Health care sector largely opposing bill
Undecided senators are receiving intense pressure to buck GOP on measure
Just four days after Senate GOP leaders revealed their health bill this summer, Tucson Medical Center hosted a town hall, drawing roughly 700 people in person and 1,900 online. In its aftermath, hospital employees, doctors and members of the public sent nearly 2,900 emails to the state’s two Republican senators, John McCain and Jeff Flake, urging them to reject any legislation that would jeopardize patient health care.
The move was like nothing the hospital had done before, said Julia Strange, the center’s vice president for community benefit. While they had sponsored educational sessions on issues such as cardiac arrest and opioid abuse, “this was clearly different,” she said — and when triple the number of expected attendees showed up, “We had to order extra cookies.”
Medical profession acts
Most corners of the U.S. health care industry have stood steadfastly opposed for months to Republican efforts to revise the Affordable Care Act. Patient advocate groups and Democratic organizers have crowded town halls since February to grill lawmakers. But in recent weeks, a last gasp of advocacy has come from an even wider range of groups and individuals trying to block the Senate health bill.
Community hospitals have held information sessions. Pediatricians have starred in videos. Patient associations have flown in hundreds of Americans with chronic illnesses to meet with lawmakers and their aides.
These events, in turn, have generated tremendous public pressure on the senators who will decide over the next week whether their health bill will succeed or fail.
The measure remained in trouble this week, with conservatives angling for a more dramatic repeal of the ACA and centrists saying the bill jeopardized coverage for too many Americans. President Donald Trump weighed in Wednesday, telling senators he will be “very angry” if they don’t pass a bill.
“It does make a big impact,” Sen. Shelley Moore Capito, R-W.Va., said of the advocacy across the country. Capito is weighing whether she can accept phasing out Medicaid coverage for nearly 180,000 West Virginians, along with other changes. Last year nearly 18 percent of those Medicaid dollars paid for substance-abuse treatment; in recent days Capito has met with state officials as well as leaders of community centers and nursing homes who have warned about the impact of limiting Medicaid funding.
A GOP opponent
The push has touched other senators, too. Sen. John Hoeven, R-N.D., said in a statement that he has met with health care leaders and particularly officials with rural hospitals, who “stressed the importance of stabilizing the health insurance market and also ensuring that low-income individuals have access to health care coverage either through Medicaid or refundable tax credits.” Hoeven said over the July Fourth recess that he opposes the bill in its current form.
Senate Majority Leader Mitch McConnell, R-Ky., has spent days reworking portions of the legislation, diverting money from a planned tax cut to insurance premium subsidies and exploring whether to let insurers offer bare-bones plans on the ACA market. But he has done little to alter the proposed cuts to Medicaid or other provisions that have alarmed health care providers and people with costly medical conditions. The new draft’s details are expected to emerge Thursday when leaders disclose a revamped package.
Widespread opposition
The plan to phase out Medicaid expansion programs that were added under the ACA in 31 states and the District of Columbia — and to restrict government spending for the program starting in 2025 — has prompted pushback not just from liberal activists but virtually every influential player in the health industry, along with several Republican governors including Arizona Gov. Doug Ducey.
“We’re a Medicaid expansion state,” McCain told reporters Wednesday, adding that the bill would have to change to earn his vote. “I’m happy with the way it is in Arizona.”
Several Senate Republicans said in interviews this week that they were committed to pressing ahead with their plan to revise the 2010 law known as Obamacare because they want to curb entitlement spending and address the needs of Americans whose premiums have soared since the law’s enactment.
“It’s a guaranteed financial crisis if we don’t do something about our entitlement programs,” said Sen. Pat Toomey, R-Pa., who has pushed for indexing Medicaid to a lower inflation rate. “It’s not a question of whether that happens, it’s just a question of when, and how devastating that is.”
Hospitals that gave up some federal payments under the ACA in exchange for the promise of more insured patients have made a particularly impassioned case against the measure.
Strange noted that Arizona froze Medicaid enrollment in 2009, and expanded the program at the end of 2013. The hospital’s bill for bad debt and charity care dropped from $25.9 million in 2014 to $8 million in 2016: even though it paid $11.1 million to help pay for Medicaid expansion last year, it still ended up ahead.
‘Armed with facts’
Meanwhile, Valley Health CEO Mark Merrill, who runs two hospitals in West Virginia and another two in Virginia, just sent his third memo to employees Tuesday on how congressional Republicans’ plans to rewrite the health care law could hurt both their patients and their business.
Twenty-five percent of his 5,500 employees live in West Virginia; he urged “those who are so inclined” to contact Capito and Sen. Joe Manchin, D-W.Va., “to advise them of your concerns and your objections to the BCRA.”
“I wanted them to act armed with facts, so they could understand what this really means,” Merrill said in an interview.
Still, these arguments have not swayed all the Republican holdouts. Capito, for her part, said her most influential conversations have been with parents who have lost children to drug overdoses who didn’t get access to treatment. While she appreciates the fact that the revised bill will give more federal funding for opioids treatment, she noted that having a new facility won’t matter if someone loses their health coverage.