Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, with the health and human services secretary, Tom Price, on Thursday. CreditStephen Crowley/The New York Times
It is a rare unifying moment. Hospitals, doctors, health insurers and some consumer groups, with few exceptions, are speaking with one voice and urging significant changes to the Republican health care legislation that passed the Houseon Thursday.
The bill’s impact is wide-ranging, potentially affecting not only the millions who could lose coverage through deep cuts in Medicaidor no longer be able to afford to buy coverage in the state marketplaces. With states allowed to seek waivers from providing certain benefits, employers big and small could scale back what they pay for each year or reimpose lifetime limits on coverage. In particular, small businesses, some of which were strongly opposed to the Affordable Care Act, could be free to drop coverage with no penalty.
The prospect of millions of people unable to afford coverage led to an outcry from the health care industry as well as consumer groups. They found an uncommon ally in some insurers, who rely heavily on Medicaid and Medicare as mainstays of their business and hope the Senate will be more receptive to their concerns.
“The American Health Care Act needs important improvements to better protect low- and moderate-income families who rely on Medicaid or buy their own coverage,” Marilyn B. Tavenner, the chief executive of America’s Health Insurance Plans, the industry’s trade group, said in a strongly worded statement.
Others were even more direct about the effects the bill would have, not only on patients but also on the industry. “To me, this is not a reform,” said Michael J. Dowling, the chief executive of Northwell Health, a large health system in New York. “This is just a debacle.”
Hospitals that serve low-income patients “will just be drowning completely when this happens,” Mr. Dowling said, noting that more people would become uninsured at the same time that government payments to cover their costs were reduced.
In contrast to hospital and doctor groups, insurers had largely remained silent about their reservations, perhaps in the hopes of bartering their low profile in exchange for assurances that billions of dollars in subsidies for low-income coverage would continue. The White House and Congress have gone back and forth about their willingness to pay for the subsidies, prompting anxiety among some companies. Several, including Anthem, have threatened to sharply raise their prices or leave markets altogether without the funding.
But a few, including Blue Shield of California, came out in opposition to the bill before the vote. “We feel compelled to oppose it,” said Paul Markovich, the company’s chief executive. “It raises the specter that the sickest and neediest among us will be disproportionately hit in losing access.”
After the House passed the bill on Thursday, the industry’s two major trade groups urged lawmakers to increase the tax credits available to help people pay for coverage, and to adjust them to assist those who are older, live in high-cost areas or have lower incomes.
But the overriding concern — for insurers, many workers and officials throughout the health care systems in many states — is the broad reductions proposed for Medicaid. Even for insurers that have largely abandoned the individual market, like UnitedHealth Group and Aetna, a substantial portion of their business is providing coverage under Medicaid. The same is true for many local nonprofit plans, said Ceci Connolly, the chief executive of the Alliance of Community Health Plans.
Employers and others said they were also concerned about the effects on freelancers, who do not have a traditional employer but are self-employed or contract workers in the so-called gig economy.
Depending on their income, those workers have shuttled between Medicaid and the individual insurance market under the federal health care law, which offered a greater level of stability, said Nell Abernathy, vice president for research and policy at the Roosevelt Institute, a left-leaning economic research organization.
“A huge swath of Americans are in insecure work arrangements,” she said. “This repeals that level of security, which was not perfect, but it was a step in the right direction.”
Small businesses, which were sharply divided over the original law, remained mixed in their response to the Republican bill, and there seemed little doubt that some companies would drop coverage in the absence of any penalty. The National Federation of Independent Business, which opposed the Affordable Care Act, said the House legislationwas “a crucial first step toward health care reform.”
In other people’s view, employees of small businesses would lose out if Medicaid were rolled back or the exchanges became threadbare, because many smaller companies rely on employees’ ability to obtain coverage through the government program or individual market.
The Main Street Alliance, a group of small-business owners that supported the Affordable Care Act, said four million small-business owners, employees and self-employed entrepreneurs had gained insurance under the law, and that an additional six million small-business workers had signed up for Medicaid through the law’s expansion.
“This bill leaves small-business owners in a terrible position, one they were all too familiar with before the A.C.A.: unable to afford premium hikes year to year, unsure their employees will be healthy and able to work, and uncertain of the future of their businesses,” said Amanda Ballantyne, national director of the Main Street Alliance.
The recent amendments to the bill also raised questions about coverage for people with pre-existing medical conditions, which has become an emotional flash point for opposition. The bill would allow states to waive some of the current rules banning insurers from charging sick people more or excluding certain benefits, and those waivers could have broad effects if employers are no longer required to provide comprehensive coverage. Before the Affordable Care Act, many employers capped how much they would pay for care over a person’s lifetime at $2 million, said Tracy Watts, a senior partner at Mercer, a benefits consultant.
