Tennessee lawmakers reserve full endorsement
NASHVILLE — U.S. Sen. Lamar Alexander praised much of Senate Republican leaders’ newly released “discussion draft” health care bill to repeal and replace Obamacare but joined with fellow Tennessee Republican Sen. Bob Corker in withholding full support for now, pending more review.
Over time, the bill would make substantial cuts to Medicaid, a state- and federally funded health program for low-income single mothers, children and some disabled and elderly people. Tennessee’s version of Medicaid, TennCare, covers nearly 1.5 million people. Federal funding for Medicaid is now open-ended,
meaning the federal government provides matching funds to what states spend.
That would change under the Senate Republican proposal, which provides to states a set amount per enrollee.
Critics are already pouncing, but Alexander defended the overall proposal, on which, as chairman of the Senate Health, Education, Labor and Pensions Committee, he had input during Republican Senate Majority Leader Mitch McConnell’s closed-door crafting of the bill.
“To begin with, it makes no change in the law protecting people with pre-existing conditions, no change in Medicare benefits, and increases Medicaid funding — that’s TennCare — at the rate of inflation,” Alexander said in a statement.
After listing numerous aspects of the draft that he likes, Alexander said he nonetheless “will continue to review this draft,” look at the measure’s costs when the Congressional Budget Office scores it and will ultimately focus “on how does it affect Tennesseans.”
Corker, meanwhile, said that under the federal Affordable Care Act, commonly referred to as Obamacare, “families in Tennessee and across our country face rising costs and have limited choice.”
Congress, Corker said, “has a responsibility to resolve these issues and stabilize the individual insurance market, and over the next several days, I will take time to fully review the legislative text and seek input from a wide range of stakeholders across our state.”
The former Chattanooga mayor, who is up for reelection in 2018 and already has an announced Democratic opponent, said, “I will make a final decision based on whether this legislation, on the whole, is better than what is in place today.”
Robert Greenstein, president of the Washington-based Center for Budget and Policy Priorities, told reporters in a telephone conference call Thursday that the 142-page Senate legislation is worse over the longer term than the GOP’s previously approved U.S. House bill.
The Senate GOP draft “will do more harm, to more Americans, than any other legislation in our nation’s modern history,” said Greenstein, singling out impacts on states’ Medicaid programs for the poor.
Starting in 2020, the Senate proposal would limit federal dollars states get. The House plan is already estimated to cut Tennessee’s share of federal funds by a half billion dollars a year, with set amounts per person, according to some analysts.
Greenstein said the GOP Senate draft is even more “draconian” because after Year 10 the measurement of inflation will shift to the Consumer Price Index, whereas medical inflation is substantially higher.
As a result, Greenstein said, “the Senate bill over time, I’m afraid, goes in a substantial way in hitting the program so hard [as] to be almost destroying it.” States like Tennessee will be forced into making “massive cuts” and/or eliminating some coverage areas, he warned.
A former Tennessee governor, Alexander said Medicaid is “one of the fastest-growing parts of the federal entitlement budget and it has been over the years in Tennessee too.”
The bill seeks to “fund Medicaid properly, but keep it on some reasonable budget,” Alexander said, noting the federal share of the program is 65 percent in Tennessee and lets it rise at the annual rate of inflation.
“Most workers in Tennessee would be happy with a pay raise that increased each year at the rate of inflation,” Alexander argued. “We think the government ought to live by the same rules.”
But the American Hospital Association and the American Cancer Society Cancer Action Network are among groups raising alarms about the bill, which also addresses Obamacare’s health care exchanges, through which uninsured persons can obtain often-federally subsidized insurance depending on their income.
Tennessee Democratic Party Chairman Mary Mancini attacked the Senate GOP plan, calling it “devastating for Tennesseans.”
It “guts” prenatal coverage for expectant mothers and “cuts funding for opioid treatment at a time when record numbers of Tennesseans are dying from overdoses,” she said. “It attacks our seniors by making them pay a crushing ‘age tax’ that will increase their premiums to 5 times higher than what everyone else is paying.”
Mancini said if the “attack on our seniors wasn’t enough, it also cuts Medicaid and puts at risk two thirds of those living in nursing homes. “
Unlike a number of other states, Tennessee never took advantage of a Medicaid expansion largely funded by the federal government. That is going away over time under the GOP overhaul but has no impact on Tennesseans.
Meanwhile, an estimated 234,000 Tennesseans with no employer health insurance have signed up this year for federally subsized insurance on the Obamacare exchange. The Senate bill keeps former President Barack Obama’s premium subsidies structure but in 2020 begins tightening eligibility criteria.
As a result, fewer middle-class folks would get assistance, but Alexander noted that it will offer health care coverage to an estimated 162,000 Tennesseans earning less than $12,000 a year, who now get nothing on the exchanges.
Unlike the House GOP bill, the Senate version does not tinker with pre-existing coverage.
But the Democratic National Committee and other critics charged it will still hurt people with pre-existing conditions because it allows states to permit insurers to apply for federal waivers to scale back on the mandated essential benefits package in Obamacare.
“The bill will allow insurers to offer watered-down plans by allowing states to opt out of providing essential health benefits, which cover services like maternity care, substance abuse treatment and mental health care, as well as other protections that guarantee quality, affordable coverage,” the DNC said in a news release.
Contact Andy Sher at asher@timesfreepress.com or 615-255-0550. Follow him on Twitter @AndySher1.