Healthcare lobbyists wait to see if Senate more pliable than House on ACA repeal
Healthcare industry groups are guardedly hopeful they will have more influence on the Senate's healthcare overhaul bill than they had on the House bill passed earlier this month.
That's not saying much, given how House Republicans shut them out. And it's far from a sure thing, because Senate GOP leaders hope to push through their legislation rapidly to clear the way for passing a major tax overhaul in late summer or fall.
Indeed, Senate Majority Leader Mitch McConnell (R-Ky.) and his lieutenants have a powerful reason not to heed the advice of industry groups, which seek to soften the House bill's big insurance coverage losses, spending cuts, and deregulation of benefits. If they follow that counsel, they risk losing the support of their most conservative members, whose votes they need to pass a bill through budget reconciliation. Advancing the bill through reconciliation means that the leadership only needs 51 votes, rather than the normal 60 that would be required to break a filibuster. Since Democrats are unlikely to aid in the effort to dismantle the Affordable Care Act, McConnell can only afford to lose two Republican votes.
Still, Senate Finance Committee Chairman Orrin Hatch reportedly has asked healthcare lobbying groups to offer ideas by May 23 on repealing and replacing the ACA. Conservative analysts say Senate Republicans aim to pass a bill before the July 4 recess.
That doesn't give hospitals, physicians, insurers and other stakeholders much time to exercise influence over the shape of the legislation. At this point, it appears the Senate will follow the House in seeking to roll back the ACA's Medicaid expansion to low-income adults and cap and sharply cut total federal Medicaid spending. That's one of the industry's biggest objections to the GOP repeal-and-replace effort, because it's projected to cause a big increase in the number of uninsured Americans.
On Thursday, leaders of six major physician groups met with six centrist GOP senators to discuss their priorities on healthcare reform. Last month, those groups—including the American Academy of Family Physicians, American College of Physicians and the American Academy of Pediatricians—sent a letter to members of Congress urging them to preserve the ACA's consumer protections and make sure that everyone who currently has coverage keeps it.
"I'm encouraged by the conversations we're having with (Senate) members and staff," said Shawn Martin, senior vice president for advocacy at the AAFP. "I think they're listening to why we and other physician organizations think the House bill is problematic and how we can move forward with improvement to the Affordable Care Act, not simply repeal. It's the start of a good dialogue on what's possible."
But other healthcare industry leaders disagree. "It seems there is a small committee of Republican senators working on a healthcare proposal, but to my knowledge, they have not asked for input from anyone in healthcare," said Sister Carol Keehan, CEO of the Catholic Health Association.
House Republicans faced fierce criticism for rushing to pass a bill with almost no feedback from industry groups, including no hearings with expert witnesses. Their bill, the American Health Care Act, has come under withering attacks from nearly all major healthcare groups, particularly providers.
"There was absolutely no effort to engage with us and other groups representing front-line clinicians," said Robert Doherty, the long-time chief lobbyist for the American College of Physicians. "The Republicans were so dead-set on repealing the ACA that they weren't willing to have a conversation about improving it."
Some lobbyists say Senate GOP leaders are at least making sounds about encouraging industry input. "We are encouraged by the initial steps by the Senate to take a deliberate approach that includes speaking to patients, providers and health plans," said Ceci Connolly, CEO of the Alliance of Community Health Plans, which represents not-for-profit insurers.
"It's too early to say definitively" whether Senate Republicans are more receptive than their House counterparts to industry input, said Jeff Van Ness, a spokesman for the Association for Community-Affiliated Plans, which represents safety-net insurers. "But it's consistent with our experience thus far."
Healthcare groups think they may have better prospects at influencing the Senate legislation because they have built stronger relations over time with GOP senators than with House members. "A lot of work has been done with the Senate already," Tom Nickels, the American Hospital Association's top lobbyist, told Politico.
But that remains uncertain, particularly because Senate leaders plan to have a limited number of GOP senators draft the bill behind closed doors, with no hearings featuring expert testimony or opportunities for senators to offer amendments.
"I think it's true the Senate will be more receptive to stakeholder input than the House was, but they still aren't doing hearings or mark-ups," said Billy Wynne, a former Democratic Senate staffer who now lobbies for hospitals and other healthcare groups. "They're likely to steamroll ahead regardless."
While Republicans seem determined to push their ACA replacement bill through, events in other policy arenas could change the equation.
Some hope that Senate Republicans will be forced, perhaps by political turmoil caused by President Donald Trump's firing of FBI Director James Comey, to drop their repeal drive and work with Democrats and industry stakeholders on bipartisan legislation to fix the ACA's insurance market problems.
"There are a lot of other factors in Washington, as we've seen this week," said the AAFP's Martin, speaking on Friday. "Is there enough real estate to work on healthcare, or will it all be occupied by other issues?"
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.