GOP bud­get would kill ACA, chop health­care spend­ing

Modern Healthcare - - REGIONAL NEWS - By Paul Demko

WASH­ING­TON— Con­gres­sional Repub­li­cans are crow­ing that the bud­get blue­print they agreed to last week proves they are gov­ern­ing ef­fec­tively by cut­ting spend­ing by more than $5 tril­lion over a decade and re­peal­ing the Af­ford­able Care Act.

But health­care ex­perts warn that the spend­ing cuts would hurt Medi­care, Med­i­caid and health cov­er­age gains made un­der the ACA. “We’re go­ing to take the his­toric progress that we’ve made on cov­er­ing the unin­sured and not only re­verse it, but go back­ward,” said Ed­win Park, a vice pres­i­dent at the left-lean­ing Cen- ter on Bud­get and Pol­icy Pri­or­i­ties.

The House passed the bud­get res­o­lu­tion last week on par­ti­san lines, and the Se­nate is ex­pected to pass it this week. For now, Repub­li­cans dropped their con­tro­ver­sial pro­pos­als to over­haul Medi­care and Med­i­caid. And they were vague about how they would achieve their big spend­ing re­duc­tions.

But the ma­jor cuts promised in the GOP blue­print are un­likely to be en­acted. Congress, ul­ti­mately, will have to pass spend­ing bills for fis­cal 2016 that will be signed by Pres­i­dent Barack Obama, and he won’t agree to many of the GOP pro­pos­als.

In­de­pen­dent bud­get watch­ers say there are big gaps in the Repub­li­can bud­get­ing. “There’s a re­mark­able dis­con­nect be­tween what the bud­get claims to do and what it ac­tu­ally does,” said Ed Loren­zen, se­nior pol­icy ad­viser at the non­par­ti­san Com­mit­tee for a Re­spon­si­ble Fed­eral Bud­get, a bud­get hawk group. “When the dust set­tles, the net ef­fect will be to in­crease spend­ing.”

The bud­get res­o­lu­tion in­cludes in­struc­tions to use rec­on­cil­i­a­tion to re­peal the Af­ford­able Care Act, which would en­able Se­nate Repub­li­cans to pass a re­peal bill with a sim­ple ma­jor­ity. But that still would run into a pres­i­den­tial veto, mean­ing that any re­peal leg­is­la­tion would largely be a po­lit­i­cal man­i­festo.

Miss­ing was any men­tion of the bud­get se­ques­tra­tion cuts, which have re­duced Medi­care re­im­burse­ments by 2% since be­ing en­acted in 2013. The bud­get res­o­lu­tion also calls for off­set­ting the full $200 bil­lion cost of last month’s leg­is­la­tion re­form­ing the Medi­care physi­cian-pay­ment sys­tem. But it doesn’t pro­vide any de­tails on where the off­sets would come from.

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