In Shroud of Secrecy, Senate Will Not Make Health Care Repeal Bill Much Less “Mean”

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The U.S. Senate plans to vote on a health care repeal bill next week that has been crafted in secret.  The Senate inherited a terrible bill (American Health Care Act, AHCA) from the House that even President Trump now admits is “mean, mean, mean.”  Despite initial claims that the Senate would start over with a new bill, it has become clear that the Senate is, in fact, using the terrible House bill as a blueprint and ultimate changes may simply be window dressing or make the bill even worse than the House bill.  Texas Senator John Cornyn predicted that, “80 percent of what the House did we’re likely to do.”

Reminder: What the “Mean” House Bill Does

  • Causes 23 million Americans to lose their insurance coverage
  • Cuts Medicaid for all 50 states- $834 billion in cuts over 10 years, which is used to pay for huge tax cuts to wealthy individuals and corporations.  Medicaid is the backbone of our health care system.  In Texas, Medicaid pays for more than half of all births, covers more than 40 percent of all children, and pays for the care of two-thirds of people in nursing homes. Medicaid funding helps keep rural hospitals open and the safety net intact.  All of Medicaid will be cut, not just the ACA expansion for adults. Cuts to Texas will be an astonishing $1.5 billion per year on average.
  • Sharply raises premiums and out-of-pocket costs for millions of Americans who do not get insurance through their jobs, especially for older people, lower income people, and people with pre-existing health conditions.
  • Erodes protections for people with pre-existing conditions and requirements that insurers cover fundamental care, like maternity, mental health care, and substance use treatment.

Possible Senate Changes

Though bill drafts are not being made public, the following are reported as some of the  changes under discussion:

  • Even deeper Medicaid cuts than the House bill, affecting every state Medicaid program.
  • Delay the ending of the ACA’s Medicaid expansion, which will ultimately lead to just as many low-income American losing coverage as the House bill.
  • Cosmetic tweaks to the rollback of protections for people with pre-existing conditions, but with similarly bad results.  For example, an insurer couldn’t deny coverage to people with cancer, but they can refuse to cover cancer treatment.
  • Making subsidies for Marketplace insurance slightly more generous than the House’s AHCA, but still dramatically lower than the current ACA subsidies so that millions can no longer afford coverage.
  • Adding a modest amount of funding to help counter the opioid crisis, but not enough to offset massive Medicaid cuts or make up for insurance policies that would no longer have to cover substance use treatment.

Unprecedented Secrecy

The bill is being written in extreme secrecy.  Even some Republican Senators are complaining that they do not know what is in the bill.  While work taking place behind closed doors isn’t new in D.C., the level of secrecy and lack of transparency with the AHCA is unprecedented for a health care bill.  When asked by a reporter why proposed policy changes are not be shared, a Senate aide said, “We aren’t stupid.”  This deeply cynical stance reflects a glaring reality – the public is overwhelmingly opposed to the AHCA.  Keeping the bill secret until the last possible moment may be the only way to pass it.

Unprecedented Opposition

Polling puts support of the AHCA at a measly 29% nationwide.  The bill is unpopular in every state, even deep-red Texas, where only one-in-three voters are estimated to support the bill.  In fact, if passed, the AHCA would be the least popular piece of major legislation out of Congress in decades, less popular than even the bank bailout during the Great Recession.  Major patient advocacy groups, like AARP, the American Cancer Society, and the March of Dimes, and major health care associations representing doctors and hospitals are united in their opposition as well.

The Bottom Line

Senate leadership wants to vote in the coming weeks, as early as the end of June, but possibly in July.  If the final Senate bill does any of these, it is still unacceptable:

  • Causes millions of Americans to lose their health coverage;
  • Contains huge Medicaid cuts and shifts costs to Texas county taxpayers through “per capita caps” or “block grants.” Medicaid cuts should be taken off of the table, period. Medicaid is not a piggy bank that can be raided to fund huge tax cuts for people who likely have great insurance;
  • Makes coverage less affordable, by increasing premiums or out-of-pocket costs; or
  • Weakens pre-existing condition protections, including by allowing insurers to exclude basic health care services needed by people with health conditions.

Don’t be misled.  If the Senate bill is “slightly less mean” than the House bill or only causes 80 percent of the harm, that is still way too much.

Stacey Pogue joined the center in 2008. She focuses on health policy issues. Before coming to the center, she did health policy and research work with the Medicaid and CHIP Division of the Health and Human Services Commission and the Texas Department of Insurance. In 2010 and 2011, she was selected to serve as a funded Consumer Representative to the National Association of Insurance Commissioners (NAIC). Pogue earned a Bachelor of Science in Geography, summa cum laude, from Texas A&M University in 1997 and a Master of Public Affairs from the LBJ School of Public Affairs at The University of Texas at Austin in 2005.

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