Senate health care bill takes slower approach to House bill, expert concerns persist
The Senate health care bill, released to the public today, maintains much from the version the House passed May 4, 2017, but presents some key changes such as a slower phase out of Medicaid expansion and funding cost-sharing exchange plans for 2 years.
“The most important take away is that both the House and Senate versions make efforts to stabilize the insurance market — the non-employer, individual insurance markets — in various ways,” Kristine Blackwood, from the international law firm Arnold & Porter Kaye Scholer LLP, told Healio.com. “There should largely be stability for the next couple of years until some of the changes in the bill would take effect. Most of the coverage changes are pushed out to 2020 and beyond.”
“We welcome the Senate’s proposal to provide Americans with much needed relief from Obamacare,” Tom Price, MD, HHS Secretary, said in a department press release. “The Senate’s proposal is built on patient-centered reforms that put the American people in charge of their healthcare decisions, not government, protecting patients, bringing down the cost of coverage, and expanding choices.”
The Medicaid expansion funds, provided by the Affordable Care Act, will continue until 2021 and then be phased out over 3 years under the Senate bill. This, along with the 2 years continued subsidies for low-income individuals in exchange plans, would provide market stability for insurance carriers that have been uncertain about the administration’s plans, according to Blackwood, as the Trump administration had recently stated that it would not commit to continue paying cost-sharing reductions beyond June 2017.
Additional changes include retaining the work requirements for able-bodied adults who are receiving benefits under the current Medicaid expansion, retaining the Affordable Care Act’s subsidies to prevent the allocation of funds for abortions, and providing $2 billion in funds to mental health and drug treatment programs for a year.
David O. Barbe, MD, president of the American Medical Association, told Healio.com: “The AMA is reviewing the Senate health system reform legislation, guided by our key objectives that people who are currently insured should not lose their coverage and that Medicaid, CHIP and other safety net programs should be adequately funded. The AMA strongly opposes Medicaid spending caps, and we have grave concern with a formula that will not cover needed care for vulnerable patients.”
In a letter to Majority Leader Mitch McConnell (R-KY), Senators Rob Portman (R-OH), Shelley Moore Capito (R-WV), Cory Gardner (R-CO) and Lisa Murkowski (R-AK) voiced concerns about the House bill, including the protection of individuals with mental health or substance use disorders: “The Department of Health and Human Services reports that nearly one-third of individuals covered under the Medicaid expansion have a mental health or substance use disorder. As the largest payer of mental health and substance use services in the United States, it is critical that any health care replacement provide states with a stable transition period and the opportunity to gradually phase-in their populations to any new Medicaid financing structure.”
Like the House bill, the Senate bill would provide an option for states to have either Medicaid block grants or move to a per capita allotment system. “Basically, what that does is convert the Medicaid program from an entitlement program to, effectively, a grant program from the Federal government while limiting the Federal government’s contribution to the Medicaid program,” Blackwood noted. Also, as proposed in the House bill, Planned Parenthood would be defunded for 1 year.
“Despite calling itself the ‘Better Care’ Act, the Senate bill would actually be worse for patients, particularly vulnerable patients such as older Americans, patients with chronic illnesses, and those enrolled in Medicaid,” Caitlin McCormick-Brault, associate director, Center for Health Law and Policy Innovation at Harvard Law, said in a statement to Healio.com. “The Senate bill makes even deeper cuts to Medicaid that the House’s American Health Care Act (AHCA) does, although they phase them in over the next several years to delay the pain until after the next election cycle.”
According to McCormick-Brault, the Senate bill would result in patients facing higher insurance costs with less robust benefits and higher cost-sharing requirements. She advises physicians that the bill would make patients, particularly those under Medicaid, less likely to seek treatment or follow doctors’ orders when additional care is needed.
“Doctors who see Medicaid patients will be significantly impacted as many of their patients will lose insurance altogether,” she said.
In a statement to Healio.com, Haywood Brown, MD, FACOG, president of ACOG, also voiced his concerns: “The American Congress of Obstetricians and Gynecologists (ACOG) is deeply disappointed by the Senate's proposed health care bill. Among other things, it limits women’s reproductive rights and freedom. This bill denies Medicaid reimbursement for Planned Parenthood, denying low-income women access to this qualified provider. As advocates for women, obstetrician-gynecologists understand and see, every day, the necessity of available family planning and abortion services.”
Additionally, Chris Hansen, president of the American Cancer Society Cancer Action Network, called out the bill for waiving essential health benefits: “While the Senate bill preserves the pre-existing condition protections, it allows states to waive the essential health benefits, which could render those protections meaningless. Without guaranteed standard benefits, insurance plans would not have to offer the kind of coverage cancer patients need or could make that coverage prohibitively expensive. Plans could also once again set annual or lifetime caps on care forcing individuals to choose between their life and life savings.”
He urged the Senate “to return to the drawing board” for a bipartisan effort.
The Congressional Budget Office will provide a score for the Senate’s version of the bill early next week. Previously, the CBO estimated that the House bill would provide $119 billion in savings over 10 years, but 23 million more Americans would become uninsured in that time compared with the American Care Act.
If the score is released within the next few days, according to Blackwood, the bill may be on the Senate floor by the end of next week. Blackwood stated that leaders in the two chambers will have to confer over which provisions in the different versions can garner enough votes for overall passage in both chambers.
Senators Ted Cruz (R-TX), Ron Johnson (R-WI), Mike Lee (R-UT) and Rand Paul (R-KY) issued a statement Thursday suggesting the bill may not have the votes needed to move that quickly: “Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor. There are provisions in this draft that represent an improvement to our current healthcare system but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their healthcare costs.” – by Talitha Bennett