Tennessee stands to lose more than 28,000 jobs by 2026 under the GOP's health care reform bill, which would reduce the health care workforce in the state and nationally, per a new study.

In the short term, the tax repeal under the American Health Care Act would add 864,000 jobs nationally, but the gains would be stripped away in subsequent years as changes to coverage and cuts to Medicaid funding took effect, according to a study from The Commonwealth Fund and the George Washington University Milken Institute of Public Health.

By 2026, a net 924,000 jobs would be lost — 725,000 in the health care sector — when changes to the premium tax credit and Medicaid funding cuts phase in, per the report.

"They kick in a little later and get gradually deeper and deeper then slowly but surely the coverage cuts are outweighing the affects of the tax repeal," said Leighton Ku, director of the Center for Health Policy Research at Milken. "Then they overwhelm it."

Tennessee would be the tenth hardest-hit state with a projected loss of 28,400 jobs over that time. By 2026, its gross state product would be reduced by $3.7 billion.

Nationally, the health care sector could expect to lose 24,000 jobs in 2018 alone, despite the increase in some industries from the tax repeal.

A little more than half of the jobs lost in Tennessee would be trimmed from hospitals, pharmacies and physician offices, said Ku. The rest would be lost from the general economy — and could be construction, retail or other jobs that rely on people or businesses spending money.

As it's currently drafted, which passed the U.S. House, the AHCA gives states the freedom to change what is covered by insurance and increases how much insurers charge older Americans for premiums.

The Congressional Budget Office has projected that if the AHCA becomes law, 23 million fewer Americans would have health insurance by 2026.

The bill has drawn intense opposition from a wide swath of consumer and health care groups. The AARP has launched an ad campaign against the bill.

The Commonwealth Fund is an independent health care think tank focused on health policy and health system performance.

The bill would cut federal funding for Medicaid by more than $800 billion, which is a big factor in the economic impact, said Ku.

The study does not include the economic impact from the cuts to Medicaid that President Donald Trump is proposing in his budget.

The U.S. Senate is in the process of revising the AHCA. Industry experts had hoped the Senate would bring a studied approach to the bill but the process has mostly been in private meetings.

“These job losses become much greater (under additional Medicaid cuts)," said Ku. “We don’t know what the Senate is going to do. Things could be better, things could be worse.”

Reach Holly Fletcher at hfletcher@tennessean.com or 615-259-8287 and on Twitter @hollyfletcher.