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Your future access to health care may depend heavily on which state you're in

  • The GOP health care bill would grant broad powers to the states
  • The management of coverage and how it's paid for could be affected

One of the key provisions in the health care overhaul bill narrowly approved by House Republicans Thursday would grant broad powers to the states to decide how insurance coverage is managed and paid for.

If the bill survives intact in the Senate, that means your future access to health care may depend heavily on where you live.

After more than seven years of coverage under the Affordable Care Act, the GOP-controlled House voted to repeal parts of the law in a mostly party-line vote, 217 to 213.

The measure now goes to the Senate, which is expected make further changes.

The so-called American Health Care Act includes some $8 billion in funding for so-called "high risk" insurance pools, intended to cover the sickest patients, thereby lowering the cost of coverage for the remainder of the population.

That could help lower costs for people with pre-existing conditions, who may now see major increases in their premiums. But until the bill is finalized, it's impossible to predict how the states might overhaul their own health care spending.

That spending already varies widely from one state to another.

Massachusetts and Alaska are among the biggest spenders on healthcare – more than $9,000 a year per person, according to the latest data from the Kaiser Family Foundation. Utah ($5,031), Arizona ($5,434) and Georgia ($5,467) were among those who spent the least.

The aide range of health care costs means higher state spending doesn't necessarily lead to more or better coverage. Texas and Georgia — which spent less than most states on healthcare — had among the highest levels of uninsured residents. But so did Alaska, which is one of the biggest spenders.

There is also a wide range in the source of coverage.

In West Virginia, some 29 percent of the population was covered by Medicaid in 2015, followed by New Mexico (27 percent) and California (26 percent).

Wyoming (10 percent), North Dakota (10 percent) and Virginia (11 percent) have the lowest levels of Medicaid coverage.

One of the most controversial provisions in the Republican overhaul bill would allow states to opt out of requirements that insurers cover people with so-called pre-existing conditions without charging them higher premiums.

The bill provides $8 billion for states that choose to set up high-risk pools to cover patients with illness or other medical requirements that could produce higher insurance claims. Critics of the provision point to the states' mixed success record with high-risk pools before the ACA became law in 2010.

About one in every four adults under 65 have health conditions that would have prevented them from getting coverage before the ACA took effect, according to a Kaiser Family Foundation study.

Watch: House passes amended health-care bill