Race is on to pass Se­nate health­care bill de­spite in­dus­try op­po­si­tion

Modern Healthcare - - NEWS - By Har­ris Meyer

Health­care providers and insurers had dif­fer­ing re­ac­tions to the Se­nate Repub­li­can bill un­veiled last week to re­peal and re­place the Af­ford­able Care Act. The “dis­cus­sion draft” bombed with health­care providers, while some insurers rev­eled at the of­fer­ing of cost-shar­ing re­duc­tion pay­ments and tens of bil­lions in tem­po­rary reinsurance fund­ing.

But it may not mat­ter what in­dus­try stake­hold­ers think. They say GOP law­mak­ers didn’t ask for their in­put. “I’ve never seen any­thing so rushed or se­cre­tive,” said Dr. Bruce Siegel, CEO of Amer­ica’s Es­sen­tial Hos­pi­tals, which rep­re­sents 300 safety-net sys­tems.

Providers warn the Bet­ter Care Rec­on­cil­i­a­tion Act of 2017 would dev­as­tate their fi­nances and pre­vent them from pro­vid­ing qual­ity health­care. And they al­most im­me­di­ately took ac­tion.

Tenet Health­care Corp. emailed its 130,000 em­ploy­ees, urg­ing them to call their se­na­tors to op­pose the bill.

As­cen­sion CEO An­thony Ter­signi noted that in 2016 his not-for-profit health sys­tem pro­vided $1.8 bil­lion in char­ity care and com­mu­nity ben­e­fit. “I sus­pect that num­ber will go up be­cause you’re go­ing to have mil­lions of peo­ple who lose their in­sur­ance, and they’re go­ing to show up in the ER. It’ll im­pact us neg­a­tively by hun­dreds of mil­lions of dol­lars.”

The Amer­i­can Hospi­tal As­so­ci­a­tion and Fed­er­a­tion of Amer­i­can Hos­pi­tals are urg­ing Se­nate Repub­li­cans to start over. But Se­nate Ma­jor­ity Leader Mitch McCon­nell wants to bring the bill to a vote this week, shortly af­ter the Con­gres­sional Bud­get Of­fice is­sues its es­ti­mate of the bill’s cost and cov­er­age im­pact. McCon­nell needs the votes of 50 of his 52 cau­cus mem­bers to pass it. Some mod­er­ate and con­ser­va­tive Repub­li­cans are hedg­ing.

Ohio GOP Sen. Rob Port­man, for one, wor­ries that Med­i­caid cuts would slash drug ad­dic­tion treat­ment dur­ing an opi­oid epi­demic. Ne­vada’s Dean Heller said he can’t sup­port the cur­rent bill.

If the Se­nate passes it, the bill goes back to the House, where its prospects are un­cer­tain.

Most health­care in­dus­try lead­ers ex­pressed fear and anger over the bill.

“The BCRA moves in a dan­ger­ous and harm­ful di­rec­tion for poor, aged and dis­abled Amer­i­cans and the health plans and providers that serve them,” said Margaret Mur­ray, CEO of the As­so­ci­a­tion for Com­mu­nity Af­fil­i­ated Plans. She com­plained that the bill would re­peal the ACA’s tax penalty for not buy­ing in­sur­ance with­out an al­ter­na­tive mech­a­nism for prod­ding younger, health­ier peo­ple to buy cov­er­age. That could cause a “death spi­ral” in the in­di­vid­ual in­sur­ance mar­ket, she warned. Amer­ica’s Health In­sur­ance Plans and the Blue Cross and Blue Shield As­so­ci­a­tion were silent last week.

The bill—which McCon­nell is ex­pected to re­vise this week to meet con­cerns raised by GOP se­na­tors— would cap fed­eral pay­ments to the states for most ben­e­fi­cia­ries at the med­i­cal com­po­nent of the Con­sumer Price In­dex start­ing in 2020. Those pay­ments would grow even more slowly af­ter 2025.

Tax cred­its for peo­ple to buy in­di­vid­ual in­sur­ance would be lim­ited to those with in­comes up to 350% of the poverty level, be­low the ACA’s 400% cut-off. The cred­its would be pegged to age, in­come and lo­cal pre­mi­ums.

The cred­its would be based on the price of plans cov­er­ing just 58% of med­i­cal costs, com­pared with 70% un­der the ACA. The bill would end the ACA’s cost-shar­ing sub­si­dies for lower-in­come en­rollees. Plans could also charge older peo­ple five times as much as younger en­rollees, com­pared to a 3-to-1 limit un­der the ACA. That means con­sumers, par­tic­u­larly peo­ple ages 50 to 64, would pay much more out of pocket.

The ACA’s en­hanced fed­eral pay­ments for Med­i­caid ex­pan­sion would be phased out from 2021 to 2023. That would likely cause 31 states that ex­panded Med­i­caid to end that cov­er­age. Phas­ing out ex­pan­sion fund­ing would come on top of caps in fed­eral Med­i­caid pay­ments to the states that the

CBO said would hold spend­ing growth be­low ac­tual per capita costs.

The bill also would en­cour­age states to opt out of ACA es­sen­tial ben­e­fit re­quire­ments, such as ma­ter­nity care, can­cer screen­ing, men­tal health and ad­dic­tion treat­ment, and pre­scrip­tion drugs.

“The BCRA cre­ates a back­door way for insurers to of­fer less gen­er­ous cov­er­age to fewer peo­ple and to make cov­er­age un­af­ford­able for pa­tients with pre-ex­ist­ing con­di­tions,” said Dr. Jack Ende, pres­i­dent of the Amer­i­can Col­lege of Physi­cians.

Insurers cel­e­brated the bill’s pro­vi­sion of $112 bil­lion for reinsurance and mar­ket sta­bi­liza­tion mea­sures, which would end af­ter 10 years. They also cheered the elim­i­na­tion of the ACA’s re­quire­ment that plans spend at least 80% of pre­mium rev­enue on med­i­cal care.

Insurers es­pe­cially liked that cost-shar­ing re­duc­tion pay­ments to help low-in­come en­rollees af­ford de­ductibles and co­pay­ments would con­tinue for two years.

Ceci Con­nolly, CEO of the Al­liance of Com­mu­nity Health Plans, which rep- re­sents not-for-profit insurers, said that move of­fered some mar­ket cer­tainty.

But Bernard Tyson, CEO of Kaiser Per­ma­nente, a mem­ber of Con­nolly’s group, panned the Se­nate bill.

“We are now at risk of los­ing ground in build­ing the Amer­i­can health­care sys­tem we de­serve,” he wrote. “Rac­ing to re­form health­care with­out of­fer­ing a work­able al­ter­na­tive with broad na­tional sup­port is not the way to go.”


Se­nate Ma­jor­ity Leader Mitch McCon­nell, R-Ky., speaks fol­low­ing a closed­door strategy ses­sion, at the Capi­tol in Wash­ing­ton on June 20, 2017.

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