As suspected, a Senate bill to repeal the Affordable Care Act was crafted in secret because, like the House Republican version, it will leave millions of Americans without health insurance and force others to pay far more for skimpier health insurance policies. It will also gut Medicaid, defund Planned Parenthood for a year — and lower taxes on wealthy Americans.
Given the destructive consequences that would result, the bill must be significantly altered before it deserves serious consideration in the Senate. If Republican leadership continues to push for a quick vote on the bill, without hearings, debate or full consideration of amendments, responsible senators like Susan Collins must reject it.
“I can’t support a bill that’s going to greatly increase premiums for older Americans or out-of-pocket costs for those who aren’t quite old enough for Medicare yet,” Collins said on Meet the Press Daily Thursday evening. “I cannot support a bill that’s going to result in tens of millions of people losing their health insurance. And I cannot support a bill that is going to make such deep cuts in Medicaid.”
Collins is also concerned that the bill could put more pressure on rural hospitals that are already struggling to provide care. She is also frustrated that there is little attention to reducing health care costs.
Like many others, Collins is upset by the rushed and secret process that resulted in the bill revealed Thursday. There were no hearings while the bill was being drafted. Hearings offer an opportunity for lawmakers to hear from experts and those affected by proposed legislation. This enables them to make more thoughtful and informed decisions.
Unlike the House, the Senate is awaiting an analysis from the Congressional Budget Office before taking action. Its report is expected early next week.
The CBO estimated that the House Republican bill would leave 23 million more people without health insurance by 2026 than if the ACA remains in place. It also concluded that “less healthy people would face extremely high premiums.” Given that the Senate bill is not vastly different in many respects, we expect the CBO will conclude that significant negative consequences will arise from the Senate version as well.
Unlike House Republicans, their Senate colleagues should not brush these consequences aside.
The Senate bill, which was negotiated by a handpicked group of 13 Republican men, does have a couple improvements over the House Republican bill. The biggest is that insurers would not be able to deny coverage to people with pre-existing conditions, nor could they raise premiums for these people. States would, however, be allowed to pare down what are known under the ACA as essential benefits, which insurers must cover. These include maternity care, prescriptions and preventative care. Without coverage, people will have to pay more for these services.
The Senate bill would allow insurers to charge older customers five times more than their younger peers. The House Republican bill allowed states to raise this ratio. The Affordable Care Act capped it at three times more.
Like the House bill, the Senate version will end the current Medicaid expansion, although it will phase out the elimination beginning in 2021. Thirty-two states, but not Maine, participated in the Medicaid expansion. More Americans received health insurance through the expansion than through the marketplaces set up under the Affordable Care Act. The expansion helped many people with substance abuse disorder begin treatment.
Worse, states would be allocated Medicaid funding on a per capita basis, with inadequate adjustments for cost increases over time. Currently, funding is based on recipients’ health care needs, so states with sicker populations, like Maine, would be especially hard hit. About 263,000 Mainers, many in Maine’s poorest counties, rely on Medicaid for care. Nearly a third of Washington County residents are covered by Medicaid; more than a quarter of residents in Aroostook, Piscatquis, Somerset, Oxford and Androsscoggin counties are covered by the public program.
Maine providers already struggle to provide care for the state’s poor, elderly and disabled because Medicaid reimbursement rates are so low. Further reducing them will only make this problem worse, harming vulnerable citizens and health care providers, which are the largest employers in many communities.
The measure of the Senate bill isn’t whether it is better than the House Republican version. It is whether it is better than the Affordable Care Act it would replace. It fails this test.