Editorial: 'This is a disaster'
Imagine the fate of a corporate tax reform bill rejected by every affected industry group, whether retailers, financial firms or manufacturers. Would that pass Congress?
Of course not. Yet that is what the Senate leadership seeks with its latest version of the Better Care Reconciliation Act. I keep searching my email inbox for a single healthcare lobbying organization that supports the bill.
The health insurance industry does not support creating an individual market that has no individual mandate, allows sale of bare-bones plans and provides inadequate high-risk pool payments for any remaining ACA-compliant plans, which will still be required to take all comers.
The nation's 5,000 hospitals, which collectively are either the largest or second-largest employer in virtually every American community, vehemently oppose ripping hundreds of billions of dollars out of Medicaid over the next decade. That will inevitably lead to higher uncompensated-care costs, higher hospital prices and force major job reductions across the sector.
Groups representing the nation's nearly 1 million physicians have come out against any bill that would roll back the insurance expansion in the Affordable Care Act. Experts say the forthcoming Congressional Budget Office score of this bill will be little different from the earlier version, which foresaw 22 million fewer insured in a decade.
Beyond industry opposition, hundreds of consumer and patient advocacy groups are mobilizing to oppose the BCRA because it will force states and insurers to strip away vital support for maternity care, behavioral health and the long-term support needed by the frail elderly, blind and disabled.
Here's just one example. The March of Dimes just released a study that estimated removing maternity care as an essential benefit would raise premiums for women who wanted that coverage by 25% to 70%, while saving everyone else just $10 a month in premiums.
The bill also defunds Planned Parenthood for a year while making it more difficult for state Medicaid programs, which pay for about half the deliveries in the U.S., to deliver prenatal care. That will inevitably lead to higher rates of infant mortality, higher rates of premature delivery and higher neonatal intensive-care unit costs.
For years, ACA supporters were subjected to false accusations that the legislation was crafted in secret without input from Republicans. It wasn't just dozens of prepassage hearings that belied that charge. At the end of the process, every major healthcare industry and special interest group signed onto the bill. That doesn't happen without dialogue.
The McConnell bill was crafted in secret by a small group of GOP legislators. Its compromises—an amendment by Sen. Ted Cruz (R-Texas) that reopens the door to bare-bones, high-deductible plans; more money for opioid treatment and high-risk pools; and an opt-out from Medicaid caps for states that declare medical emergencies—do nothing to change its fundamental flaws.
Millions of Americans will still lose insurance coverage or have vastly inferior plans. The BCRA will still reduce the subsidies for low-income people who buy plans on the exchanges. It will still raise premiums for older, sicker people in the individual insurance market. And it will still force states, especially those that expanded Medicaid, to cut back coverage.
The head of the organization representing state Medicaid directors, two-thirds of whom report to Republican governors, offered this public evaluation of the McConnell bill. "This is unworkable. . . . This is a disaster."
The Trump administration and the GOP leadership in Congress do not seem to understand that repeating a lie does not make it true. Obamacare is not failing. More people are insured today than ever before. The individual insurance markets need fixing, but in most areas of the country they are stabilizing.
A handful of GOP moderates in the Senate are now all that stand in the way of legislation that would turn that lie into reality, and makes things worse than before the ACA. Here's hoping they listen to their constituents.
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