While it is unclear what states would allow under a waiver or when such waivers would go into effect, employers could revisit the limits and drop types of benefits if a state deemed them nonessential.
A January survey of 666 employers by Willis Towers Watson, a benefits consultant, found that while many employers planned to keep most of the mandatory benefits, a significant minority were already mulling changes. While half indicated that they were unlikely to reinstate lifetime limits, 15 percent said they would consider doing that.
And employer groups generally favored provisions of the bill that would reduce taxes, particularly the so-called Cadillac tax on high-cost health plans, which was delayed for several years. Employers favor its overall repeal.
Some health care groups, like medical device manufacturers, supported the bill because of specific provisions like the repeal of a 2.3 percent device tax under the Affordable Care Act. That tax was suspended for two years in 2015, but the industry wants a permanent repeal. The Pharmaceutical Research and Manufacturers of America, the drug industry’s largest trade group, said it had not taken a position on the bill.
Unlike doctors and hospitals, which would most likely experience an immediate hit if millions of Americans lost insurance, medical device manufacturers and the drug industry would probably feel a more muted effect. The drug industry, for example, might sell fewer products and lose revenue.
“Fewer patients are treated, so it’s bad for them, but it’s a lot worse for hospitals and the impact on physicians,” said Ronny Gal, an analyst for Bernstein who covers the drug industry. “They’re a little bit on the tail end of this.”
The new Republican Healthcare Bill has passed the House of Representatives. Next, it goes to the Senate.
But the Resistance continues. It must, because it is clear that the Republicans on the Hill and in the White House are prioritizing removing former President Obama from the history books as much as possible, instead of prioritizing the health, well-being and safety of their constituents.
With this new bill rape and domestic violence can be considered pre-existing conditions. So can pregnancy. Worse, there is a provision to allow states to remove protections for pre-existing conditions. The Republicans in Congress voted for this, against everything that morally right and decent.
A note I saw on Facebook yesterday puts it best: With this new law, the mentally ill will not have access to healthcare, but will still have access to guns.
Think about that.
Doctors, Hospitals and even the Insurance companies find this to be a bad bill. It will increase healthcare costs and lower the level of coverage for thousands, if not millions, of people. Many small businesses dislike this, as well, as it makes it more difficult for them to provide decent healthcare to their employees.
There were many things wrong with the Affordable Care Act, it must be admitted.
This bill fixes none of them and makes much of it worse.
Call your Senator, and hold your Representative accountable for their vote. Go to Town Hall meetings, mail postcards, keep the pressure up.
This must not pass the Senate, and we CAN make a difference. We did the first time they tried this horrible bill, we must do so again.
WASHINGTON — A Republican bill to replace Obamacare would lead to 14 million fewer Americans with health insurance by 2018 and 24 million fewer by 2026, the non-partisan Congressional Budget Office said Monday in an analysis that could make the controversial legislation even tougher for GOP leaders to push through Congress.
Health and Human Services Secretary Tom Price said the projections of uninsured were too high and called them “just not believable.”
Most of the initial increase in uninsured people in 2018 would come from consumers deciding not to buy insurance because they would no longer have to pay a penalty for failing to do so, the CBO said in an analysis done with the Joint Committee on Taxation. However, others would stop buying insurance because premiums will go up over the next two years, the report said.
The bill is expected to raise the average premiums that Americans would have to pay before 2020, and then lower them after that, the CBO projected. In 2018 and 2019, the average premiums for single policyholders who do not get insurance from their employers would be 15% to 20% higher than under Obamacare, the analysis said. Starting in 2020, those premiums would begin to go down. By 2026, average premiums would be roughly 10% lower than under the existing Affordable Care Act, the CBO projected.
However, younger Americans would benefit more than older ones. The GOP bill would allow insurers to charge five times more for older patients than younger ones — rather than three times more as allowed under Obamacare, the report said. The effect, the report said, would be “substantially reducing premiums for young adults and substantially raising premiums for older people.”
“If ever there was a war on seniors, Trumpcare — this bill — is it,” said Senate Minority Leader Chuck Schumer, D-N.Y.
The number of uninsured Americans would rise dramatically during that same period as the Republican replacement plan phases out Obamacare’s Medicaid expansion, the CBO said.
“In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law,” the analysis said.
The Republican bill would reduce federal deficits by $337 billion over the 2017-2026 period, according to the CBO. The biggest savings would come from reductions in outlays for Medicaid and from the elimination of the Affordable Care Act’s subsidies for low-income Americans to buy insurance.
Administration officials said the CBO overestimated the number of people who would lose insurance and did not take into account future phases of the Republican proposal. However, unlike the current GOP bill under consideration, any subsequent legislation would have to attract support from Democratic senators, who are unlikely to provide it.
