close to 300,000 Rhode Islanders, or nearly one-third of the population. (Arditi, 3/22)

Three out of five nursing home residents in Colorado are covered by Medicaid. Older people with disabilities, in long-term care, make up nearly 10 percent of the state’s overall Medicaid population, but they account for more than 40 percent of the costs, according to the state budget office. Matt Salo, the head of the National Association of Medicaid Directors, said they “serve the sickest, the frailest, the most medically complex and the most expensive populations in the country.” For Salo, it’s important to understand that Medicaid, not Medicare, the federal program that covers elderly Americans, picks up costs for long-term care. (Daley, 3/22)

[Waynesboro, Pa.] has two messages for President Donald Trump and his party as they consider reworking the nation’s health insurance system: Go full-speed at repealing the Affordable Care Act, but keep the costs of insurance down. ... Waynesboro is also full of the lower-income voters for whom a bump in insurance costs could be a hardship. Its median household income is roughly $38,000, lower than the national average by more than $15,000. (Chinni, 3/22)

Many in Texas are keeping a close eye on the Republican bid to replace the Affordable Care Act. One of the big changes is how it would affect low-income people, seniors and people with disabilities who all get help from Medicaid. And Texans on both sides of the political spectrum say the Lone Star State is not going to fare well. As the GOP bill, the American Health Care Act, works its way through Congress, Anne Dunkelberg, with the left-leaning Center for Public Policy Priorities in Austin, said she’s a little stumped. (Lopez, 3/23)

[Luke Franco is] a member of the millennial generation. They represent more than a quarter of the nation’s population. These are people loosely defined as 18 to 34 years old, and they figure prominently in the health care debate. How they fare under the GOP health care bill going through Congress is complicated. (Gourlay, 3/22)