To some extent, the division within the GOP's ranks reflects geography. It will lead to disabled children not getting services. It will hammer rural hospitals, it will close nursing homes. history,' said Bruce Siegel, president of America's Essential Hospitals, a coalition of about 300 hospitals that treat a large share of low-income patients. 'There has never been a rollback of basic services to Americans like this ever in U.S. Then, four years later, the federal government would apply an inflation factor to spending increases that would be equal to the urban consumer price index rather than the higher medical inflation rate used in the House bill. What is now an open-ended entitlement, with federal funding available for a specific share of whatever each state spends, would be converted to per capita payments or block grants. The expansion, which has provided coverage to roughly 11 million people, would be phased out. Under the Senate GOP version, 2021 is when Medicaid's transformation would begin.