One of the subsequent steps that Republicans are pushing is for Price to use his administrative power to reduce regulations to inspire more insurance companies to participate, which Price said would give consumers more choices at competitive costs.
“They’re going to be able to buy a coverage policy that they want,” Price said.
The CBO report came as Republican leaders in Congress were already scrambling to keep their fractious caucus together on the bill. Some conservatives have denounced the plan as “Obamacare lite,” arguing that it does not go far enough in scrapping the Affordable Care Act and creates new entitlements by replacing the current law’s federal subsidies for low-income people with tax credits. At the same time, some moderate Republicans in the Senate fear their low-income constituents and seniors in nursing homes will lose coverage because the legislation phases out the expansion of Medicaid that Obamacare helped fund in many states.
Democrats, who were already fiercely opposed to the legislation, said the CBO score underscores that President Trump was wrong when he promised “insurance for everybody” under the GOP plan.
“The CBO score shows just how empty the president’s promises, that everyone will be covered and costs will go down, have been,” Schumer said. “This should be a looming stop sign for the Republicans’ repeal effort.”
House Speaker Paul Ryan, R-Wis., is leading the push for the bill, saying it is the best hope that Republicans have of ending Obamacare and passing a replacement bill under a fast-track budget procedure that cannot be blocked by Senate Democrats.
“This report confirms that the American Health Care Act will lower premiums and improve access to quality, affordable care,” Ryan said. “CBO also finds that this legislation will provide massive tax relief, dramatically reduce the deficit, and make the most fundamental entitlement reform in more than a generation. These are things we are achieving in just the first of a three-pronged approach.”
House Minority Leader Nancy Pelosi, D-Calif., said Ryan is wrong when he says Republicans want to kill Obamacare as “an act of mercy” because it is in a death spiral of rising costs and decreasing insurance choices for consumers.
She said that 24 million more uninsured Americans by 2026 is “a remarkable figure” that underscores the need for GOP leaders to scrap their bill.
“It speaks remarkably to the cruelty of a bill that the Speaker calls an act of mercy,” she told reporters Monday. “In terms of insurance coverage, it’s immoral.”
The Congressional Budget Office, which was created by Congress in 1974, is a non-partisan group of economists and analysts that produces hundreds of cost estimates for Congress on proposed legislation each year. The office has a reputation for being impartial and its cost estimates — or “scores” — of bills are taken seriously by lawmakers as they decide whether to support legislation.
Republican leaders unveiled the American Health Care Act last week, and it has already been approved by the House Ways and Means Committee and the House Energy and Commerce Committee. It is scheduled to be taken up by the House Budget Committee on Wednesday, unless an expected snowstorm forces the Capitol to close. The bill will then go to the House Rules Committee, followed by a vote on the House floor as soon as next week. If the House passes the bill, it will be sent to the Senate for approval.
The GOP bill would no longer require Americans to buy health insurance. It also would replace direct federal subsidies with tax credits to help low-income people buy insurance, phase out the expansion of Medicaid, and allow insurance companies to charge older Americans more for their coverage. It increases the amount of money people can contribute to Health Savings Accounts, which are tax-exempt accounts that can be used to pay medical expenses.
Trump promised not to cut Medicaid. His health bill will cut $880 billion from it.
As a candidate, Donald Trump promised that he wouldn’t cut Medicaid. He’d “save Medicare, Medicaid, and Social Security without cuts,” he pledged during his announcement speech. “Have to do it.”
The House Republican health care bill doesn’t just break that promise — it makes a mockery of it.
According to the Congressional Budget Office estimate released Monday, the American Health Care Act would slash $880 billion in federal funds from Medicaid in the next 10 years. As a result, 14 million fewer people would have Medicaid coverage in 2026, the agency estimates.
Trump’s promise not to cut Medicaid wasn’t a one-off — he used it specifically to argue that he was different from other Republicans. In May 2015 when he was preparing his campaign, he said, “I’m not going to cut Medicare or Medicaid. Every other Republican is going to cut.”
I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid. Huckabee copied me.
Trump has also repeatedly promised, even after his election, that his health care plan would provide insurance for everyone. “We’re going to have insurance for everybody,” he said in January. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
The American Health Care Act utterly breaks that promise. Not only does it roll back Obamacare’s Medicaid expansion, it would overhaul the entire Medicaid program to cap how many federal dollars states would get per enrollee, as Dylan Matthews explains. As a result, it would cause millions of people to be tossed off Medicaid without offering them an affordable alternative.
I am continuing to bring you information on the activities of the GOP Congress and the White House. The possibility of of millions of Americans losing their health insurance after the Democrats and President Obama worked so hard to provide this important resource to them. Americans will die and suffer without the Affordable Care Act or Obamacare as people often refer to it. We need to be calling our representatives and Senators to vote No to this cruel and malice GOP health bill. Please let me know where you stand on this repressive bill.