‘Lives of our patients are at stake’ as concerns about Senate health care bill mount
The cost savings that would be realized under the Senate’s proposed health care bill would have a dramatic negative effect on the quality of health care offered in the United States, according to policy experts and physicians.
“What we knew qualitatively was that the bill was more about cutting taxes, slashing the social safety net and shifting health care costs onto average Americans,” Caitlin McCormick Brault, associate director of the Center for Health Law and Policy Innovation at Harvard Law School, told Healio.com. “[The Congressional Budget Office] has now quantified the depth and severity of those cuts.”
The Senate’s Better Care Reconciliation Act — publicly introduced on June 22 — would reduce the federal deficit by more than $321 billion by 2026, according to estimates from the nonpartisan Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation. That is approximately $202 billion more in savings than would be realized under the House-proposed American Health Care Act.
The largest savings would result from reductions in outlays for Medicaid, as spending would be reduced by 26% by 2026. The CBO estimated Medicaid enrollment under the Senate’s health care legislation would fall 16% by that time.
Also, the number of uninsured Americans would increase to 49 million if the Senate’s health care bill becomes law, the CBO estimated.
Eugenia Pierson , senior health policy adviser in the Arnold & Porter Kaye Scholer LLP Legislative Practice Group, told Healio.com that the enhanced savings of the Senate proposal are a plus and “definitely gives them some wiggle room to negotiate last-minute deals” to get the required number of votes for passage.
However, the anticipated loss of health coverage for millions of Americans remains a considerable problem.
“Senate leadership is still working to corral the votes they need,” Pierson told Healio.com. “I am just hearing from [Capitol] Hill staff that they are postponing the vote until after the July 4 recess, so it’s clear these issues are a real challenge.”
The New England Journal of Medicine today published an online editorial from the journals editors, who argued there is “good reason” why a majority of the public finds the approach Republicans in both the House and Senate have taken toward health care reform “deeply unpopular.”
The Senate bill would effectively raise insurance costs for millions, force 22 million Americans to lose health insurance, and give insurers the option to drop coverage for many critical health care services, according to the editorial authors.
“Under the [Senate bill], states could easily receive waivers to drop many of the insurance regulations created by the Affordable Care Act (ACA),” Jeffrey M. Drazen, MD, professor in the department of environmental health at Harvard T.H. Chan School of Public Health and the journal’s editor-in-chief, and colleagues wrote. “Although the ACA requirement that insurers take all comers would nominally remain intact, states could reject the ACA’s mandated essential benefits, allowing insurers to refuse to cover such critical services as emergency care, mental health care, maternity care, chemotherapy, and prescription drugs, among others.”
The editorial writers said they share the same concerns as the many other physician and hospital organizations that have already criticized the Senate proposal.
“We wholeheartedly oppose sacrificing Americans’ health care and health to further enrichment of the wealthy,” Drazen and colleagues wrote. “The future of our health care system and the lives of our patients are at stake.”
The American Medical Association criticized the Senate proposal after its public introduction, prior to the CBO report.
Legislators should work to develop a health care plan that is more inclusive, James L. Madara, MD, CEO and executive vice president of the AMA, wrote in a letter to Senate leaders.
“We sincerely hope that the Senate will take this opportunity to change the course of the current debate and work to fix problems with the current system,” Madara wrote. “We believe that Congress should be working to increase the number of Americans with access to quality, affordable health insurance instead of pursuing policies that have the opposite effect, and we renew our commitment to work with you in that endeavor.”
The American Academy of Family Physicians also cited the CBO report in its criticism of the Senate legislation. – by Robert Linnehan and Katrina Altersitz
Congressional Budget Office. H.R. 1628, Better Care Reconciliation Act of 2017. Available at: www.cbo.gov/publication/52849. Accessed on June 27, 2017.
Malina D, et al. N Engl J Med. 2017;doi:10.1056/NEJMe1708506.
Editor's note: This article has been updated to correctly reflect the name of the AAFP.