Earlier this year, Richard Foster, the Chief Actuary for the Centers for Medicare and Medicaid Services (CMS), issued a report projecting that about half of all seniors and disabled Americans enrolled in Medicare Advantage plans will be pushed out of that program due to the new health care reform law, the Patient Protection and Affordable Care Act (PPACA).

In response to a request from Sen. Charles Grassley (R–IA) and three other Republican Senators, Foster recently confirmed that in addition to losing access to the health plan of their choice, those who are able to remain in Medicare Advantage plans will face substantially higher out-of-pocket costs as a result of the cuts to Medicare Advantage in the new law.

The Senators requested an analysis of the relative impact of the changes on urban compared to rural areas. The letter from the Actuary declined to answer that question, saying his office had not made such a calculation.

However, we have done these calculations. Jim Capretta, Jason Richwine and I have calculated the impact of the Medicare Advantage changes—both in terms of lost enrollment, and lost dollars—for seniors and the disabled not only nationally, but regionally as well.

Taking into account those who remain in the less-generous Medicare Advantage program and those pushed out of it completely, our report found substantial regional variations—benefit losses range from a low of $2,780 in Montana to a high of $5,092 in Louisiana. The percentage of beneficiaries pushed out of the program ranges from 38 percent in Montana to a 67 percent in Washington, D.C., and 84 percent in Puerto Rico. We have calculated separate results for each state, for each county, and for each congressional district.

The bottom line is clear: As a direct result of the Medicare cuts used to pay for a massive Medicaid expansion and subsidy scheme under the new law, senior citizens and disabled Americans will pay more but receive less care, and despite repeated promises that “if you like your health plan, you can keep it,” half of those who like the Medicare Advantage plan they’ve chosen will not be able to keep their plan. Even those who are able to keep their plan will find that it’s not the same plan any more—it will have higher out-of-pocket costs and cover fewer services.